May 2, 2013
Researchers investigated whether supervised and unsupervised testing (self-tests) increased screening, promoted earlier treatment initiation, reduced transmission, and whether these methods could be safely and inexpensively implemented worldwide. The researchers reviewed the literature on self-testing, searching databases and conference abstracts published between January 1, 2000, and October 30, 2012. They analyzed 21 studies, of which 7 evaluated unsupervised self-testing and 14 examined supervised strategy. Also, 7 studies examined blood-based self-tests and 14 used oral testing methods; 16 explored self-testing in higher-income countries and 5 were in resource-limited settings, including Kenya, Nairobi, and Malawi.
Findings indicated high levels of acceptance for home-based tests in supervised and unsupervised settings. Many participants preferred self-testing to facility-based testing (61 percent to 91 percent) and were more likely to recommend self-testing to a partner (80 percent to 97 percent). Participants preferred self-testing because of convenience, time, rapid results, confidentiality, and privacy. Participants in a Canadian study preferred counseling at community clinics, by telephone, or at pharmacies, while those in Malawi preferred face-to-face counseling.
For both supervision strategies, self-testing had high specificity. Test sensitivity was lower in the unsupervised group than in the supervised group. Researchers found several problems with the use of self-test kits: individuals made errors in both supervised and unsupervised settings, such as removing the test kit from the developer solution too early or having difficulty interpreting or reading the results. The cost of self-tests also was a potential obstacle to widespread use. Most participants were willing to pay less than $20 for a supervised or unsupervised test, but in Kenya health professionals wanted free self-tests.
Research on counseling and treatment after self-test was limited, and understanding how to get HIV-positive self-testers into treatment was not well understood. Nitika Pant Pai, MD, PhD , assistant professor in the Department of Medicine at McGill University and McGill University Health Center in Montreal, Canada, and lead author of the study concluded that HIV self-tests may reduce the incidence of HIV by motivating more people to be screened. Although she had concerns about countries with weaker health systems and poor regulation of test kit quality, Pant Pai concluded that self-testing eventually may benefit health systems in a variety of countries and economies and could be part of a strategy to control HIV transmission.
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).