HIV Self-Testing: Is Malawi Ready?
Issues of supervision and safely linking HIV self-testing to counseling and care came to the fore on April 19, when scientists and members of the public met in the College of Medicine’s Breeze Bar to debate the best way to scale-up HIV Testing and Counseling (HTC) in Malawi.
The Science Café initiative, titled “HIV Self-Testing: Is Malawi Ready?” was MCed by Tamara Chipasula and featured scientists who argued either for or against the viability of oral self-testing with the OraQuick Rapid Antibody test – Principal Investigator for the Malawi-Liverpool Wellcome Trust (MLW) Clinical Research Programme Dr. Liz Corbett, College of Medicine Head of Pathology and Medical Laboratory Sciences Dr. Geoffrey Chipungu and John Hopkins Project Director Newton Kumwenda.
Corbett argued that a 2010 MLW study has “already shown that Malawi is ready to self-test” and that self-testing with OraQuick promises to “plug the gaps” that standard HTC rapid finger-prick blood tests have left in the early identification of the virus.
She said the 2010 MLW feasibility study on the uptake and accuracy of oral kits for HIV self-testing involved 287 randomly selected participants in Ndirande, Likhubula and Chilomoni and that of the 287 participants 261 consented to self-testing. Ninety-nine percent of participants who chose to self-test rated it “not hard at all to do” and 56 percent of participants rated it as their future preferred option.
Based on the “very successful results” of the study, Corbett said home-based HIV self-testing could bypass challenges for early identification such as the inconvenience and cost involved in visiting facility-based rapid diagnostic testing services, and encourage regular repeat testing, couple testing and first-time testing in hard-to-reach groups such as men.
While Kumwenda agreed that “people are ready to take the test” he questioned if “the technology itself is ready to be used in that way” due to challenges such as people misinterpreting their results or failing to follow-up a positive result with HIV/AIDS care.
“The test alone is not enough,” he said. “The technology is not ready.”
But according to Corbett “with Internet-based sales it’s happening whether policy-makers like it or not.”
“The Malawi government is very interested in the oral self-testing despite its high price (US$3 compared to US$0.70 for a finger-prick blood test) because they seem to be more accurate in practice than the blood-based test, they’re more simple to do,” she said. “But at the moment there is no regulation around diagnostic kits… so it means that anyone can sell anything and claim anything for their kit here.
“Don’t buy kits on the Internet,” she cautioned. “Don’t buy kits over the counter. Until you know that they’ve been licensed in the country, which at this point they haven’t.”
She said community information sites could be set up to link HIV self-testing to counseling and care before Chipungu closed the café saying, “I think the take-home message here is that one individual test is not enough.”