VIOLET MENGO, Lusaka
SELF-TESTING in the privacy of one’s home has long been proposed as one sure way of expanding the number of people testing for HIV.
The World Health Organisation (WHO) recommends HIV self-testing as an additional testing approach that will ensure that as many people as possible are tested for HIV.
HIV self-testing (HIVST) addresses stigma and confidentiality that may keep at-risk individuals from testing through conventional means.
Currently, a number of people living with HIV have to go far away from where they live to access antiretroviral treatment or be tested in confidence.
Many fear to be recognised by those known to them. It is even worse for adolescents who are more concerned about confidentiality and privacy, which are key barriers to HIV testing services.
However, the HIV self-testing is slowly gaining ground in Zambia since it was first piloted by the Society for Family Health (SFH) in 2015.
Its major objective then was to give chance to individuals to test themselves in the privacy of their homes.
SFH programme manager for STAR project Hambweka Munkombwe says self-testing is a process where an individual takes his or her own specimen, administers a test and interprets the results on their own at their convenient time.
This idea behind self-testing is to allow individuals that have difficulties to seek HIV services in already existing facilities or communities using conventional testing methods to do so.
“When we piloted the self-testing, we were looking at looking at feasibility, acceptability and getting proof of consent of whether it could work in communities,” Mr Munkombwe said.
He says the innovation covers key populations because they are not testing due to several reasons, among majorly structural barriers and individual barriers.
Results of the pilot project showed that HIV self-testing was acceptable and also feasible for scale up.
It revealed that 34 percent of the people that were given the self-testing kit had never tested for HIV before in their lives. These included 56 percent males, whereas 50 percent were young people.
Results of the two-year pilot project prompted the Ministry of Health (MoH), SFH and other cooperating partners to scale up to cater for a larger population.
The ministry’s target however includes men, adolescents, young men and women who, due to various reasons, are not able to access testing services from health care facilities.
MoH assistant director for infectious diseases, Tina Chisanga, said self-testing is one of the innovative ways to improve access to HIV testing in Zambia.
This, however, is in addition to the routine universal counseling and testing that the ministry conducts in all its facilities.
Dr Chisanga said the MoH is on a mass campaign for self-testing of HIV in the high density areas of Lusaka, Livingstone, Kitwe and Ndola.
The targeted areas in the four cities include markets and bus stations where self-testing kits are being distributed.
In addition, the MoH recently launched the HIV Self-Testing Strategic Framework to guide the implementation of self-testing.
This aims to guide the implementation and scaling-up of ethical, effective, acceptable and evidence-based approaches to HIV self-testing.
The self-testing initiative has received goodwill from donors. For example, the President’s Emergency Plan for AIDS Relief (PEPFAR) donated 800,000 self-testing kits to enhance the implementation of self-testing for HIV.
Further, the MoH has also received support for self-testing from the Global Fund.
A number of delivery approaches to reach underserved populations by existing models and also to increase efficiencies are being used to maximise the benefits of the HIVST.
One way is facility-based distribution whereby trained health workers give test kits to individuals that go to health centres to seek health services.
This type of distribution of test kits includes outreach programmes by health care providers.
There is also the community-based distribution of kits through non-health facility and community-based structures. The targeted mobile testing is conducted by community volunteers who distribute the kits door to door.
Health workers also take advantage of such occasions to provide a variety of information on HIV- positive individuals before handing them HIVST kits.
In addition, specific step-by-step information on how one should conduct the test is also given, thereby preparing an individual adequately for the test.
Health providers also get the verbal consent from individuals on whether they are willing to take the test on their own or not.
Individuals that need some form of support are helped through assisted self-testing or interpretation of the results.
“When one tests positive, we encourage them to go to the facility for confirmatory tests because self-testing does not give a diagnosis for HIV infection, it is just a screening test,” Dr Chisanga said.
If the self-testing results are negative, it simply means one is HIV-negative, while the opposite is also true. However a confirmatory test still needs to be done.
Individuals that test HIV- positive are encouraged to seek support and access treatment.
According to the strategic framework, it is important to create audience-tailored messages that will empower communities to make informed decisions, and this the MoH has taken seriously.
As at December 2016, there were 1.2 million people living with HIV in Zambia.
According to the Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey conducted between 2015 and 2016, 12 percent of people aged 15 to 59 are living with HIV.
The survey further revealed that approximately 46,000 new cases of HIV occur each year.
In terms of progress in HIV testing, the survey indicated that there are still a lot of gaps as many people still do not know their HIV status.
The gaps identified are mainly among men, young people, and the key hidden populations such as men who have sex with men, commercial sex workers and lesbians.
While Paul Kaluba prefers self-testing because he feels the structures at most clinics do not offer patients privacy Maureen Zulu is sceptical about it.
Ms Zulu is worried about the effectiveness of self-testing because many people may not cope with the results after discovering their HIV-positive status.
However, Mr Kaluba says, “I would be glad to receive the self-testing kit just to avoid being seen in the section of people associated to AIDS.”
Despite worried sentiments by sceptics like Ms Zulu, the nationwide implementation of the self-testing programme is expected to improve access to HIV testing.
A successful implementation of HIV self-testing will help Zambia in its quest to attain the UNAIDS 90-90-90 target to have 90 percent people living with HIV diagnosed by 2020.
However, sensitisation is required for people to fully understand and embrace the innovation of self-testing to help fight HIV and AIDS.
VIOLET MENGO, Lusaka