Date Published: January 26, 2017
Publisher: Public Library of Science
Author(s): Peter M. Mugo, Murugi Micheni, Jimmy Shangala, Mohamed H. Hussein, Susan M. Graham, Tobias F. Rinke de Wit, Eduard J. Sanders, Charlene S. Dezzutti.
While HIV testing and counselling is a key entry point for treatment as prevention, over half of HIV-infected adults in Kenya are unaware they are infected. Offering HIV self-testing (HST) at community pharmacies may enhance detection of undiagnosed infections. We assessed the feasibility of pharmacy-based HST in Coastal Kenya.
Staff at five pharmacies, supported by on-site research assistants, recruited adult clients (≥18 years) seeking services indicative of HIV risk. Participants were offered oral HST kits (OraQuick®) at US$1 per test. Within one week of buying a test, participants were contacted for post-test data collection and counselling. The primary outcome was test uptake, defined as the proportion of invited clients who bought tests. Views of participating pharmacy staff were solicited in feedback sessions during and after the study.
Between November 2015 and April 2016, 463 clients were invited to participate; 174 (38%) were enrolled; and 161 (35% [95% Confidence Interval (CI) 31–39%]) bought a test. Uptake was higher among clients seeking HIV testing compared to those seeking other services (84% vs. 11%, adjusted risk ratio 6.9 [95% CI 4.9–9.8]). Only 4% of non-testers (11/302) stated inability to pay as the reason they did not take up the test. All but one tester reported the process was easy (29%) or very easy (70%). Demand for HST kits persisted after the study and participating service providers expressed interest in continuing to offer the service.
Pharmacy HST is feasible in Kenya and may be in high demand. The uptake pattern observed suggests that a client-initiated approach is more feasible compared to pharmacy-initiated testing. Price is unlikely to be a barrier if set at about US$1 per test. Further implementation research is required to assess uptake, yield, and linkage to care on a larger scale.
HIV testing and counselling (HTC) is a key entry point for treatment as prevention . It is also an HIV prevention intervention in its own right, as it may result in more consistent condom use  and adoption of other risk reduction strategies . Recognition of the central role of HTC in HIV prevention has intensified its implementation in recent years . In Kenya, the proportion of adults 15–64 years who have ever tested increased from 37% in 2007 to 70% in 2012 , and to 80% in 2014 . However, despite this increase in first-time testing, 53% of HIV-infected adults in a 2012 national survey were unaware they were infected , hence were not on treatment and may have continued high risk behaviour. This highlights the need for innovative HTC approaches.
This study demonstrates the feasibility of pharmacy HST in a developing country setting. Uptake was high among pharmacy clients seeking HIV testing (84%), but very low among those seeking other services (11%), suggesting that a client-initiated approach would be more feasible compared to pharmacy-initiated testing. Only 4% of non-testers stated inability to pay as the reason they did not take up the test, suggesting that cost might not be a barrier if subsidized and set at about one dollar per test, as was the case in the study. Acceptability was high among testers and service providers. Privacy was predictably the most popular aspect of HST, but personal empowerment was also cited as an important benefit. A large majority of testers expressed interest in using the method again in future and a high likelihood of recommending it to others.