On Tuesday, the World Health Organisation (WHO) released its first-ever guidelines on HIV self-testing, but South Africa may be ahead of the curve. The WHO’s move comes almost a year after the Pharmacy Council of South Africa approved the sale of home HIV testing kits in pharmacies and just months after the health department included HIV self-testing in national guidelines.
South Africa is now one of 23 countries whose national guidelines support self-testing as a way to increase HIV testing rates.
“Millions of people with HIV are still missing out on life-saving treatment, which can also prevent HIV transmission to others. HIV self-testing should open the door for many people to know their HIV status and find out how to get treatment,” said WHO director general Margaret Chan in a statement Tuesday.
How to test for HIV at home
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Research shows that HIV self-testing may increase testing rates among groups such as men who do not regularly test for HIV. In Kenya, self-testing doubled rates of HIV testing among men who have sex with men and the male partners of pregnant women, according to the WHO.
Today, self-testing kits are already on the shelves of major South African pharmacy retailer Clicks. Currently, no national body regulates which HIV self-tests may be sold in the country but the government is expected to release draft regulations this week.
Clicks’s internationally approved take-home tests can deliver results that are about 99% accurate in 20 minutes or less as long as people have not contracted the virus in the previous 12 weeks — or during what is often called a “window period” — according to Clicks spokesperson Susann Caminada.
A window period is the time after which a person has contracted HIV, but during which many HIV tests would produce an HIV-negative result because the infected person’s body hasn’t yet produced HIV antibodies.
The health department, the WHO and other organisations offering self-testing still require people who test HIV positive at home to go for confirmatory testing at a health facility.
In Khayelitsha, international humanitarian organisation Doctors Without Borders (MSF) has been piloting HIV self-testing at a community health centre and among wellness centre patients who declined to be tested at the facility.
MSF is trying to figure out how home testing might look when expanded to large numbers of people.
In addition to self-testing kits being handed out at health facilities in Khayelitsha, MSF is also considering potentially providing free testing kits through private pharmacies or via members of community-based adherence support groups for people living with HIV, says MSF’s South Africa head of mission Rodd Gerstenhaber.
Malawi, Zambia and Zimbabwe are also piloting HIV self-testing as countries including South Africa scramble to meet the latest round of international HIV goals.
Gerstenhaber says: “With self-testing, there is definitely a possibility that it could help expand HIV testing in general and help us reach the UN goal [that 90% of people must know their HIV status by 2020]”.