Currently, it is estimated that only 79% of people living with HIV know their HIV status. Countries are looking for ways to rapidly increase uptake of HIV testing services, especially for populations with low access and those at higher risk that would otherwise not get tested.
One approach is HIV self-testing, where a person collects his or her own specimen (oral fluid or blood) and then performs an HIV test and interprets the result, often in a private setting, either alone or with someone he or she trusts.
A Basel research group has now been able to significantly improve the success of “door-to-door” testing campaigns thanks to HIV self-tests.
In 2019, around 38 million people worldwide were infected with HIV. Two-thirds of those affected live in Africa, mainly south of the Sahara. To contain the epidemic, it is essential that all infections are treated with antiretroviral therapy to prevent the transmission of the virus.
This, however, requires an early diagnosis. Especially in remote regions, which are a long way from clinics and test centers, access to HIV-testing remains a challenge.
Case study Lesotho
In Lesotho, every fourth adult is infected with HIV. It is estimated that about 15 percent of the infections in the small mountainous country at the southern tip of Africa remain undetected and contribute to the further spread of HIV.
For many Lesotho inhabitants, the nearest clinic is a few hours’ walk or an expensive cab ride away. To facilitate access to health services and HIV testing, health centers regularly organize “door-to-door” health campaigns. Studies have shown, however, that they reach only about 60 percent of the village population.
A team led by Niklaus Labhardt, professor at the University of Basel and research group leader at the Swiss Tropical and Public Health Institute (Swiss TPH), has now developed a strategy to improve test coverage by 20 percent.
For the first time, the team combined home visits with HIV self-tests. If villagers are absent during the home visits, the campaign team leaves self-tests with instructional material in the local language. Village health advisors, who have been trained in using and evaluating the self-tests, collect the self-tests afterward.