Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Karen Champenois, Maison Blanche Hospital, Paris
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
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Scaling up HIV testing: the role of self-testing
1. Scaling up testing
The role of HIV self-testing
Karen Champenois
Research Department,
Maison Blanche Hospital,
Paris, France
2. Definition of HIV self-test
• HIV rapid test performed by the user
– Sampling
– Process
– Interpretation of the result
• Whole / finger-stick blood or oral fluid
sample
• Any positive result should be confirmed
by another testing according to a
national validated algorithm
Source: F. Simon
8. HIVST – pros & cons: accuracy
Pros
• Sensitivity
– Blood test > oral fluid test
(96.4%- 98.8%) > (65.0%-97.9%)
• Specificity ~ 100%
• Invalid test (<5%)
– Blood test > oral fluid test
Cons
• Low sensitivity in early infections
• Window period of 3 months
• Increased rate of false negative
tests when people are on ART
– Implication for PrEP
Pant Pai et al. Plos One 2013; Figueroa et al. AIDS Conference 2016; Pavie et al. Plos One 2010;
Suntharasamai et al. Plos one 2015
9. HIVST – pros & cons: acceptability
Pros
• High acceptability up to 98%
• Preference
– HIVST > conventional testing
– Oral fluid > blood sample
• Confidentiality, convenience,
immediacy
Cons
• Remaining concerns
– Lack of counseling
– Risk of handling error
– Test reliability
Pant pai et al. Plos One 2013; Figueroa et al. AIDS Behav 2015; Greacen et al. AIDS care 2012
10. HIVST – pros & cons: side effects
Pros
• Enhance autonomy,
empowerment
– Controling one’s health choice
– Reducing at risk behaviour
• Reduce barriers as stigma
Cons
• Self-harm
• Uncertain access to information,
counseling and care
• Social harm
– Intimate partner violence
– Coercive testing
Figueroa et al. AIDS Behav 2015; Brown et al. AIDS Behav 2014; Carballo-Diéguez et al.
AIDS and Behav 2012
11. HIVST – pros & cons: access
Pros
• Large availability
– Pharmacies
– Internet
– Over the counter approaches
• Privacy
Cons
• Actual accessibility
• Internet : numerous tests of
questionable quality
• Price
– €28 / £30 / US$40
≠ socially vulnerable populations
Figueroa et al. AIDS Behav 2015; Myers et al. AIDS Behav 2016;
12. Values and preferences
of key populations in France
• MSM
– Accuracy and reliability of tests. Preference for blood-based HIVST
– HIVST as a prevention tool (repeated testing), used in a context of risk behaviour
• Migrants from Sub-Saharan Africa
– Security for using HIVST
– Benefit to know HIV status and free access to care regardless the administrative
situation
– Communication tool adapted (color, shape, …)
• PWID
– Implication of service providing specific health care and substance misuse
community organisations
• Transgender people
– HIV testing is not the health priority
13. HIVST: expected to increase uptake and frequency of
HIV testing mainly in key populations
Encouraging first results
• In France, MSM the most interested in HIVST were those who
‒ live their sexual life with men in the absolute secrecy
‒ had never been tested
• In NL, HIVST succeeded in reaching first-time and infrequent testing population
• In USA, using ads on Grindr increased the HIVST uptake in MSM
• In USA and Australia, 2 RCTs showed an increase in testing frequency in MSM in
the HIVST arm
• Lack of evidence remains
‒ Reduction of the time period between infection and diagnosis
‒ Linkage to care after a HIVST in high income country
Greacen et al. AIDS Care 2012; Zuure et al. AIDS Conference 2016; Huang AIDS Prev 2016;
Rosengren et al. Sex Health 2016; Katz et al. IAS 2015; Jamil et al. AIDS conference 2016
14. As conclusion
• WHO new guidelines
HIV self-testing should
be offered as an
additional approach to
HIV testing services
(strong recommendation,
moderate quality evidence)
Available at http://www.who.int/hiv/pub/vct/hiv-self-testing-guidelines/en/