Self-testing doubles the likelihood of uncovering new HIV diagnoses
Around 40% of all HIV infections are left undiagnosed worldwide, and new approaches such as self-testing are needed to ensure 90% of all people with HIV by 2020 are aware of their status.
HIV self-testing is likely to identify more people with HIV who had been previously undiagnosed compared to standard testing services, according to a systematic review led by the World Health Organization (WHO), with two trials finding self-testing to double the likelihood of uncovering HIV-positive diagnoses.
Self-testing for HIV enables people to diagnose their HIV status in private by testing their saliva or blood. It is thought to be particularly beneficial to stigmatised groups such as men who have sex with men (sometimes referred to as MSM), young people, people who inject drugs, sex workers, and transgender people.
This is the first review to directly compare self-testing to standard testing, and assess its effect on uptake and frequency of testing, diagnosis, linkages to care, and its association with risk behaviour and social harm.
Five randomised controlled trials involving 4,145 people from four countries, published between 2015 and 2017, were analysed. The largest study was conducted among 1,113 male partners of pregnant women in Kenya. An additional Kenyan study, which assessed self-testing delivered by women to their male partners, was also included as were trials from Australia, Hong Kong, and the United States of America among men who have sex with men. All the trials offered free, oral-fluid rapid self-testing, but differed in terms of the number of kits distributed and the level of assistance provided.
Three of the trials showed self-testing to double the uptake of testing among men, while two trials (among men who have sex with men) showed the frequency at which people had further HIV tests nearly doubled, resulting in two more tests in a 12 to 15-month period.
The review identified limited information on linkages to care. Of the two trials reporting on this factor, one found 72% of participants reported accessing further testing to confirm their result. The study highlights the need for further research to identify ways to enhance linkages to care following HIV self-testing, particularly for key populations who may be less likely to link to services due to restrictive laws and policies.
Social harm such as intimate partner violence or suicide were not found to increase as a result of self-testing. Although the Hong Kong trial found self-testing could increase multiple sex partners, these results were not statistically significant meaning that, overall, risk behaviours were not found to increase. However, the presence of this uncertainty emphasises how important it is to include HIV prevention messages, such as the importance of using condoms, with self-testing kits.
Although the evidence review is limited to studies of men who have sex with men and the male partners of women, its findings on increased uptake are consistent with studies of other populations known to have poor testing coverage, including men, young people and the households of people newly diagnosed with HIV, although these studies did not make direct comparisons between self-testing and traditional testing.
The analysis, released last month, was already used to inform WHO’s updated consolidated HIV testing guidelines released in December 2016.