Researchers scale up self-testing tool to fight HIV in Kenya
Ms Violet Otindo National Syndemic Diseases Control Council Communication officer explains how a dapivirine vaginal ring works in the prevention of HIV infection during the Media for Environment, Science, Health and Agriculture (MESHA) science café in Kisumu City on October 7, 2022.
Top scientists and researchers have intensified their study for an effective HIV self-testing performance method to end one of Kenya's public health threats by 2030.
According to the latest data from the National Syndemic Diseases Control Council (NSDCC) Aids-related deaths have reduced by 67 per cent from 58,446 in 2013 to 19, 486 in 2021.
This is attributed to the 83 per cent increase in the number of people on antiretroviral treatment from 656,369 in 2013 to 1,199,101in 2021.
The new HIV infections have also reduced by 68.4 per cent from 101,448 in 2013 to 32,027 in 2021 with an attendant decline in HIV prevalence from 6 per cent to 4.3 per cent during this period.
HIV transmission from mother to child has also reduced from 13.9 per cent in 2013 to 9.7 per cent in 2021 averting an estimated 65,000 new HIV infections among children between 2013 and 2020.
The research study dubbed, "HIV-self testing performance study," is led by Prof Elizabeth Bukusi.
Prof Bukusi is a renowned research professor whose areas of research focus on sexually transmitted infections, women's health, reproductive health, and HIV care, prevention and treatment.
HIV self testing
Other researchers in the team include Prof Kenneth Ngure of Jomo Kenyatta University and Dr Katrina Ortblad from Fred Hutch Cancer Centre who are also principal investigators and Dr Daniel Were who is the project director from Jhpiego, a non-profit organization for international health affiliated with Johns Hopkins University.
The World Health Organization (WHO) recommends the use of HIV self-testing (HIVST) as an HIV testing strategy to support the so-called "first 90" of the HIV/AIDS 90-90-90 targets.
This essentially means persons who are HIV positive should have known their status by 2020.
HIVST was found to be appropriate for increasing HIV testing uptake and frequency among diverse populations in a range of countries, including Kenya.
At the same time, HIVST may increase self-efficacy, knowledge of one partner's HIV status and awareness of one's Pre-exposure prophylaxis (PrEP) eligibility.
PrEP is the taking of a prescription drug as a means of preventing HIV infection in an HIV-negative person.
"HIV self-testing is appropriate for increasing testing and uptake among the diverse population in Kenya and other countries," said the study coordinator Mr Benn Kwach.
Mr Kwach was briefing journalists in Kisumu City on Friday who are members of the Media for Environment, Science, Health and Agriculture (MESHA) during their 67th edition of the science café.
The more than 30 journalists were drawn from Kisumu, Nakuru, Nairobi, Busia and Kakamega counties and were led by their chief executive officer Daniel Aghan.
Mr Kwach explained that HIVST is only permitted as screening, and not a diagnostic tool, consistent with WHO guidelines.
"Some of the reasons for not allowing HIVST for diagnosis include lower test sensitivity [of HIVST only] for oral fluid HIVST."
"For the Blood-based HIVST there are concerns for individuals' and providers' ability to properly conduct and interpret HIVST in real-world settings," said Mr Kwach.
Blood-based HIVST
Mr Kwach said for this study the researchers wanted to measure the performance of the blood-based model by allowing clients to test by themselves and then test them again using the standard of care and then compare the results.
The study's second objective is to measure the percentage of poor Blood-based HIVST performance in retail pharmacies attributable to misinterpretation.
“We're going to allow the clients and the providers to interpret the results and thirdly we're going to have HIV testing services counsellors stationed at the pharmacies indicate their interpretation as well to find if there was any misinterpretation," said Mr Kwach.
The third objective of the study was to develop, evaluate, and refine a computer process to provide an Artificial Intelligence interpretation of the HIVST result.
The last objective of the study wanted to measure pharmacy providers' interest in delivering PrEP and preferences for client payment or public-sector payer compensation models that might support PrEP delivery in retail pharmacies.
"The study wanted to establish if the providers can comfortably deliver PrEP at what cost at their pharmacies," added Mr Kwach.
The study was conducted in Kisumu City and involved a population of adult clients seeking HIV testing or services associated with HIV risk in retail pharmacies.
At least 20 pharmacies within the greater Kisumu area that are already delivering HIVST and a sample size of 1,500 clients and 40 providers were involved.
The data was collected electronically for six months from January this year using the Dimagi CommCare platform in Massachusetts in the US.
The researchers are currently analysing the data.
The study analysed is aimed at finding out clients whose interpretation first matched pharmacy providers' interpretation and clients that asked pharmacy providers for assistance with HIVST use.
The study also analysed errors attributable to misinterpreted results and clients that were HIV negative and were correctly diagnosed and clients that were HIV positive and were correctly diagnosed.
The researchers expect the findings from this study will support the use of Blood-based HIV self-testing as a diagnostic tool in models of pharmacy-based PrEP delivery.
The findings will also help identify and develop interventions to improve HIV self-testing interpretation and field performance.
However, before this model can be scaled up, the researchers say further research is needed on implementation strategies that can enhance model adoption, implementation, sustainability, and adaptations that can improve model fit and effectiveness.
"A major gap in our understanding of pharmacy-delivered PrEP implementation includes performance [accuracy] of HIV self-testing (HIVST) to support pharmacy PrEP delivery," read part of the initial report.
It added: "This evidence is critical, as it can potentially enable the HIVST to move from a screening tool to a diagnostic tool that could be used for both PrEP initiation and continuation in community settings," concluded the report.
