Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in Malawi

MacPherson, Peter; Lalloo, David G.; Webb, Emily L.; Maheswaran, Hendramoorthy; Choko, Augustine; Makombe, Simon D; Butterworth, Anthony E.; Oosterhout, Joep J. van; Desmond, Nicola; Thindwa, Deus; Squire, S. Bertel; Hayes, Richard; Corbett, Elizabeth L.

doi:10.1001/jama.2014.6493

Cited by 178 publications

(209 citation statements)

References 27 publications

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“…Low rates of linkage are already a concern in HTC [16–18] and this is heightened in the self-testing model where link between tester and health professional is no longer clear-cut. Promising early studies show that home initiation of Antiretroviral treatment (ART) can lead to very high rates of linkage to care after HIVST, but this is based on a semi-supervised model and significant additional input that may not be replicable to scale or if testing is unsupervised [21]. Our data therefore point towards HIVST country readiness predicated on a supervised approach, where testing and counselling remains under some control of the health care worker [31,40].…”

Section: Discussionmentioning

confidence: 98%

What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa

Rooyen

Tulloch

Mũkoma

et al. 2015

Journal of the International AIDS Society

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IntroductionHIV self-testing (HIVST) has the potential to increase uptake of HIV testing among untested populations in sub-Saharan Africa and is on the brink of scale-up. However, it is unclear to what extent HIVST would be supported by stakeholders, what policy frameworks are in place and how variations between contexts might influence country-preparedness for scale-up. This qualitative study assessed the perceptions of HIVST among stakeholders in three sub-Saharan countries.MethodsFifty-four key informant interviews were conducted in Kenya (n=16), Malawi (n=26) and South Africa (n=12) with government policy makers, academics, activists, donors, procurement specialists, laboratory practitioners and health providers. A thematic analysis was conducted in each country and a common coding framework allowed for inter-country analysis to identify common and divergent themes across contexts.ResultsRespondents welcomed the idea of an accurate, easy-to-use, rapid HIV self-test which could increase testing across all populations. High-risk groups, such as men, Men who have sex with men (MSM), couples and young people in particular, could be targeted through a range of health facility and community-based distribution points. HIVST is already endorsed in Kenya, and political support for scale-up exists in South Africa and Malawi. However, several caveats remain. Further research, policy and ensuing guidelines should consider how to regulate, market and distribute HIVST, ensure quality assurance of tests and human rights, and critically, link testing to appropriate support and treatment services. Low literacy levels in some target groups would also need context-specific consideration before scale up. World Health Organization (WHO) policy and regulatory frameworks are needed to guide the process in those areas which are new or specific to self-testing.ConclusionsStakeholders in three HIV endemic sub-Saharan countries felt that HIVST will be an important complement to existing community and facility-based testing approaches if accompanied by the same essential components of any HIV testing service, including access to accurate information and linkages to care. While there is an increasingly positive global policy environment regarding HIVST, several implementation and social challenges limit scale-up. There is a need for further research to provide contextual and operational evidence that addresses concerns and contributes to normative WHO guidance.

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Section: Discussionmentioning

confidence: 98%

What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa

Rooyen

Tulloch

Mũkoma

et al. 2015

Journal of the International AIDS Society

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“…The self-testing approach offers distinct advantages. By giving people the opportunity to test discreetly and conveniently, self-testing may increase the uptake of testing among people not reached by other existing testing services many whom are first-time testers [204][205][206][207]. The experience with hepatitis self-testing is currently very limited, but it represents a potentially important approach to expand access to hepatitis testing in the future.…”

Section: Self-testingmentioning

confidence: 99%

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

Easterbrook

2016

Journal of Hepatology

114

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“…A large number of studies on HTC have been conducted in sub-Saharan Africa and a previous systematic review was completed in 2012, but facility testing was not included and uptake in men and young adults was not assessed. In addition, several large-scale interventions have been published since 2012 11,13–15 . Recently, the World Health Organization’s released guidelines that strongly recommend implementing community HTC 16 .…”

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confidence: 99%

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

Sharma

Ying

Tarr

et al. 2015

Nature

454

532

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HIV testing and counselling is the first crucial step for linkage to HIV treatment and prevention. However, despite high HIV burden in sub-Saharan Africa, testing coverage is low, particularly among young adults and men. Community-based HIV testing and counselling (testing outside of health facilities) has the potential to reduce coverage gaps, but the relative impact of different modalities is not well assessed. We conducted a systematic review of HIV testing and counselling modalities, characterizing facility and community (home, mobile, index, key populations, campaign, workplace and self-testing) approaches by population reached, HIV-positivity, CD4 count at diagnosis and linkage. Of 2,520 abstracts screened, 126 met eligibility criteria. Community HIV testing had high coverage and uptake and identified HIV-positive individuals at higher CD4 counts than facility testing. Mobile HIV testing reached the highest proportion of men of all modalities examined (50%, 95% CI = 47–54%) and home with self-testing reached the highest proportion of young adults (66%, 95% CI = 65–67%). Few studies evaluated HIV testing and counselling for key populations (commercial sex workers and men who have sex with men), but these interventions yielded high HIV positivity (38%, 95% CI = 19–62%) combined with the highest proportion of first-time testers (78%, 95% CI = 63–88%), indicating service gaps. Facilitated linkage (for example, counsellor follow-up to support linkage) achieved high linkage to care (95%, 95% CI = 87–98%) and ART initiation (75%, 95% CI = 68–82%). Expanding mobile HIV testing, self-testing and outreach to key populations with facilitated linkage can increase the proportion of men, young adults and high-risk individuals linked to HIV treatment and prevention.

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Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in Malawi

Abstract: clinicaltrials.gov Identifier: NCT01414413.

Cited by 178 publications

References 27 publications

What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa

What are the constraints and opportunities for HIVST scale‐up in Africa? Evidence from Kenya, Malawi and South Africa

Who to test and how to test for chronic hepatitis C infection – 2016 WHO testing guidance for low- and middle-income countries

Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa

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