Dear Colleagues,

I am glad I got this information from you today, as we at the Society for Women and Aids in Africa, Nigeria chapter (SWAAN), plan to disseminate this information tomorrow being the Works AIDS Day.

Below is an excerpt, culled out from a write up by Jenny Lei Rovale (02, August 2019), at AIDS 2018, a strong push for HIV self-testing. But is everyone on board? I accessed this today, after trying the URL-
https://web-prod.who.int/publications-detail/who-
recommends-hiv-self-testing-evidence-update, which did not open.

Unitaid (https://www.devex.com/organizations/unitaid-41957), one of its champions, announced two new projects promoting self-testing to a wider population in sub-Saharan Africa.

An estimated 75 percent (http://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf) of
people living with HIV are aware of their status, according to latest statistics by the Joint United Nations Programme on HIV/AIDS (https://www.devex.com/organizations/unaids-23691). This is a significant leap from two years ago, when UNAIDS estimated 40 percent of people living with HIV remain undiagnosed.

But concerns abound that such improvements are not seen in certain populations
(https://www.devex.com/news/aids-2018-told-the-story-of-a-global-health-crisis-93197?utm_source=article&utm_medium=88888&utm_campaign=line).
In fact, latest statistics (http://www.unaids.org/sites/default/files/media_asset/miles-to-go_en.pdf) show
an increase in new infections among high-risk groups, including men who have sex with men, people who inject drugs, sex workers and transgender people.

But an alternative to the current standard testing approach could help close the gap, creating a domino effect that would lead to more people getting on treatment and eventually, reduce their viral loads. Unitaid, together with its partners and several HIV experts and activists, is convinced that promoting self-testing could be the key.

“It’s not the only thing that will help close [the] gap, but we’re quite convinced that it will be a critical tool in helping to close it,” said Robert Matiru (https://unitaid.org/about-us/secretariat/?sec=robert-matiru), Unitaid Director of Operations.

How much self-testing will impact the current numbers— and how far can it go to help meet the UNAIDS global targets set for 2020— is currently hard to tell. But some initial evidence have shown promise, he said. In the initial phase of the HIV Self-Testing Africa Initiative (http://hivstar.lshtm.ac.uk/) the organization funded in 2015, they found groups of high-risk populations that had not undergone testing before, such as young men and sex workers, actually used the test.

“That first project basically proved in three countries in sub-Saharan Africa that self-testing is feasible, that it is acceptable, that it is safe, and that it is effective,” said the Unitaid official.

But in the past few years, several international organizations have made efforts in further bringing down the cost of these products, particularly for low- and middle-income countries. OraQuick HIV Self-Test (http://www.oraquick.com/), the first and only WHO pre-approved HIV self-test kit, is currently made more affordable under a $20 million partnership in 2017 between manufacturer OraSure Technologies and the Bill & Melinda Gates Foundation (https://www.devex.com/organizations/bill-melinda-gates-foundation-b-mgf-44525).
That partnership has allowed OraSure to bring down the cost of the kit to $2
per test (http://www.orasure.com/products-infectious/products-infectious-oraquick-self-test.asp) in 50 developing countries in Asia and Africa through governmental and nongovernmental organizations, excluding delivery, distribution costs, and taxes.

Currently, Unitaid is seeking to bring down test pricing and convince governments and international funders to invest in the approach, Matiru explained.

“We committed an additional $80 million to now position self-testing for scale up. By that, I mean completing effectiveness studies to show to governments and funders that investing in self-testing is a good use of [their] money...and secondly, to negotiate better pricing for tests and generate demand, making people, particularly young people, young men, and their partners aware that self-testing is safe, normal, and effective,” he said.

“So, a lot of our investment now are about getting better pricing, getting more companies to sell the product in the market, and getting people to actually seek and use the test,” he added.

Another concern is linkage to care. But trials presented in last week’s AIDS 2018 conference showed self-testing doesn’t have an effect on people’s initiation to treatment.

In Vietnam, a high percentage of people who undertook self-testing— either with the help of peer educators or alone— went on to confirm their status and signed on for antiretroviral treatment. But there were exceptions.

“You will see there are few people among (key populations) who did not go for confirmatory testing or ART. The first reason is that not every person who had reactive results after screening for HIV agreed or were ready to go for confirmatory testing or ART right after having tested or diagnosed. Sometimes, it takes several months. Thus, at any time point, there will be someone who needs time to accept their HIV status and to be ready for their lifelong treatment,” Nguyen said.

I hope this information would throw more light to the discussion.

Best Regards
Halima Salisu Kabara

 

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Felix Emeka Anyiam

 

Research Officer & Data Analyst/Scientist

Centre for Health and Development

University of Port Harcourt (UNIPORT)

Top Floor, Medical Library Building

University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt

River State, Nigeria.

 ORCID ID: http://orcid.org/0000-0003-2774-7406

 Skype ID: @felix.emeka.anyiam

tel: +234 (0) 806 499 5462                                                    

email: chd@uniport.edu.ng

http://www.uniport.edu.ng/centres/170-centre-for-health-and-development-chd.html

 I don't mind not knowing.  It doesn't scare me.  - Richard Feynman

To consult the statistician after an experiment is finished is often merely to ask him to conduct a post mortem examination. He can perhaps say what the experiment died of. -Ronald A. Fisher.

 

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