By CHIPEMA SAKAIMBO –
SOCIETY for Family Health (SFH) in partnership with the Ministry of Health recently launched a self HIV testing kit called OraQuick which will help in bridging some of the HIV testing gaps in the country.
The project, which is called ‘Self Testing in Africa (STAR)’, is intended to boost access to HIV testing and its impact on the achievement of HIV prevention and treatment goals.
HIV testing in the privacy of one’s home has long been proposed as a way of expanding the number of people tested, by addressing issues of access, stigma and confidentiality that may keep at-risk individuals from testing through conventional venues.
The HIV-OraQuick self test involves the use of a simple oral fluid swab that allows individuals to test themselves at a time and location convenient to them.
The OraQuick test package contains step-by-step instructions.
It detects HIV antibodies in saliva.
The test kit also contains an information booklet such as “What your results mean to you”, which is designed to instruct individuals on what to do once they have obtained their test results.
The test is relatively reliable if there has been sufficient time for HIV antibodies to develop in the infected person.
For the OraQuick HIV test, there is also a period of time called the window period, which is about three months.
It is suggested that if you had recently been engaging in behaviour that puts you at high risk for HIV infection, you should take the test again at a later time.
Alternatively, you should see your health care provider who can discuss other options for HIV testing.
The idea of HIV home-based testing has been debated for decades, almost as long as HIV testing has been available, but it has not been widely endorsed.
Recently, the debate about the oral testing kit has been ignited, with the approval in some African countries like Zambia.
Most people have several questions on the HIV home-based tests (focusing on OraQuick) with regards to how they work, where they are available, their acceptability and accuracy, and the potential benefits and ongoing concerns surrounding home-based testing.
Research studies from other countries show that the OraQuick test is as accurate (99.9 per cent of the time) at identifying HIV-negative results as blood-based testing done in a lab by trained professionals.
OraQuick is 91.7 per cent accurate at identifying HIV-positive test results.
This means that almost 10 per cent of people who are HIV positive may be incorrectly identified as HIV negative using the OraQuick test.
OraQuick is not as accurate as blood-based testing in a lab, which has been shown to be 99.7 per cent accurate at identifying positive test results.
False-negative results when the test comes back negative but a person is actually HIV positive can occur with OraQuick if a risk event (unprotected sex or borrowing injection equipment, for example) occurs within the three-month window period (as with the standard blood HIV antibody test).
This happens because the test relies on the detection of antibodies in the saliva, which may take up to three months to develop.
Clients considering self-testing need to be counselled about the window period.
Again, false negative results may also occur if the test is incorrectly read by the user as negative; if the test instructions are not followed carefully and the user does not swab the gum line; or if the user is wearing a dental product, such as dentures that cover their gums, while they use the swab.
Former Health Minister Joseph Kasonde in a speech read on his behalf by Ministry of Health Director of Disease Surveillance, Control and Research Elizabeth Chizema, during the launch said the introduction of the HIV self-testing kit is a great initiative aimed at augmenting the fight against HIV and AIDS.
Dr Kasonde said minimizing the number of HIV-infected people in the country required expanded coverage of HIV testing as well as increased testing frequency among those at greatest risk of infection.
He said the Government, through the Ministry of Health, is committed to serve lives of people, especially those living with HIV and AIDS.
The former health minister said if Zambia achieves the first 90 goal, which is to diagnose 90 per cent of people living with HIV, then the country will need to scale up HIV testing, with self-testing being one of the feasible approaches.
“Although significant progress has been made in the HIV response in our country, Zambia still remains one of the countries in the world carrying the heaviest burden of the epidemic at 13.3 per cent prevalence among adults aged between 15 and 49 years,” he said.
Dr Kasonde suggested that more effective preventive measures must also be implemented to counter the high incidence of HIV among young women and other vulnerable groups.
Zambia was part of the member countries that gathered in New York from June 8 to 10 this year during the United Nations (UN) General Assembly’s high level meeting on HIV and AIDS to renew the commitment of reaching the 90-90-90 targets globally.
SFH Executive Director Namwinga Chintu said a new innovation has been introduced which is likely to have an important place in future global HIV strategies that is expected to increase the number of people getting tested for HIV.
Dr Chintu said by giving people the opportunity to test discreetly and conveniently, HIV self-testing may increase the update of HIV testing among people not reached by other HIV testing services, including many people who have never taken a test.
She said 1,500 test kits have so far been distributed in Lusaka’s George Township and Ndola’s Masala Township where community based distributors have been trained.
Other towns are Choma and Kapiri Mposhi and within two years of the project the aim is to distribute more than 200,000 kits.
“The STAR is finally here: it is up to us in the prevention, research and advocacy community to monitor actual patterns of use, predict their impacts and carefully determine the optimal role for self-testing in our overall testing strategy,” she said.
Dr Chintu said before the kits are distributed, members of the public are counselled and given the chance to decide whether they are ready for the test.
She further explained that testing using the OraQuick is voluntary and people who are not ready are advised not to test themselves so that no suicidal cases are recorded.
She said a toll free line will be created for those who would want to be re-counselled before and after testing.