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WHO releases new guidance for HIV self-testing
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WHO published new guidance today recommending the use of HIV self-testing to increase the number of people who are aware of their HIV status.
According to a new WHO report, 40% of all people with HIV, which is estimated to be more than 14 million individuals, are unaware of their status. Many of them have a higher risk for HIV infection and cannot easily access existing testing services.
“Millions of people with HIV are still missing out on life-saving treatment, which can also prevent HIV transmission to others,” WHO Director-General Margaret Chan, MD, said in a press release. “HIV self-testing should open the door for many more people to know their HIV status and find out how to get treatment and access prevention services.”
HIV self-testing involves the use of oral fluid or finger-pricks to determine an individual’s personal HIV status in a private setting. According to WHO, tests that meet quality, safety and performance standards can produce results in 20 minutes or less with 80% to 100% sensitivity and 95.1% to 100% specificity. However, in its recommendations, the organization reported that a single rapid test is not enough to confirm a positive HIV diagnosis. Individuals who do have a positive self-test result must receive additional testing from a trained professional. WHO also advises that self-testers with negative results retest if they were exposed to HIV within 6 weeks or have a high, ongoing risk for infection. Self-testing is not recommended for patients receiving antiretroviral drugs or those who are uncertain how to properly perform self-tests or interpret their results.
Compared with standard HIV testing, WHO found evidence that self-testing more than doubles testing uptake among men who have sex with men and male partners of women who are pregnant or postpartum. The benefits of self-testing are achieved without decreasing the frequency of testing for other sexually transmitted infections or increasing risky behaviors such as condomless anal sex, according to WHO.
Twenty-three countries currently have national regulations that support HIV self-testing, and many others are developing policies. Despite this, widespread implementation remains limited. To increase its use, WHO recommends that countries develop an age-of-consent policy to self-test, and to incorporate HIV self-testing into existing national policy and regulatory frameworks, including laws that permit the sale, distribution, advertisement and use of quality rapid diagnostic tests. The organization also recommends the adoption of human rights laws and policies to protect individuals and address misuse of HIV self-testing, as well as quality assurance and post-market surveillance systems. In addition, WHO supports the free distribution of self-test kits and is working to reduce costs.
“By offering HIV self-testing, we can empower people to find out their own HIV status and also to notify their partners and encourage them to get tested as well,” Gottfried Hirnschall, MD, MPH, director of WHO’s department of HIV, said in the release. “This should lead to more people knowing their status and being able to act upon it. Self-testing will be particularly relevant for those people who may find it difficult to access testing in clinical settings and might prefer self-testing as their method of choice.”
For more information: Guidelines on HIV self-testing and partner notification.
Disclosures: Chan and Hirnschall report no relevant financial disclosures.