HEALTH CORNER
HIV Self-Testing: A Useful But Challenging Tool In The Prevention Box
By Yusuf Kaggwa, OIC, Health Promotion and Infectious Diseases Prevention Unit, Formerly HIV/AIDS Unit, Entebbe
An HIV self-test is an antibody test that can be used at home or in a private location by yourself with results being available within 20 minutes. According to (UNAIDS 2020), one in five people living with HIV globally remain unaware of their HIV status yet there is an urgent need to identify these individuals and link them to HIV treatment services and support them to modify behaviors that contribute to HIV transmission and prevention. HIV self-test kits have the potential to increase testing rates around the globe, and thereby lead to reductions in HIVrelated incidences and mortality.
HIV self-testing (HIVST) is a convenient and confidential option for HIV testing. In 2016, the World Health Organization (WHO) recommended HIVST as a safe, accurate and effective way to reach people who may not otherwise test, including people from key populations and those who would feel some stigma or discrimination at health facilities or have extremely high demands for privacy.
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Most self-test kits require either an oral swab or simple finger prick to draw a sample. It is important that individuals improve their knowledge and skills to perform accurate selftests. Some key basic steps are: 1. Read the kit’s instruction manual, check the expiration date, remove the test stick from the packet, swipe your upper and lower gums once with the pad, Insert the test stick into the test tube and set a timer for 20 minutes or as recommended by the manufacturer if using an oral test. 2. For finger pricks, clean the finger area to be pricked, puncture your finger with the lancet, wipe away the first droplet of blood with the alcohol swab, squeeze two drops
of blood on the testing kits and apply a buffer, then read your results between 5 to 20 minutes or as per manufacturer’s recommendations. 3. Remember, YOU MUST go to a testing center for a confirmation test if you get a positive reading. If the HIV self-test is invalid, then the test did not work. You will need to use another HIV self-test kit or go to a health center. 4. You should always interpret HIV self-test results according to the manufacturer’s instructions. In instances where one is unable to read the manufacturer’s instructions, it is recommended to go to a health or testing center. HIVST are well-suited for key populations, including men who have sex with men (MSM) and female sex workers (FSWs) because it addresses additional barriers these populations face at facility-based testing. There is high acceptability by individuals who fear the stigma of receiving a test at a clinic, convenience for those who may struggle to find time to visit a testing center and oral kits have made HIVST more attractive to individuals who do not wish to have blood drawn or fingers pricked.
A case in point is where Uganda’s Leading Daily, The New Vision published a lead story “Fake Testing Kits Flood the Market: HIV selfTesting Kits Spark Alarm (Saturday Vision 24th June 2023). Other challenges include lack of pre- and posttest counseling, linkage to care, increased unplanned pregnancies and the need for confirmatory testing, and the “window period” during which any antibody test for HIV may show a negative result if the individual has been very recently infected. In conclusion, it is important to know that the ability to self-test for HIV is vital to preventing transmission especially in this era where it is recommended by WHO that HIV screening be made part of general routine healthcare. The United Nations continues to avail free Voluntary Confidential Counseling and Testing (VCCT) services and Post Exposure Prophylaxis (PEP) for those who are exposed. Individuals seeking HIVST, however, must be cognizant of the limitations of self-testing especially with pirated testing kits aggravated by inadequate knowledge and skills to conduct accurate tests. HIVST opportunities should not be looked at as an opportunity for risk behavior.
Among the major challenges that are likely to affect the uptake of HIV self-Testing initiatives include: Fake testing kits available on the market placing a huge burden on users to be cautious of where they purchase their kits.
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