Research Article: Investigating the addition of oral HIV self-tests among populations with high testing coverage – Do they add value? Lessons from a study in Khayelitsha, South Africa

Date Published: May 2, 2019

Publisher: Public Library of Science

Author(s): Hazel Ann Moore, Carol A. Metcalf, Tali Cassidy, Damian Hacking, Amir Shroufi, Sarah Jane Steele, Laura Trivino Duran, Tom Ellman, Richard John Lessells.


HIV self-testing (HIVST) offers a useful addition to HIV testing services and enables individuals to test privately. Despite recommendations to the contrary, repeat HIV testing is frequent among people already on anti-retroviral treatment (ART) and there are concerns that oral self-testing might lead to false negative results. A study was conducted in Khayelitsha, South Africa, to assess feasibility and uptake of HIVST and linkage-to-care following HIVST.

Participants were recruited at two health facilities from 1 March 2016 to 31 March 2017. People under 18 years, or with self-reported previously-diagnosed HIV infection, were excluded. Participants received an OraQuick Rapid HIV-1/2 Antibody kit, and reported their HIVST results by pre-paid text message (SMS) or by returning to the facility. Those not reporting within 7 days were contacted by phone. Electronic and paper-based clinical and laboratory records were retrospectively examined for all participants to identify known HIV outcomes, after matching for name, date of birth, and sex. These findings were compared with self-reported HIVST results where available.

Of 639 participants, 401 (62.8%) self-reported a negative HIVST result, 27 (4.2%) a positive result, and 211 (33.0%) did not report. The record search identified that of the 401 participants self-reporting a negative HIVST result, 19 (4.7%) were already known to be HIV positive; of the 27 self-reporting positive, 12 (44%) were known HIV positive. Overall, records showed 57/639 (8.9%) were HIV positive of whom 39/57 (68.4%) had previously-diagnosed infection and 18/57 (31.6%) newly-diagnosed infection. Of the 428 participants who self-reported a result, 366 (85.5%) reported by SMS.

HIVST can improve HIV testing uptake and linkage to care. SMS is acceptable for reporting HIVST results but negative self-reports by participants may be unreliable. Use of HIVST by individuals on ART is frequent despite recommendations to the contrary and its implications need further consideration.

Partial Text

The United Nations AIDS Program (UNAIDS) 90-90-90 target aims to ensure that 90% of people living with HIV (PLHIV) will know their status by 2020 [1]. Worldwide, 25% of PLHIV do not know their status [2], and in South Africa this figure is 15% [3]. HIV incidence in South Africa has decreased (from 1.72% annually in 2012 to 0.79% annually in 2017), but at the end of 2016 only 70.6% of the 7.9 million people with HIV infection were on antiretroviral therapy (ART) [3,4]. HIV self-testing (HIVST) has been shown to increase uptake and frequency of HIV testing [5,6] and has the potential to provide access to testing for high-risk, untested, hard-to-reach and test averse populations [7]. The World Health Organisation (WHO) recommends HIVST as an additional approach to HIV testing services [5] and WHO prequalified OraQuick HIV Self-Test (OraSure Technologies Inc) in July 2017 [8] and a blood-based HIV self-test in 2018 [9].

This study demonstrated that HIVST was feasible and could increase HIV testing uptake in a setting with high testing coverage, particularly amongst those who declined clinic-based HTS. Despite attempts to exclude people with previously-diagnosed HIV infection, 39 enrolled in the study. The assessment of care status before and after enrolment found that participating in the study did not result in participants disengaging from care, despite some PLHIV with previously-diagnosed HIV infection reporting negative HIVST results.