Mixed reactions to HIV self-testing kit but doctors upbeat

Last week, the Ministry of Health approved two HIV self-test kits which will be available for between Sh700 and Sh800 in selected pharmacies.

The feat placed Kenya on the map as among the first in the world to introduce the kits in a public setting.

Nearly 500,000 Kenyans are infected with HIV and should be on antiretroviral (ARV) treatment, but do not know their status, data from the Ministry of Health show.

Kenyans above 15 years will be able to purchase, perform the HIV test and interpret the results on their own and at their convenience.

One is an oral kit, OraQuick, which will require the user to do a 360 degrees swab of the upper and lower mouth gums using a collection kit.

The swabbed saliva sample is placed in a solution which comes with the kit and gives the results in 20 minutes.

RESULTS READY IN 20 MINUTES

The second one, a blood sample kit known as Insti, would involve pricking the finger for blood which is put on the kit. The results are ready in a minute.

Those who test positive for HIV in either tests can visit a health facility for a re-test to confirm the results.

This is because both methods are screening tests, meaning they do not provide a definite HIV diagnosis and thus a confirmation test by a trained health worker is necessary.

While the government hopes to make the test kits available for free in public health facilities by next month, Kenyans have expressed their reservations.

For instance, Frank Munyao wrote on his Facebook page last Thursday: “I don’t agree with the idea of making HIV testing easier by making the test kits readily available...

What about counselling for those who unexpectedly find out that they are, unfortunately, positive? Are we not facing possible suicides, depression and other psychological issues? Will this not embolden rapists now that they can test their victims before the act? This is also likely to encourage sexual immorality! It should not be allowed!”

The comments that followed were many, saying the move could be catastrophic in cases such as those of HIV positive children whose parents have never told them of this status, or when one partner is HIV positive and the other is not.

ALLAY FEARS

Dr Martin Sirengo, Head of the National AIDS and STI Control Programme, set to allay these fears.

At the onset, he said, it is important to know your status “so that you make the correct life choices.”

The self-test, which will also increase social awareness on HIV, will be beneficial to adolescents, especially sexually active girls who fear going for tests in health facilities due to social stigma.

Men, most of whom remain untested for HIV, will also benefit, he said. The World Health Organisation says men shy away from health facilities.

In 2014, seven in 10 adult HIV tests reported in 76 low-and-middle-income countries were conducted on women, WHO states.

UNMANAGED ANXIETY

Regarding an increased risk of unmanaged anxiety, with potential for suicide and depression, Dr Sirengo said that while expected, the screening is recommended for people who have made up their minds to know their status.

“Pilot studies show that many people would like to do the tests. In fact, some complain that voluntary counselling and testing (VCT) centre staff take too much time counselling people than in conducting the test, yet they just want to know their status,” he told the Nation.

Pre and post HIV test counselling mainly involves discussions on how the virus is transmitted, the need to continue using condoms, and how to link up with support groups. Further, Dr Sirengo said, no one should be coerced to take the test.

“There should be no forced testing; whereas there is that risk, knowing one’s status is an individual choice; use of force is against the law. If this happens, someone should take legal action. Besides, people should not be scared that someone might try to kiss you to take your saliva for testing — the results might actually be their own. The test requires a 360 swab.”

DISCLOSE STATUS

The HIV Prevention and Control Act 2006 prohibits compulsory testing. It also states that a person has the right to refuse to take a HIV test or stop the procedure at any time.

In addition, the decision to disclose one’s status is personal; coercion is unlawful.

There is also the chance of intimate partner violence and psycho-social distress, especially in settings with pre-existing violence, if one spouse tests positive and the other negative (discordant couples).

But the Nascop director said that since 2011 when they did HIV self-test demonstrations in the country, they “hadn’t reported related violence or divorce. If there were such cases, he said, they were similar to those in the general population.”

Concerns on potential harm are not new. In a 2016 study of self-tests in Khayelitsha, South Africa, by Médecins Sans Frontières (Doctors without Borders), healthcare workers said the kits should be provided only to individuals who demonstrate they fully understood the procedures involved and who are ready to attend post-test counselling.

SELF TESTING

But this would mean increased contact with health workers or follow-up and would beat the perceived benefits of self-testing.

In addition, it can take up to three months after exposure to HIV for the test to detect it. Meaning, if the test is taken during the window period — a phase when an individual is HIV-infected and is highly infectious but with no HIV antibodies — the test will read negative.

Dr Sirengo warns: “Negative is a good result to get and you would want to celebrate. But use a condom or Pre-Exposure Prophylaxis (PrEP). It could be the window period. Another test should be done after three months to be sure.”

PrEP is an antiretroviral drug taken daily by HIV negative people who are at risk of contracting the virus.

This, too, was launched last week alongside the HIV self-tests.

STRINGENT EVALUATION
The Ministry of Health says the tests, which have undergone stringent evaluation by both the World Health Organisation and local experts for safety and accuracy, will be simple to understand and use. If used correctly, they are over 80 per cent sensitive — the probability of correctly identifying the HIV virus, if present.

PrEP is aimed at discordant couples, those with multiple sexual partners, individuals with sexually transmitted infections, self-injecting drug addicts, people with recurrent use of post-exposure prophylaxis, sex workers and those who do not use condoms consistently.

Anyone else who wishes to access the drug will spend about Sh3,600 a month.

The two innovative technologies are part of the Be Self Sure campaign to encourage people to get tested for HIV.

One can get more details on the campaign’s website: www.besure.co.ke on where to get the testing kits and videos demonstrating how to use the kits.

There is also advice on what to do if HIV-positive or HIV-negative.