Malawi surveys HIV saliva self-test

Malawi-Liverpool-Wellcome Trust and London School of Hygiene and Tropical Medicine have started conducting a research to measure effectiveness of HIV self-testing with possibilities of implementing the initiative in the country.

The two institutions are working in partnership with College of Medicine and Liverpool School of Tropical Medicine on the study, which has already rolled out in selected high density townships, which include Ndirande and Bangwe among others.

According to a media statement made available to Nyasa Timesfrom Malawi-Liverpool-Wellcome Trust, the study, which is first of its kind anywhere in the world, is expected to engage adult residents of 14 study neighbourhoods and their partners (about 18,000 people in total) on voluntary choice to self-test.

A saliva test used to diagnose the human immunodeficiency virus (HIV), is comparable in accuracy to the traditional blood test, according to a new study led by the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University.

During the study, selected participants will be given oral HIV testing kits to test themselves for HIV. The test works by detecting the response that a person’s body makes when become infected with HIV what is called “antibody” response.
Prior Self-testing study

The current research follows up self-testing evaluation in 2010 by Malawi-Liverpool-Wellcome Trust and London School of Hygiene and Tropical Medicine, which indicated that self-testing had promising results.

“Following this demonstration that oral supervised self-testing was highly acceptable and accurate, the same researchers are now investigating whether or not high uptake at local community level can be achieved and if self-testing can be safely linked to counselling and HIV care by supporting volunteers from the community to distribute self-testing kits from their own homes,” reads the press release.

Intended Results

The release states that the research will determine if self-testing with confirmatory blood testing could be an effective way of bringing down rates of undiagnosed HIV and new cases of TB in this area of high HIV prevalence.

“Participants thought that making self-testing available in the community would increase HIV-test uptake and frequency, especially among men, by couples and by people who had already tested once or more before. 28 volunteers have been trained in HIV testing and counselling by the Ministry of Health.

“Since the research started in February just a few weeks ago the volunteer Community Counsellors have provided kits with instructions to over 2,800 residents of defined study neighbourhoods. 90% of participants return for post-test counselling and 64% have shared their results with the counsellor, including 174 provisionally positive people.

“Even without having to know the results the counsellors provide advice and instructions on where to go to get confirmatory testing and HIV care, linking participants in to nurses at nearby clinics using a “self-referral” card held by the participant themselves,” further reads the release.

Once implemented, HIV self-testing initiative is believed will offer greater confidentiality and increase number of people taking up voluntary HIV testing thereby improving HIV/TB control which has been hit by low regular uptake of HIV testing by adult individuals. Recommendations are that all adults should test for HIV at least once every year.

“Self-testing was thought to be less inconvenience and to offer the opportunity for people to take full control of their testing environment. A dislike of testing in local clinic facilities where the level of privacy that people needed was difficult to obtain was cited as a major disincentive to voluntary testing at the moment.

“This allows HIV treatment to be started as soon as indicated, contributing to reduced spread of HIV, reducing the risk of TB, and greatly improving overall health and survival prospects. Studies have shown that almost all African adults will take up an HIV test if it is directly offered to them at home.

However, the press release indicated that in practice HIV testing is stressful and people don’t like to test too close to their homes, because of need for privacy despite major investment by the Ministry of Health in HIV testing services (with between one and two million Malawians tested each year).

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