HIV self-testing a useful tool for pre-exposure prophylaxis (PrEP) delivery in Kenya
Mixed-status couples using PrEP could benefit from HIV self-testing as a way to quickly diagnose any new infections and reduce frequency of clinic visits.
Testing for HIV in the home could become a useful tool for the delivery of pre-exposure prophylaxis (PrEP) programmes among mixed-status couples – where the HIV-negative partner is taking antiretroviral treatment to protect themselves from HIV.
A recent study found that couples participating in a PrEP demonstration project in Kenya liked receiving the HIV self-testing kits, with 98.2% of study participants finding the method “highly acceptable” and continuing to use it.
222 HIV-negative people in mixed-status couples received oral fluid self-testing kits to use at home in the two-month gap between scheduled quarterly visits. The study participants noted that the self-test was convenient, easy to use and confidential.
More than half (52.2%) of the participants in the study said they would prefer to be tested by self-test only, while 8.8% would prefer clinic-based testing. Thirty-nine percent preferred a mix of the two, as used in the study.
Confidentiality of HIV testing was important among study participants, more than half of whom did not share their results with anyone, including their study partner. The study authors point to couples testing and counselling and already knowing their status as probable reasons for this.
Self-testing was said to reduce anxiety around returning to the clinic for testing, with one participant commenting: “Every day, every time thinking to yourself, ‘how will it be when I go back there?’ When you test yourself, you know your status; you relax.”
For PrEP programmes to be effective, it is vital that the HIV-negative partner is tested for HIV before they start treatment and regularly thereafter. This is because any suboptimal drug taking could lead to HIV infection and the emergence of HIV drug resistance, which will make managing treatment options once they are diagnosed more challenging.
Currently, people on PrEP in Kenya need to visit a healthcare facility to get tested for HIV. While the World Health Organization has recognised the potential HIV self-testing holds for increasing access to testing and reaching the undiagnosed, there is relatively limited experience on the African context.
Finding strategies to ensure PrEP can be delivered effectively to populations at high-risk from HIV is important for realising the benefits of antiretroviral treatment for prevention.
HIV self-testing can provide this by reducing the burden of frequent visits for HIV testing on the healthcare facility and on the patient, who can do it in their home. This also makes it a more sustainable option.