Government anticipates HIV self-testing kits

Government anticipates the nationwide introduction of HIV self-testing kits by end of this year following the completion of the trials that are currently underway.

IN 2015, the preliminary results of the feasibility and acceptability study carried out by the Ministry of Health and Child Care revealed that the introduction of HIV self-testing kits has been widely accepted by the people of Zimbabwe. The Government intends to introduce HIV self-testing kits as a way to encourage people to know their HIV status.

Zimbabwe continues to experience one of the worst HIV infection rates in sub-Saharan Africa with a prevalence rate of about 15 percent, despite the achievements gained in the reduction of the prevalence rate from 26,5 percent in 1997.

Inadequate uptake of testing for HIV remains a primary bottleneck towards universal access to treatment and care, and is an obstacle to realising the potential of new interventions for preventing HIV infection, including treatment for prevention and pre-exposure prophylaxis.

The director of Aids and TB unit in the Ministry of Health and Child Care, Dr Owen Mugurungi, said the trials are still on-going.“Before we introduce something new to the people, we run feasibility and acceptability tests as a way to check if the people are ready to receive the new product,” he explained. “The self-testing kits have been widely accepted, hence we have moved on to the trials stage. Between the end of this year and early next year, we should be rolling out the self testing kits on a national scale. Currently, the private sector is providing them.”

HIV self testing kits are being sold between $3 and $5 each in the private sector.However, experts have reservations on the introduction of HIV self-testing before proper mechanisms have been put in place.

They suggest online counselling, toll free services and designated places for counselling as some of the mechanisms.

A clinical psychologist who agreed to speak on condition of anonymity is of the view that adequate preparatory exercises must be put in place before users are exposed to self-testing kits as these may fuel suicidal cases in the country.

“Before people are exposed to the self-testing kits, there must be preparation done to the user prior to usage. The most critical preparation for any HIV test no matter how it is done is counselling so that the user is prepared emotionally to accept the results,” he said.

“There must also be a clause, probably on the kits, articulating what the user must do after testing themselves.”

Dr Mugurungi is on record acknowledging that the issue of counselling and links to referral services after testing is a critical component that should be in place before self testing is adopted in the country.

“Before we introduce the self-testing kits, we have to think about the pre and post-testing counselling. This can be done by the provision of a 24-hour online counselling service which will cater for those in need of the services,” Dr Mugurungi said.

“Toll-free services are of paramount importance since there will be a counsellor ready to assist all the time and also have a new set of counsellors who will be available 24 hours.”HIV self-testing kits allow people to test themselves for HIV using a rapid HIV antibody test in their homes without a healthcare provider present.

The person takes either a blood or saliva sample and can interpret the result within 20 to 40 minutes. The test requires users to swab their upper and lower gum line for the saliva sample. The swab is placed in a solution, which allows the test reaction to develop. A positive result must be confirmed by a blood test conducted by a health care worker in a clinic.

United States has effectively been using HIV self-testing kits (OraQuick) since last year although FDA approved the usage in 2002. OraQuick provides a 24-hour toll-free telephone counselling service and helps link people who test positive to nearby clinics.

ln Kenya, self-testing for healthcare workers is being implemented, with oral test kits available to take home for healthcare workers and their partners.

Nevertheless, Dr Mugurungi bemoans lack of funding as the major challenge to the nationwide introduction of HIV self-testing kits in the country as Government has to rely on donor-funding.

“The major obstacle in the introduction of HIV self-testing kits is financial constraints. But I’m confident that by the time we finish to write the concept note for Global Fund, we should be good to roll,” he said. UNAids says self-testing can be a solution in parts of the world where people living with HIV are not reached by existing services and do not know their status.

The permanent secretary in the Ministry of Health and Child Care, Brigadier-General (Rtd) Dr Gerald Gwinji said health institutions need to be prepared to absorb those who would have tested themselves.

“We also want to incalculate for people who choose that as an entry point. If one tests themselves and the results come out positive, the system must be made ready to absorb and accept the situation,” he explained.

“However, confirmatory tests will be undertaken but it means a slight change in the manner of conduct and one must be ready to take it up from there.”

Dr Gwinji added that the public will have to be educated appropriately as self-testing is just an initial indicative stage, the user will then have to report to the next continual level.

“The messaging will be more or less along the lines after you have tested yourself, there is always a requirement for you to then go to the next stage because after that you cannot self manage, you cannot treat yourself and perhaps do the other tests such as the CD4 count,” he said.HIV self-testing offers an approach to scaling up testing that could be high impact, low cost, confidential and empowering for users.

In light of the introduction of HIV self-testing kits, data collection will pose a challenge.

“The only challenge that may come with self HIV testing is the collection of data of those who would’ve tested themselves but we’re hoping that we can find a better alternative way,” added Dr Mugurungi.

“Sometimes our strategies and regulations can fall slightly behind what is happening elsewhere in the world and if it’s not regulated, someone can start practicing in a certain way,” said Dr Gwinji.

“When OraQuick was introduced, we hadn’t developed appropriate evidence-based strategies on how to implement and deal with it. So the recourse was - until we have developed a strategy, selling of self-testing kits isn’t approved.”

According to a recent WHO study, as HIV self-testing is increasingly being sought and offered globally, there remains limited information about the required test features that will make a self-test easy to use, acceptable to users, and feasible for manufacturers to produce.

Currently, more than 1 600 health care facilities are providing free integrated HIV testing and counselling services through ante-natal clinic, opportunistic infections (OI) clinics, stand alone testing and counselling centers, outreach centers, tuberculosis and sexually transmitted infection clinics.

According to the 2016 statistics; 1,4 million people are living with HIV.