Self-testing kits are critical tools in the effort to end HIV

NEWS ANALYSIS | THE INDEPENDENT | The most recent statistics from the Uganda Aids Commission show that Uganda registered 52,000 new HIV infections since the year began. Fort Portal and Mbarara cities took first and second positions respectively in HIV/AIDS prevalence in Uganda.

Teenage girls and older men registered the highest number of new infections for the last three years, especially in the Mbarara district. The district is shown to have registered 1,789 new HIV infections. If we are to go by the latest report it could be an indicator that we are losing the battle to end HIV by 2030.

The Human Immune deficiency Virus (HIV) remains a global public health threat. Statistics show 37.6 million people were affected globally by 2020.  Africa bears the highest burden with 25.7 million people living with HIV. In East Africa Uganda has the highest burden with an HIV prevalence rate of 5.8% among the 15-49 years old.

HIV infection, initially described as “slim disease” was first recognized in Uganda in 1982, and 41 years on, is still a major health problem.

The southwestern part of Uganda is indicated to have a higher burden of HIV with prevalence at 10.4%. It is attributed to high-risk sexual practices, like people having unprotected and unplanned intercourse in the bush while grazing cattle, gender, economic causes, and prenatal transmission, not limited to primitive cultural habits of men inheriting windows and sharing wives.

According to the experts, prevention strategies, such as treatment as prevention, safer sex, and more recently pre-exposure prophylaxis (PEP) have been viewed as the pillars in efforts to reduce HIV incidence. However, one essential part of the prevention tool that has at times been overlooked is accessible testing.

The study Determinants of testing for HIV among young people in Uganda published in the PLOS Global Public Health journal says despite progress in enhancing access to HIV services, HIV testing among young people in Uganda is below target.

Across the world, statistics show adolescents between the age of 10-19 constitute a growing proportion of people living with HIV. It is due to early initiation to sexual activity, succumbing to peer pressure, the lack of problem-solving skills, and also the desire for quick money which sugar daddies and sugar mummies who most likely are HIV positive are willing to provide.

Globally, young people (15-24 years) contribute over 30% of new HIV infections. However, awareness of HIV serostatus helps individuals to regulate behavior or link to care. Young people associated their decisions about HIV testing, with self-evaluation of their risk and seeming ability to manage the consequences of a positive result.

High levels of support for HIV testing came from peers, partners, and family members. However, from the study young people regarded health facilities as confusing, distant, expensive, and staffed by judgmental, older health workers as barriers.

They felt that mobile testing points solved some of these problems, but had less privacy and greater confidentiality concerns. This is likely the feeling of so many other Ugandans, but HIV testing today should not attract fear, it can be taken in the comfort of someone’s home or a private space where someone won’t feel intruded upon.

Research shows in 2019, an estimated 480 million HIV tests were carried out globally. However, 7.1 million (19%) of People Living with HIV (PLHIV) remain undiagnosed. To address the HIV testing gap, the World Health Organisation (WHO) recommended HIV self-testing (HIVST) as an innovative strategy to reach UNAIDS targets to end HIV by 2030.

Self-testing has become the acceptable option to overcome significant barriers to clinic-based HIV testing services such as privacy and confidentiality. It complements traditional HIV testing programs, removing barriers, and increasing access to tests.

HIVST allows individuals to use a rapid test to determine their HIV status in a private setting. It ensures better uptake, encourages earlier diagnosis, and potentially increases access to HIV testing services, therefore helping to avoid the 3Ds which have impacted greatly on morbidity and mortality rate, that is (Delay in reaching the hospital, Delay in getting diagnosis, Delay in starting treatment).

Today a quick swab of the gums will enable an individual to know their HIV status. There are no needles or blood required and also don’t require invasive technical special training to use The oral test kits for HIV play a crucial role in promoting widespread, and timely testing for HIV. It is a convenient, confidential, and non-invasive method for individuals to know their HIV status.

For instance, OraQuick HIV self-testing kit produced by OraSure Technologies which is among the diverse HIV self-testing kits available in Uganda, targets young people and other key persons at risk of getting HIV.

By eliminating the need for blood samples, oral test kits reduce barriers to testing, encouraging more people to take control of their health. The impact of oral test kits is significant as they contribute to early detection and timely interventions in the fight against HIV.

Early diagnosis is key in managing HIV, preventing its progression, and reducing the risk of transmission. It all starts with testing.  By facilitating self-testing at home or in private spaces, the oral self-testing kits empower individuals to overcome stigma and privacy concerns, ultimately increasing the overall testing rates.

Furthermore, oral test kits align with the global effort to achieve the UNAIDS 95–95–95 target to end AIDS by 2030.

The target aims at 95% of the people who are living with HIV knowing their HIV status, 95% of the people who know that they are living with HIV being on lifesaving antiretroviral treatment, and 95% of people who are on treatment being virally suppressed.

The accessibility and simplicity of oral test kits contribute to achieving these targets by enhancing the first step of knowing one’s HIV status. Oral test kits are instrumental in promoting HIV testing, offering a practical solution to overcome barriers, encouraging early detection, and contributing to global efforts to control and ultimately end the HIV/AIDS epidemic.

Evidence shows that self-testing is safe and accurate and increases testing uptake among people who may not test more so men who are more likely to be diagnosed late. The yearning for confidentiality and privacy is addressed by HIVST, and the results come in quickly. For instance, with OraQuick HIV self-testing kit which is approved by WHO in Africa, one is able to get their result in 20 minutes in the comfort of their home, unlike the blood tests that require someone to visit a clinic and also cater to individuals who have a phobia for needle pricks.

WHO estimates that the total HIVST need for Low and middle-income countries (LMICs) among populations recommended, will grow from 177m to 192m tests by 2025. Populations driving the results will include those with sexually transmitted infections (STIs) who will total 42 million by 2025.

Others will include adolescent girls and young women, men aged 35 to 59 years, Sero-discordant partners of PLHIV who know their status, female sex workers, and people who inject drugs. The projections are of 25 countries including Uganda that account for more than 75% of the total HIVST need for LMICs.

On the other hand, total LMIC- HIVST demand is projected to reach 29 million tests by 2025 whereas the total estimated funding gap to meet demand in 2025 is $104 million. The forecasted demand of 29 million HIVST in 2025 will require an estimated funding of $180 million to implement.

This was the reality Uganda faced as it marked World AIDS Day  December 1. Experts say it is important that government and its partners explore new and innovative approaches that will make oral HIV self-testing kits more easily available, cheaper, and easily accessed by people in Uganda as a tool which ensures that more people test for HIV, know their status, prevent HIV or get on treatment. This will bolster the goal to end HIV by 2030.