HIV self-testing kits can now be bought over-the-counter in the UK. In April 2014, the UK government made it legal for people to test and diagnose themselves for HIV at home. At this time it was expected that the availability of home HIV tests would take another 8 till 10 months, but the first HIV self-test is now available this week. Brought to the UK market by Home HIV Test, it is now easier and more convenient for people who are afraid of being diagnosed by a GP or at a local clinic.
An estimated 98,400 people in the UK are infected with HIV, of which approximately 22 percent are unaware of their infection. Wider access to HIV testing is identified as one of the key measure to reduce new HIV infections. Studies suggest that self-testing could increase access as it is convenient, provides results on the spot and is perceived as being more confidential than testing in a health care facility.
Although the availability of these kinds of tests might increase the number of people testing for HIV, it will also raise concerns about the appropriateness and impact of the test on a personal and epidemic level. Criticism of the home testing kits discusses the implementation and validation of the self-test.
To create an effective self-testing environment, a number of key elements have to be in place. First of all, the test should be user-friendly. A recent study by the Program for Appropriate Technology (PATH) about the user-friendliness of HIV self-testing kits in Kenya, Malawi and South Africa, highlighted that the user manuals often contain unclear instructions and use complicated terminology, causing errors when performing the test. Despite this, 80% of the participants rated the test as easy to use. More than 80% felt confident doing the tests and there was a general sense of enthusiasm about the prospect of HIV self-testing.
The second requirement for successful implementation is for healthcare systems to have regulations in place promoting confirmatory testing, linkage to care and retention in care. Regulatory frameworks are needed to protect people against mandatory or coercive testing; consent policies may need to be reviewed to ensure access for adolescents and other groups; and national testing strategies and procedures may need to be adapted.
WHO and UNAIDS both believe that self-testing will be part of future strategies in the fight against the HIV epidemic, but at the same time they underline that current evidence and international guidance to start implementation is limited. In some countries HIV self-testing remains illegal and regulatory processes are often unclear or complex.