Scaling up testingThe role of HIV self-testing

Karen ChampenoisResearch Department,

Maison Blanche Hospital, Paris, France

Definition of HIV self-test

• HIV rapid test performed by the user– Sampling– Process– Interpretation of the result

• Whole / finger-stick blood or oral fluidsample

• Any positive result should be confirmedby another testing according to a national validated algorithm

Source: F. Simon

HIVST available in UK (April 2015)

Lab: Nazeing

www.autotest-sante.com

HIVST available in France (September 2015)

Instructions for use

HIVST available in France (January 2017)

Lab : BiolLytical

Test stand

Test DevicePouched Device

Pouched Developer Vial

Stepwise Instructions

Pre & Post-Test Informational Booklet

Package Insert

HIVST available in USA (October 2012)

Policy and implementation of HIVST

HIVST – pros & cons: accuracy

Pros• Sensitivity

– Blood test > oral fluid test (96.4%- 98.8%) > (65.0%-97.9%)

• Specificity ~ 100%

• Invalid test (<5%)– Blood test > oral fluid test

Cons• Low sensitivity in early infections

• Window period of 3 months

• Increased rate of false negativetests when people are on ART– Implication for PrEP

Pant Pai et al. Plos One 2013; Figueroa et al. AIDS Conference 2016; Pavie et al. Plos One 2010; Suntharasamai et al. Plos one 2015

HIVST – pros & cons: acceptability

Pros• High acceptability up to 98%

• Preference– HIVST > conventional testing– Oral fluid > blood sample

• Confidentiality, convenience, immediacy

Cons• Remaining concerns

– Lack of counseling– Risk of handling error– Test reliability

Pant pai et al. Plos One 2013; Figueroa et al. AIDS Behav 2015; Greacen et al. AIDS care 2012

HIVST – pros & cons: side effects

Pros• Enhance autonomy,

empowerment– Controling one’s health choice– Reducing at risk behaviour

• Reduce barriers as stigma

Cons• Self-harm• Uncertain access to information,

counseling and care

• Social harm– Intimate partner violence– Coercive testing

Figueroa et al. AIDS Behav 2015; Brown et al. AIDS Behav 2014; Carballo-Diéguez et al. AIDS and Behav 2012

HIVST – pros & cons: access

Pros• Large availability

– Pharmacies– Internet– Over the counter approaches

• Privacy

Cons• Actual accessibility• Internet : numerous tests of

questionable quality

• Price– €28 / £30 / US$40≠ socially vulnerable populations

Figueroa et al. AIDS Behav 2015; Myers et al. AIDS Behav 2016;

Values and preferences of key populations in France

• MSM– Accuracy and reliability of tests. Preference for blood-based HIVST– HIVST as a prevention tool (repeated testing), used in a context of risk behaviour

• Migrants from Sub-Saharan Africa– Security for using HIVST– Benefit to know HIV status and free access to care regardless the administrative

situation– Communication tool adapted (color, shape, …)

• PWID– Implication of service providing specific health care and substance misuse

community organisations

• Transgender people – HIV testing is not the health priority

HIVST: expected to increase uptake and frequency of HIV testing mainly in key populations

Encouraging first results

• In France, MSM the most interested in HIVST were those who‒ live their sexual life with men in the absolute secrecy‒ had never been tested

• In NL, HIVST succeeded in reaching first-time and infrequent testing population

• In USA, using ads on Grindr increased the HIVST uptake in MSM

• In USA and Australia, 2 RCTs showed an increase in testing frequency in MSM in the HIVST arm

• Lack of evidence remains‒ Reduction of the time period between infection and diagnosis‒ Linkage to care after a HIVST in high income country

Greacen et al. AIDS Care 2012; Zuure et al. AIDS Conference 2016; Huang AIDS Prev 2016; Rosengren et al. Sex Health 2016; Katz et al. IAS 2015; Jamil et al. AIDS conference 2016

As conclusion

• WHO new guidelines

HIV self-testing should be offered as an additional approach to HIV testing services (strong recommendation, moderate quality evidence)

Available at http://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/

Thank you for your attention

15

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