April 3, 2013
The Research Institute of the McGill University Health Centre (RI-MUHC) concluded from a systematic review of 21 worldwide studies that HIV self-testing is effective and removes social stigma that prevents people from being tested for HIV. According to Dr. Nitika Pant Pai, clinical researcher and assistant professor in the RI-MUHC Department of Medicine, many people are reluctant to be screened for HIV because of stigma and discrimination associated with the disease. Self-testing linked to expedited counseling and care could remove social barriers to testing, encourage early detection and treatment, and reduce HIV transmission.
Pant Pai and her colleagues reviewed methods for expanding access to HIV testing and overcoming reluctance due to discrimination and "perceived attitudes" toward testing. A variety of networks in Africa, North America, and Europe have studied strategies for linking HIV self-tests with counseling and referral services. RI-MUHC researchers compared 21 strategies for "acceptability, feasibility, and accuracy and success with linkages to care." The researchers defined "acceptability" as the number of people who self-tested divided by the number of people who consented to self-test.
The studies reviewed by the RI-MUHC team used two methods for self-testing: self-testing with counseling from a healthcare professional (supervised self-testing), or self-testing with counseling available by phone or Internet (unsupervised self-testing). Most of the studies were conducted in high-income settings.
Acceptability was high for both supervised and unsupervised self-testing. Pant Pai also stated that self-testing participants preferred using the oral swab to submitting to a finger-prick or blood draw, and they preferred the home setting over HIV testing in a medical facility. Self-testing also makes it possible to take a self-test home for a partner.
The full report, "Supervised and Unsupervised Self-Testing for HIV in High- and Low-Risk Populations: A Systematic Review," was published online in the journal PLoS Medicine (2013; doi: 10.1371/journal.pmed.1001414).