London School of Hygiene & Tropical Medicine

The World Health Organization (WHO) has released new guidelines on HIV self-testing to improve access to and uptake of HIV diagnosis, to coincide with World AIDS Day.

The WHO progress report states at least 18 million people with HIV are currently taking antiretroviral therapy (ART) but that a similar number are still unable to access the treatment, of whom the majority are unaware of their HIV positive status. Over 40% of people with HIV, approximately 14 million people, remain unaware of their status.

Lack of diagnosis is a major obstacle to reaching the 90-90-90 goals set by the UNAIDS programme, namely that by 2020, 90% of all people living with HIV will know their status, 90% of those with HIV will receive sustained ART and 90% of all people receiving ART will have durable suppression.

HIV self-testing is a way of breaking down the barriers that people currently face to access testing services. It offers a convenient, quick and easy way for people to screen themselves for their HIV status. The process only requires oral fluid or blood from finger-pricking, with results available in 20 minutes, all of which can be done in a private setting. Those with positive results are advised to seek confirmatory tests at health clinics.

The School and partners are collaborating with the WHO in three countries in southern Africa, which have started large scale implementation of HIV self-testing through the UNITAID/PSI Self-Testing Africa (STAR) project. Population Services International (PSI) leads the implementation of HIV self-test distribution in each country, including all marketing and demand creation activities. The STAR research activities are designed and led by the London School of Hygiene & Tropical Medicine, with Liverpool School of Tropical Medicine and University College London. The results have informed WHO normative guidance, which will support the establishment of appropriate policy and encourage new manufacturers to enter the self-test market.

In Phase One of the STAR project, funded by a $23m investment from UNITAID, researchers are conducting the world's largest evaluation of HIV self-testing to date, involving the distribution of nearly 750,000 self-test kits. This will generate vital information about how to distribute self-test products effectively, ethically and efficiently, with adequate post-test support services, and will answer key questions about the feasibility, acceptability and impact of this intervention. Phase Two of the project (2017-2019) is planned to then scale-up successful distribution models and demonstrate the population-level health impact of HIV self-testing.

The increase in HIV testing has led to over 80% of all people diagnosed with HIV receiving antiretroviral therapy. Between 2005 and 2015, the number of people with HIV learning their status improved dramatically from 12% to 60%. However, testing coverage still remains low among various population groups, for example - men who have sex with men, sex workers, transgender people, people who inject drugs, and people in prisons comprise approximately 44% of the 1.9 million new adult HIV infections that occur yearly.

Liz Corbett, Professor of Tropical Epidemiology at the London School of Hygiene & Tropical Medicine and Research Director of the STAR project said: 
"There are millions of undiagnosed HIV-positive people who should be receiving the treatment they need. HIV self-testing has a vital role to play in helping people to find out their HIV status and get access to crucial treatments. HIV self-testing also has the potential to empower and enhance awareness in local communities, bringing services closer to them, and breaking taboos by increasing people's willingness to undertake HIV testing. HIV self-testing is particularly important for those who find it a challenge to physically access testing centres or would prefer the comfort of privacy in what can be a difficult time. Adult men, adolescents and groups at high risk of HIV stigma (such as sex workers) are among the groups most keen to take up HIV self-testing, having shown a lack of willingness to take up facility services."

Related Links

• HIV Self-Testing Africa (STAR) project
• What will it take to end HIV? - Feature
• Watch - WHO: HIV self-testing Q&A (YouTube)
• WHO - Guidelines on HIV self-testing and partner notification
• WHO - World Aids Day 2016
• UNAIDS

Related Courses

• Infectious Diseases by Distance Learning (Certificate, Diploma and MSc)
• MSc Reproductive & Sexual Health Research

Image: Community Based Distribution Agent conducting an HIV self-test kit demonstration Credit: Malawi-Liverpool Wellcome Trust