Eradicating Aids through self-testing
Vivian Mugarisi recently in Durban, South Africa
As the world gear up the response to HIV/Aids, self-testing appears to be of great importance in achieving the 90-90-90- target. The 90-90-90 is an ambitious target to help eradicate Aids. But other long standing barriers to accessing comprehensive HIV testing remain significant, especially in Africa.There are still people who worry about HIV-related stigma, those who do not see the need to know their status for one reason or the other and those who are afraid of dying of Aids-related diseases so they would rather not know.
While self-testing could actually be the key for the Zimbabwe to achieve the first 90, which seeks to ensure that all persons living with HIV know their status, lack of linkage to care, counselling and the ability of individuals to test themselves accurately and interpret results remain a major challenge in the successful implementation of home service testing.
But the introduction of this HIV self-service looks imminent.
In an interview on the side lines of the 21st International AIDS Conference in Durban, Aids and TB Unit director Dr Owen Mugurungi said the pilot project which was demonstrated in Mazowe in March was a way of evidence gathering to present to the World Health Organisation for guidance.
He said for the country to secure funding for the project from various donors, there should be guidelines on how to carry out self-testing.
“The unfortunate thing is that when countries that have resource constraints like Zimbabwe go to our partners and ask for some money for self-testing, they will then say there is no guidance for it.
“So what we are doing now is to get evidence for WHO to be able to give normative guidance so if the evidence is good WHO would then come up with guidelines then we can go back to our partners and say give us money for self-test,” he said.
Dr Mugurungi said the country will embark on the programme despite resource challenges in preparation for a full-blown project once resources are secured.
“We, however, feel that with our own limited resources, we should not let the idea or capacity or ability to self-test fade before WHO give us guidance or before donors give us money to do that,” added Dr Mugurungi.
Mr Itai Rusike, the director of the Community Working Group on Health, said information on HIV should be availed such that individuals understand what it means to be positive. He also said there was need to ensure that disclosure issues are addressed and counselling is offered right up to the family level. “I think it is helpful as long as the community understand what it is doing,” he said.
“My worry is the event that someone conducts the test, fails to interpret the results and is nowhere near a clinic for psycho-social support, they may commit suicide.
“Counselling services should then be available at all levels, disclosure issues need to be addressed and we also need to consider gender issues, action after tests, stigma in community, the accuracy of tests, availability of confirmatory tests and so on,” said Mr Rusike.
Gutu South legislator, who is a member of the Parliamentary Portfolio Committee on Health, Dr Paul Chimedza said the country has been ready for a long time and more people now have the knowledge on HIV/Aids related issues compared to decades ago.
“I think Zimbabwe has been ready for a long time it’s just that we have been hesitating to move into this, we need people to have access to testing themselves.
“I know people talk about committing suicide and this and that but we have had diseases that are worse than HIV. “We have had cancers that can kill with no cure but people have been told they have cancer but they survived,” he said.
Dr Chimedza also said self-testing is one way to close the testing gap as nearly 45 percent of the people who should know their status are still in the dark.
Despite the loopholes that need urgent addressing before rolling out home-testing programmes, manufacturers of the rapid self-test kits said it was high time developing countries embrace the low- cost kits to meet the 2020 target.
Premier Medical Corporation Limited president Nilesh Mehta said developing countries can start using these kits as they are very affordable compared to previous testing methods, among them the oral self-testing approach.
“We understand that some of the African countries cannot afford expensive test kits so we produce the highest quality product at a low price,” Mr Mehta said.
One self-testing kit is going for 75 cents which is four times lower than the oral test which costs at least $3 per kit.
The high temperature stable test kits comes with everything one would need to do the test and the product has already been used in South Africa, Ethiopia and Ghana; with South Africa getting at least 40 million kits a year.
Diagnostic Laboratory Suppliers managing director Mr Edgar Chandiwana said various stakeholders should come together to support Government in ensuring that links to counselling are put in place for comprehensive approach to offering HIV testing, treatment and support.
He said telecommunication companies must provide toll free numbers for the public to connect with health care providers at any given time.
“It’s in our best interest to move towards the 90-90-90 and it can only be possible if we can get to have more people knowing their status,” said Mr Chandiwana.
Added Mr Chandiwana: “Though issues of counselling are paramount, we need to keep on moving.
“In our current situation in Zimbabwe, it is an issue that the ministry is looking at closely and with the current infrastructure, someone should be able to call, toll free, and information should be readily available in pharmacies and supermarkets.”
“We need mobile communication companies to come on board to make this a success as they could help bridge the gap of the missing link to counselling services through toll free services,” he said.
He argued that while developing countries are lagging behind in terms of technology, there is need to take a bold move and roll out self-test to achieve the UNAIDS target to end Aids by 2030.
According to the World Health Organisation, self-testing is not new as it is already in use in Australia, France, Britain and the United States.