HIV: Self Testing Increased Number of Adults Starting Treatment

Dr Peter MacPherson MBChB PhD Wellcome Trust Clinical Research Fellow Liverpool School of Tropical Medicine Department of Clinical Sciences Liverpool School of Tropical Medicine Pembroke Place, Liverpool L3 5QAMedicalResearch.com Interview with:
Dr Peter MacPherson MBChB PhD
Wellcome Trust Clinical Research Fellow
Liverpool School of Tropical Medicine
Department of Clinical Sciences
Liverpool School of Tropical Medicine
Pembroke Place, Liverpool L3 5QA

Medical Research: What are the main findings of the study?

Dr. MacPherson: In 2012, an estimated 35 million individuals were infected with the human immunodeficiency virus (HIV) worldwide. Antiretroviral therapy (ART) substantially reduces the risk of HIV transmission as well as greatly reducing illness and death, raising hopes that high uptake of annual HIV testing and early initiation of ART could improve HIV prevention as well as care. Achieving high coverage of HIV testing and treatment is a major challenge however, with low rates of HIV testing and poor linkage into HIV care.

Self-testing for HIV infection (defined as individuals performing and interpreting their HIV test in private) is a novel approach that has seen high acceptance in Malawi and the United States, and is a process that could overcome barriers to conventional facility-based and community-based HIV testing, which lack privacy and convenience. However, no studies in high HIV prevalence settings have investigated linkage into HIV care after HIV self-testing.

Among 16,6660 adults in Blantyre, Malawi offered HIV self-testing, optional home initiation of HIV care (including two-weeks of ART for those eligible) compared with standard HIV care resulted in a substantial and significant increase in the proportion of adults initiating antiretroviral therapy.

HIV self-testing was also extremely popular, with 58% of the adult population self-testing with just 6-months.

To our knowledge, this is the first study to investigate a comprehensive home-based HIV testing, eligibility assessment and treatment initiation strategy.

Medical Research: What should clinicians and patients take away from your report?

Dr. MacPherson: At a time when universal test and treat approaches to controlling the HIV epidemic are being considered, home initiation of HIV care shows high promise as a simple strategy to improve uptake of ART when HIV self-testing is carried out at home. HIV self-testing has high potential to improve access to convenient and confidential HIV testing.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. MacPherson: HIV self-testing was implemented through neighborhood volunteers living close to participants. Home initiation of HIV care was a highly feasible option in this situation and may not apply to other models of HIV self-testing delivery. Other models for encouraging linkage may need to be developed and ideally directly compared for effectiveness.

Although rates of loss from ART by 6-months were not significantly different between home and facility group ART initiators, future studies should examine clinical outcomes over longer periods of follow-up.

Citation:

Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in MalawiA Randomized Clinical Trial

MacPherson P, Lalloo DG, Webb EL, et al. Effect of Optional Home Initiation of HIV Care Following HIV Self-testing on Antiretroviral Therapy Initiation Among Adults in Malawi: A Randomized Clinical Trial. JAMA. 2014;312(4):372-379. doi:10.1001/jama.2014.6493.

 

 

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