Self- testing for HIV Infection and other STDs

The talk was presented by Dr Jeffrey D Klausner, Professor of Medicine, Department of Infectious Disease, University of California, Los Angeles, USA

Outline

·         What is self – testing?

·         How is self – testing Adopted?

·         What is the fidelity of self – testing?

·         Where can self – testing can be disseminated?

Self – Testing for HIV Infection

Only US FDA approved in Home HIV testing kit which used similar technique of Western Blot

Used by over a million consumers and same device used by health care professionals recently

The technique is simple oral swabs, no blood, and results will be in 20 minutes

24 bilingual customer phone support and details product website offering information, referrals to care, product usage instructions and more

Higher consumer satisfaction

Self – testing adoption

Influenced by user’s perception of costs, benefits, personal need and convenience.

Users greatly prefer painless oral testing over finger stick or venepuncture

Additional benefits include increased confidentially, privacy and reduced social stigmatization

Self – testing Fidelity

Original studies by manufacturer < 2 % failure

-          Limited by use of select population (MSM)

-          US adult vs trained providers ( Sensitivity 92.9% vs 99.3 % )

Singapore, error rate 0.6 %

Atlanta, 9 % error rate

China (non – Oraquick) 10 % difficulty swabbing, 17.5 % difficulty reading results

In NYC young MSM and transgender women reported concerns of anxiety, test correct use and instructions

Self – testing Dissemination – Los Angeles

-          Vending machines

-          Vouchers

-          US Priority mail

-          Online

Vending Machines in sex clubs which are located at private areas with self – contained unit that can be monitored remotely as well as posted instruction how to use the kit

Initial Concerns for Vending Machines

·         Cost of HIV home test kits

·         Emptying the vending machine

·         Conflict with existing testing programs

·         Home test kit window period

·         Result anxiety

Results summary over 7 weeks, in 2014

-          1176 hours and 312 tests for Vending machines versus 64 hours with 58 tests for traditional testers with clinicians

Providing Vouchers for the free test kit that can available at Pharmacy is also very positive outcome 

Social Medical Promotion commenced since 2014 through Periodic advertisements

In General, among three choices; vouchers, vending machine, priority mail to home 

Approximately 2/3 used Mail services and 1/3 of other consumers accessed through free vouchers, 67 % and 30 % respectively. Only 3 % used vending machine to get the self – testing kit  

Linkage to care for community

HIV Self- test added as a reported element in HIV Surveillance and also follow up management goes through by receiving the positive test kit photos taken by consumers

STD Self – Testing

·         Self -collection urine send via mail for STD testing

·         Self – referral syphilis lab testing

·         Commercial home – based collection and shipping

·         True home – based collection and self – testing.. .. not yet but coming soon.

Among all, using Mail for screening is the most cost effective method

Summary

·         HIV self – testing is desirable, safe and effective – WHO recommended

·         Need more evidence on outcomes, impact and cost effectiveness

·         STD home – specimen collection and self – referral options

·         True STD home – based self – testing …. Coming soon and waiting approval from FDA