Doctors Without Borders (MSF) strongly welcomes the World Health Organisation (WHO) release this week of guidelines for HIV self-testing (HIVST) and partner notification, and fully endorses any efforts to implement self-testing more widely and make self-tests freely available in the public sector, says Dr. Amir Shroufi, MSF Medical Coordinator in South Africa.
HIVST empowers people to know their status, and the huge potential offered by this new tool to improve access to patient-centred testing should be grabbed with both hands. At present, HIVST can act as a screening tool to minimize the time people need to spend at healthcare services, or be done in the privacy of one’s own home with people referring themselves to care if they test HIV-positive. The finalization of South Africa’s next National Strategic Plan for HIV, TB, and STIs (2017-2022) should set high ambitions for the introduction and availability of self-tests over the next five years.
MSF experience has shown that different testing methods reach different demographic groups, and new methods are likely to be particularly important in reaching those who remain untested. Long waiting times at health facilities, or being asked to repeat counselling sessions at each test may deter people from accessing conventional HIV testing services. Patients and communities should have the option to decide when to test for HIV and choose if they want to do it in privacy.
MSF research in Khayelitsha, Western Cape, and Eshowe, KwaZulu-Natal, has shown that self-tests are an acceptable form of testing—including among youth, who are at high risk of HIV infection—and can be used correctly under supervision to return accurate results. In KwaZulu-Natal, outreach testing by MSF counsellors and community health workers in the communities of Eshowe and Mbongolwane has made it possible to learn one’s HIV status while at school, work, home, or doing business in town, and increased the numbers of people testing. Self-tests can take HIV testing a step closer to these communities, though further research is urgently needed to better understand strategies for self-test distribution, as well as how best to support linkage to confirmatory testing and treatment initiation.