London School of Hygiene & Tropical Medicine

HIV self-testing could be widely used, safe, accurate, and acceptable in urban settings of sub-Saharan Africa, according to a new study published in PLOS Medicine.

In sub-Saharan Africa, only one quarter of adults have had a recent test and only half of people with HIV know their status.

Researchers from the London School of Hygiene & Tropical Medicine and the Malawi-Liverpool Wellcome Trust Clinical Research Programme carried out a prospective study to assess how well HIV self-testing would perform compared to home-based HIV testing and counselling, which requires heavy involvement of trained healthcare workers. HIV self-testing involves training individuals to perform and interpret their own oral HIV test.

The two-year study of 16,660 adults took place across 14 neighbourhoods in urban Blantyre, Malawi. Three-quarters of residents in the study took an annual self-test (14,004 in the first year and 13,785 in the second year). The highest uptake was among women and adolescents, but there was also unusually good participation by men.

The researchers found that more than half of the 1,257 participants who discovered they were HIV-positive accessed HIV care, which compares favourably with many other approaches. There was no evidence of major social harms such as partner violence or suicides attributed to HIV self-testing.

Compared to HIV testing by a trained healthcare worker, 99.4% of the HIV self-test results were found to give the same result. Importantly, 94.6% of the participants reported that they were "highly satisfied" with HIVST even though 2.9% reported being forced to take the test, usually by a main partner.

Senior author Professor Liz Corbett, Wellcome Trust Senior Fellow and Clinical Epidemiologist at the London School of Hygiene & Tropical Medicine, said: "Continued high uptake in the second year suggests that scaling up HIV self-testing could have a sustained impact on the coverage of HIV testing and care in Africa, especially for men and adolescents."

The authors acknowledge limitations in the study design that will have introduced some imprecision around the estimates of uptake and linkage into care, and also that the acceptability and accuracy of HIV self-testing may differ between, for instance, urban and rural communities. Nevertheless, these findings suggest that scaling-up HIV self-testing could complement existing strategies for the control of the HIV/AIDS epidemic.

The research was funded as part of Prof Corbett's Wellcome Trust Senior Research Fellowship in Clinical Science. Lead author Augustine Choko recently joined the London School of Hygiene & Tropical Medicine to begin his PhD, also funded by a Wellcome Trust Fellowship.

Publication:

• Augustine T. Choko, Peter MacPherson, Emily L. Webb, Barbara A. Willey, Helena Feasy, Rodrick Sambakunsi, Aaron Mdolo, Simon D. Makombe, Nicola Desmond, Richard Hayes, Hendramoorthy Maheswaran, Elizabeth L. Corbett. Uptake, Accuracy, Safety, and Linkage into Care over Two Years of Promoting Annual Self-Testing for HIV in Blantyre, Malawi: A Community-Based Prospective Study. PLOS Medicine. DOI:10.1371/journal.pmed.100187