KENYA AWAITS LAUNCH OF HIV SELF-TESTING
In her key note address of the HIV STAT Dr. Nduku Kilonzo said, “It is time we got started with HIV self-testing as a county. Let’s not wait until everything is perfect but let’s be willing learn as we go along”
Indeed, there is a lot of evidence on HIVST already and much of it generated through research and experiences in Kenya. This was the subject of the well-attended webinar on HIV self-testing hosted by the Maisha Marifa research hub www.maishamaarifa.org.
Dr. Miriam Taegtmeyer of the Liverpool School of Tropical Medicine gave feedback from the “HIV self-testing going to scale” STAR workshop being held in Nairobi 27th -30th March. This large international workshop included the regional roll out of the WHO guidelines as well as interim analysis findings from large scale studies on HIV self-testing in Zimbabwe, Zambia and Malawi. With policymakers, MoH, civil society and WHO country representatives from 18 countries there had been some lively discussions and debate as critical issues around translating pilot projects to scale were discussed. It was clear from the meeting that many countries in the region are including HIVST in policy and are planning for scale-up. The recent Global Fund Expert Review Panel-Diagnostics provides an opportunity for including HIV self-testing in global fund proposals whilst full WHO pre-qualification of tests is awaited and further advocacy on price reductions is made. The workshop’s 6 main panels and skills building workshops highlighted experience, learning and research evidence of direct relevance to scale up in Kenya.
- Panel 1: Getting started at national level- strategy, planning and oversight
- Panel 2: Optimising accuracy of HIV self-tests
- Panel 3: HIV distribution models, service delivery and linkage
- Panel 4: Self-testing scale up and health Systems: integrating HIV distribution into existing community health platforms and public sector HTS services
- Panel 5: Moving HIV self-testing from research to policy and practice – a policy maker’s perspective
- Panel 6: Research methods for scale up
The findings from STAR will be made available as published papers, as policy briefs and as toolkits and will be available through the much lauded www.hivst.org website that acts as a clearing house of information on HIV self-testing and enables collaboration between global public health stakeholders. Please do feel free to visit.
In December 2016, the WHO launched Guidelines on HIV self-testing and partner notification and the last week of March saw the roll out of these guidelines in the Africa region. Dr. Brian Chirombo of WHO South Africa made a presentation on moving HIVST from guidance to implementation and impact. It strongly came out that self-testing is the innovation that is needed to close the testing gap. The WHO HIVST strategy encourages self-testers with a reactive (positive) result to receive further testing from a trained provider using a validated national testing algorithm. Self-testers with a non-reactive test result should retest if they might have been exposed to HIV in the preceding 6-12 weeks or are uncertain of their result. It is vital to note that self-testing is not recommended for people taking anti-retroviral drugs as this may cause a false negative result. The WHO recommendation is based on a strong evidence base that feeds into its ‘GRADE’ system for assessing the evidence. Research indicates that HIVST doubled uptake and frequency compared to standard HTS alone and identified twice as many HIV infections as standard HTS. With regards to linkage to prevention and care, HIVST research findings indicate linkage can be good – but as with all HTS – supportive interventions can further facilitate linkage. Studies have reported that HIVST is empowering and has no identifiable increased risk of social harm and adverse events. HIVST is highly acceptable across different populations and settings including men, young people, key populations and couples. User preferences vary, with some preferring oral HIVST as a painless option and others who prefer fingerpick HIVST valuing the accuracy or having more trust in the results of a blood test. Preference across service delivery approaches vary. Young people for example, preferred community-based options while key populations preferred pharmacies, internet and over-the-counter approaches as they are more discreet and private. It is highly recommended that HIVST should be offered as an additional approach to HIV testing services.
Dr. Sarah Masyuko from NASCOP made a presentation on rolling out HIV self-testing in Kenya, on how to reach the unreached. HIVST is a tool to achieve the 90-90-90 goals. The populations that are most unidentified and hence most targeted by this strategy are the men, adolescents and youth. In Kenya, HIVST was first included in the national guidelines in 2008, and it has taken 9 years to kick off its implementation. In Kenya, high uptake of HIVST has been reported especially among youth, men and those who had never tested. The first-time testers reported loving the approach due to its convenience, privacy and reduced stigma. HIVST has again been included in the Kenya HIV Testing Guidelines 2015 and will be launched alongside PrEP in April 2017. Some of the HIVST service delivery approaches include facility based and community based. HIV ST is a screening test and hence it is recommended that all who have a positive self-test should visit the nearest health facility for the results to be confirmed as per the national protocols. Moving forward, there will be public private partnership, capacity building. Rollout of HIVST will begin with private sector at a wider scale and procurement of test kits to kick off public sector self-testing and distribution will commence in the near future.
There were a lot of questions on ‘what now?’ and participants were as eager to hear from NASCOP as each other. Some of the questions were focused on “how the rollout of HIVST would happen in Kenya? Will there be rollout in specific counties for pretesting uptake or will it be a generalized uptake throughout the country after the launch? How will we address the loss of data on HIV which was listed as a challenge given that it is highly sensitive and has to be voluntary? A number of participants asked to have the names of the approved three kits in Kenya. Has NASCOP considered using HIV self-testing to ease PrEP delivery? Will the cost of the kits be standardized with the pharmacies or will it be open to the pharmacies to determine? How will comprehensive linkage be ensured given that we have vast treatment sites? Will the test kits be available on sale for everyone and anyone? Will there be an age limit for purchase? Are there any specific measures under consideration to take into account ‘window period’?
The webinar was lauded by the participants, many capturing the fact that it was very enlightening, insightful, very elaborate. A participant even went ahead to say, “The evidence is overwhelming.”
As Kenya prepares to launch HIV self-testing in May of 2017 this webinar could not have been more timely and the high number of participants reflect the current interest in the discussions on Kenya, in particular. The webinar’s 63 participants more than doubled the previous webinar attendances. Time lapsed and an hour and a half suddenly felt like a blink of an eye with many people still asking questions and giving comments. This created a need for further discussion on the Community of Practice on HIV Prevention (http://www.maishamaarifa.org/communities-of-practice/hiv/hiv-prevention ). Participants were encouraged to register on the Maisha Maarifa Research Hub and subsequently on the Community of Practice on HIV Prevention to be a part of the continued discussions. They were also advised of other fora and to look out for such as a follow up twitter chat on the same. Thanks are due to Lynda Keeru (LVCT Health), Kevin Hiuhu (National AIDS Control Council) and others for their work on ensuring that the webinar was a success.
By Dr. Miriam Taegtmeyer, Cheryl Johnson, Dr. Brian Chirombo, Dr. Sarah Masyuko, Jordan Kyongo, Lynda Keeru.