What do Key Stakeholders Think About HIV Self-Testing in Canada? Results from a Cross-Sectional Survey

Abstract

Human immunodeficiency virus (HIV) self-testing presents an empowering alternative to facility-based testing for reaching undiagnosed HIV infected individuals, but is not currently available in Canada. We surveyed stakeholders (clinical providers, public health professionals, researchers) engaged in HIV testing initiatives nationwide to identify the concerns, opportunities and challenges to implementing HIV self-testing in Canada. An online cross-sectional survey was disseminated by the Canadian Institutes of Health Research Centre for REACH 2.0 National HIV & sexually transmitted and blood borne infections working group to stakeholders nationwide, with a target sample size of 200. Quantitative and qualitative data were analyzed using a mixed-methods, respondent-informed approach, to inform subsequent HIV self-testing in a country where self-testing is not yet accessible. A total of 183 responses were received. A majority (70.7%) (128/181) felt that self-testing was a necessary investment to reach the undiagnosed. 64.6% (117/181) felt that self-tests should be made available to their clients and 71.5% (128/179) of respondents agreed that self-test instructions required improvements. However, 50% (90/180) felt that self-testing will pose an economic challenge to current HIV testing models. Regardless, 21% urged for timely action and availability of HIV self-tests. Thematic analyses reflected the following concerns: (a) need for affordable self-tests, (b) need for expedited, customized, and accessible linkages to counselling, (c) concern for patients to cope with positive self-test results, (d) accuracy of self-tests to detect acute HIV and (e) liability in the context of non-disclosure. Stakeholders agreed to the provision of an option of HIV self-testing to reach the undiagnosed individuals. Concerns regarding costs and accuracy of self-tests, expedited linkages to counselling, and integration of self-test within prevailing HIV testing models, will need to be addressed before their widespread implementation.

An Unsupervised Smart App–Optimized HIV Self-Testing Program in Montreal, Canada: Cross-Sectional Study

“…Recently, we surveyed Canadian stakeholders involved in HIV testing initiatives across the country and found that many were in favor of self-testing but were concerned about linkages to care and accuracy of self-tests. Furthermore, HIV self-testing strategies were perceived to pose an economic threat to the prevailing HIV testing models in Canada [13]. While global research on the implementation of HIV self-testing has increased exponentially, few studies have explored self-testing in the Canadian context.…”

Opinions towards Key Operational Aspects for the Implementation of HIV Self-Testing in Spain: A Comparison between Stakeholders and Potential Users

“…Self-testing can be viewed as a competitive option to the rapid testing programs offered in nearly all of the CBO/NGOs that employed our participants, as they both could be targeting similar populations. The results of a study conducted in Canada pointed towards this direction, with stakeholders involved directly in testing activities viewing HIV self-testing as a challenge to current HIV testing delivery models [14]. However, self-testing is rapidly expanding across the world, and the WHO estimated that the global self-test volumes would grow from 1 million in 2017 to an estimated 16.4 million (12.9 million-19.3 million) by the end of 2020 [22].…”

“…Some qualitative studies aimed at capturing key stakeholders' opinions working in sub-Saharan countries [12,13] identified self-testing as an opportunity to increase testing. In Canada, a study that surveyed stakeholders engaged in HIV testing concluded that stakeholders were generally in favor of self-testing [14] but results were not provided by stakeholder type. Additionally, the difference between the opinions of stakeholders and PUs remain unknown.…”

Time for HIV self-testing in Canada: a vision and an action plan

“…This will require sustained collaboration with private providers, pharmacies, community-based organizations, public clinics, test manufacturers and laboratories. 12 Third, addressing the economics of integration of HIVST service delivery is key to sustainability. The Canadian health systems are largely operated provincially and combine public and private care.…”