Countries share experiences and lessons learned on implementing HIV self-testing and pre-exposure prophylaxis
HIV self-testing (HIVST)
All countries shared they are intensively seeking to scale-up HIV testing services and achieve the 90-90-90 goals, and HIVST has been identified as a key approach to reaching those not accessing existing services, such as men, key populations and young people.
In Brazil and Thailand, HIVST is specifically being considered as a way to reach men who have sex with men and transgender people. Both programmes reported are using online platforms where users can access pre-test information, instructional videos and other support services and also order a kit. In Brazil which offers oral fluid-based self-tests and Thailand which offers fingerstick blood-based self-tests, results are promising with high acceptability. While Brazil has been able to adopt HIVST in the national policy and “hopes HIVST kits are available in commercial pharmacies by the end of this year”, Thailand reports some remaining legal and operational barriers. In particular, Dr Pengnonyang noted that while there is “great potential for HIVST as it encourages normalization of HIV and HIV testing, at the moment, HIV testing outside facilities is not “legal” and there are questions and concerns about how to select the best test considering the cost and the sensitivity of the current products …implementation research is critical for nudging policy-makers to start planning an adoption of HIVST in the relevant regulation or policies in Thailand”.
Zimbabwe and South Africa have ongoing implementation studies looking at how HIVST can reach not only key populations, but also young people and men who are less likely to utilize existing services. According to Dr Maponga, “We have put a lot of effort in scaling-up HIV testing, but we still have challenges, primarily reaching men and key populations who do not know their status. We need to do more to make it easier to test for HIV and enable people to test themselves in a discreet and convenient way, especially when the facilities are far away or have long-lines and when services are not friendly to key populations”.In Zimbabwe, HIVST implementation using oral fluid-based rapid tests has reported high acceptability, good performance has been achieved using validated videos and instructions and high uptake among men and young people. Moving forward, Dr Maponga stated that “The Ministry of Health formed a HIVST technical working group that is developing guidance and will lead adaptation of forthcoming WHO guidelines. Further implementation is planned to scale-up HIVST under the UNITAID Self-Testing Africa (STAR) project and through the PEPFAR DREAMS districts to reach adolescent young women and girls and their male partners.”
While HIVST implementation research is underway in South Africa and results are promising, Dr. Pillay stated “The biggest challenge to implementation is the lack of a WHO prequalified HIVST kit…We are keen to do HIVST as it has many advantages and the South African Pharmaceutical Council has lifted the ban on the sale of HIVST kits in pharmacies. But for us to recommend and make HIVST available we need a quality-assured WHO pre-qualified test. When are we going to get it?”
Countries will have to see how best to deliver PrEP and HIVST within their national programmes. To guide them, WHO is finalizing PrEP implementation guidelines to be released July 2015 and the HIVST guidance to be released in December 2016.
These country experiences show promising results on the uptake and results and show four countries leading the way in implementing innovative approaches. UNITAID’s support and investment in HIVST and PrEP will be critical to implementation and scale-up. While there are challenges ahead, investing in effective HIV prevention and HIV testing services which can reach those at high risk is critical to achieving global goals and the end of the HIV epidemic.