Background In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. Methods A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. Findings Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0–100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0–51.0). A majority of participants (78.1%) were females, aged 18–24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8–6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9–91.0); specificity:100% (95% CI, 98.1–100). Interpretation Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered.
References
[1]
WHO, UNICEF, UNAIDS (2010) JUNPoHA Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report 2010. Geneva, Switzerland. Accessed 2013 Oct 1.
[2]
Meiberg AE, Bos AER, Onya HE, Schaalma HP (2008) Fear Of Stigmatization As Barrier To Voluntary HIV Counselling And Testing In South Africa. East Afr J Public Health 5: 49–54.
[3]
Kalichman SC, Simbayi LC (2003) HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect 79: 442–447.
[4]
Walensky RP, Paltiel AD (2006) Rapid HIV Testing at Home: Does It Solve a Problem or Create One? Ann Intern Med 145: 459–462.
[5]
Schlumberger MG, Desenclos J, Papaevangelou G, Richardson SC, Ancelle-Park R (1999) Knowledge of HIV serostatus and preventive behaviour among European injecting drug users: Second study. Eur J Epidemiol 15: 207–215.
[6]
MacNeil JM, Mberesero F, Kilonzo G (1999) Is care and support associated with preventive behaviour among people with HIV? AIDS Care 11: 537–546.
[7]
Marks G, Crepaz N, Senterfitt JW, Janssen RS (2005) Meta-Analysis of High-Risk Sexual Behavior in Persons Aware and Unaware They are Infected With HIV in the United States: Implications for HIV Prevention Programs. AIDS 39: 446–453.
[8]
Mills EJ, Bakanda C, Birungi J, Yaya S, Ford N, et al. (2012) The prognostic value of baseline CD4(+) cell count beyond 6 months of antiretroviral therapy in HIV-positive patients in a resource-limited setting. AIDS 26: 1425–1429.
[9]
UNAIDS, WHO (2011) Global HIV/AIDS Response: Epidemic update and health sector progess towards Universal Access - Progress report 2011. Available: http://www.unaids.org/en/media/unaids/co？ntentassets/documents/unaidspublication/？2011/20111130_ua_report_en.pdf. Accessed 2013 Oct 11.
[10]
Africa SS (2012) Mid-year population estimates, 2011. Pretoria. Available: http://www.statssa.gov.za/publications/P？0302/P03022013.pdf. Accessed 2013 Sept 30.
[11]
Richter M, Venter WDF, Gray A (2010) Home self-testing for HIV: AIDS exceptionalism gone wrong. S Afr Med J 100.
[12]
Kalibala S, Tun W, Muraah W, Cherutich P, Oweya E, et al.. (2011) ‘Knowing myself first’: feasibility of self-testing among health workers in Kenya. Nairobi: Population Council.
[13]
Pai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, et al. (2013) Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Med 10: e1001414.
[14]
Pai NP, Bhargava M, Sharma J, Balram B, Joseph L, et al.. (2012) Will HIV self testing be accepted by low to medium risk educated populations? A pilot cross sectional study in students of McGill University, Montreal. Canadian Association for HIV Research Conference. Montreal, Quebec.
[15]
Technologies O (2012) Final Advisory Committee Briefing Materials: Available for Public Release, in OraQuick？ In-Home HIV Test.
[16]
Carballo-Dieguez A, Frasca T, Balan I, Ibitoye M, Dolezal C (2012) Use of a rapid HIV home test prevents HIV exposure in a high risk sample of men who have sex with men. AIDS Behav 16: 1753–1760.
[17]
Gaydos CA, Hsieh YH, Harvey L, Burah A, Won H, et al. (2011) Will patients “opt in” to perform their own rapid HIV test in the emergency department? Ann Emerg Med 58: S74–78.
[18]
de la Fuente L, Rosales-Statkus ME, Hoyos J, Pulido J, Santos S, et al. (2012) Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results? PLoS One 7: e46555.
[19]
Anderson JE, Carey JW, Taveras S (2000) HIV testing among the general US population and persons at increased risk: information from national surveys, 1987–1996. Am J Public Health 90: 1089–1095.
[20]
Pai NP, Balram B, Shivkumar S, Martinez-Cajas J, Claessens C, et al. (2012) Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis. Lancet Infect Dis 12: 373–380.
[21]
van der Helm J, Zuure F, Fennema H, Davidovich U, Prins M (2012) Announcing a new method of HIV testing: the planning of robust home testing for HIV combined with internet counseling. 19th International AIDS Conference. Washington D.C.
[22]
Spielberg F, Quraishy ZB, Crean K, Wilson D, Kumar P, et al.. (2007) Computer counseling and self-testing for HIV prevention in Southern India. Seattle, Washington.
[23]
Hottes TS, Farrell J, Bondyra M, Haag D, Shoveller J, et al. (2012) Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: opinions and expectations of prospective clients. J Med Internet Res 14: e41.
[24]
Gaydos CA, Dwyer K, Barnes M, Rizzo-Price PA, Wood BJ, et al. (2006) Internet-based screening for Chlamydia trachomatis to reach non-clinic populations with mailed self-administered vaginal swabs. Sex Transm Dis 33: 451–457.
[25]
Masek BJ, Arora N, Quinn N, Aumakhan B, Holden J, et al. (2009) Performance of three nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of self-collected vaginal swabs obtained via an Internet-based screening program. J Clin Microbiol 47: 1663–1667.
