HIV self-testing: finding its way in the prevention tool box
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COMMENTARY
Open Access
HIV self-testing: finding its way in the prevention tool box Katrina F. Ortblad1* and Joanne D. Stekler1,2,3 Background One in five people living with HIV globally remains unaware of their HIV status [1]. There has been much emphasis on identifying these individuals so they can link to HIV treatment services and modify behaviors that contribute to HIV transmission [1]. Novel intervention strategies have been developed to expand access and reach of HIV testing services, including assisted partner notification systems, community-based testing, and more recently HIV self-testing (HIVST) [2]. HIVST, which has some advantages (e.g., increased privacy and convenience) and disadvantages (e.g., lower sensitivity of oral fluid self-tests and potential challenges with linkage to care) over these other strategies, has gained particular enthusiasm and is currently being scaled in a number of high HIV prevalence settings and populations [3]. HIVST may be especially well-suited for key populations, including men who have sex with men (MSM) and female sex workers (FSWs), by addressing additional barriers these populations face to facility-based testing (e.g., stigma, discrimination, and inconvenient clinic hours). In this study, Dr. Witzel and colleagues conducted a systematic review and meta-analysis to understand the effect of HIVST versus standard facility-based HIV testing for key populations [4]. Overall, the authors found that HIVST increased testing uptake, frequency, and yield of positive results for cisgender MSM and transgender persons but not for FSWs. Of note is that the increased yield of positive results for MSM and trans people was due to a mix of increased diagnosis of established infections and, in at least one study, a higher number of incident cases among This comment refers to the article available at https://doi.org/10.1186/ s12916-020-01835-z. * Correspondence: [email protected] 1 Department of Global Health, University of Washington, 908 Jefferson St, Seattle, WA 98104, USA Full list of author information is available at the end of the article
those randomized to HIVST. In terms of harms, HIVST did not impact STI testing, condom use, or social harm for all key populations but was associated with lower reported linkage to HIV treatment across populations. The authors conclude that HIVST is safe for key populations but strategies to improve linkage to treatment are needed for effective roll-out.
HIVST as a gateway to HIV/STI prevention One role for HIVST not included in the review is its potential to improve linkage to HIV prevention interventions. The majority of individuals that self-test (even in high incidence populations) will test negative for HIV infection. These individuals should not be forgotten; rather, HIVST delivery should be paired with resources to increase engagement in and access to behavioral (e.g., condom distribution and negotiation skills) and biomedical (e.g., pre-exposure prophylaxis [PrEP]) HIV prevention interventions, as well as uptake of testing for sexually t
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