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Researchers investigated whether
supervised and unsupervised testing (self-tests) increased screening, promoted
earlier treatment initiation, reduced transmission, and whether these methods
could be safely and inexpensively implemented worldwide. The researchers
reviewed the literature on self-testing, searching databases and conference
abstracts published between January 1, 2000, and October 30, 2012. They
analyzed 21 studies, of which 7 evaluated unsupervised self-testing and 14
examined supervised strategy. Also, 7 studies examined blood-based self-tests
and 14 used oral testing methods; 16 explored self-testing in higher-income
countries and 5 were in resource-limited settings, including Kenya, Nairobi,
and Malawi.
Findings indicated high levels of
acceptance for home-based tests in supervised and unsupervised settings. Many
participants preferred self-testing to facility-based testing (61 percent to 91
percent) and were more likely to recommend self-testing to a partner (80
percent to 97 percent). Participants preferred self-testing because of
convenience, time, rapid results, confidentiality, and privacy. Participants in
a Canadian study preferred counseling at community clinics, by telephone, or at
pharmacies, while those in Malawi preferred face-to-face counseling.
For both supervision strategies,
self-testing had high specificity. Test sensitivity was lower in the
unsupervised group than in the supervised group. Researchers found several
problems with the use of self-test kits: individuals made errors in both
supervised and unsupervised settings, such as removing the test kit from the
developer solution too early or having difficulty interpreting or reading the
results. The cost of self-tests also was a potential obstacle to widespread
use. Most participants were willing to pay less than $20 for a supervised or
unsupervised test, but in Kenya health professionals wanted free self-tests.
Research on counseling and treatment
after self-test was limited, and understanding how to get HIV-positive
self-testers into treatment was not well understood. Nitika Pant Pai, MD, PhD ,
assistant professor in the Department of Medicine at McGill University and
McGill University Health Center in Montreal, Canada, and lead author of the
study concluded that HIV self-tests may reduce the incidence of HIV by
motivating more people to be screened. Although she had concerns about
countries with weaker health systems and poor regulation of test kit quality,
Pant Pai concluded that self-testing eventually may benefit health systems in a
variety of countries and economies and could be part of a strategy to control
HIV transmission.
The full report, “Supervised and
Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic
Review,” was published online in the journal PLoS Medicine (2013;
doi:10.1371/journal.pmed.1001414).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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