Fast-track the end of AI​​​DS 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.

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

3. HIVST available in UK (April 2015)
Lab: Nazeing

4. www.autotest-sante.com
HIVST available in France (September 2015)
Instructions for use

5. HIVST available in France (January 2017)
Lab : BiolLytical

6. Test stand
Test DevicePouched
Device
Pouched
Developer Vial
Stepwise
Instructions
Pre & Post-Test
Informational Booklet
Package Insert
HIVST available in USA (October 2012)

7. Policy and implementation of HIVST

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/

15. Thank you for your attention
15

16. SlideF.Larue

17. Fast-track the end of AIDS in the EU
practical evidence-based interventions