Kirby Institute researchers have authored a report evaluating whether new HIV at-home or community-based testing models would be an acceptable and feasible approach to boost HIV testing in Papua New Guinea (PNG).
“PNG experiences one of the highest burdens of HIV in the Pacific*, and there is currently no regulatory support for the available self-testing kits in the country,” says Associate Professor Angela Kelly-Hanku, who co-authored the report with Dr Stephen Bell. “However, testing rates are extremely low. It’s important that we explore a range of options to increase testing, because as we know, knowing your HIV status essential to initiating treatment, and curbing transmission.”
Self-testing is recommended in the latest World Health Organization (WHO) guidelines on HIV testing services as a tool to work towards achieving the global goal of 90% of people knowing their HIV status. It involves a person collecting their own saliva or blood specimen, and performing an HIV test in a private setting. It is a relatively new method of testing and its benefits include the removal of barriers such as geography, as well as the stigma sometimes associated with visiting a sexual health clinic.
There are a range of approaches to self-testing, both assisted and unassisted. However, with a lack of PNG-specific data available, Associate Professor Kelly-Hanku and Dr Bell undertook an extensive review of previous studies and literature into HIV self-testing in other low- and middle-income settings, as well as broad community consultation in PNG to establish what people knew and how they felt about this approach. They developed a set of recommendations to support the implementation of community-based HIV testing; locally described as a Haus Dur (house door) model.
“In some low- and middle-income settings, people are comfortable administering the test themselves, but in PNG, it was found that there was a clear preference for some involvement of a trained healthcare worker, to support the delivery of results,” explains Associate Professor Kelly-Hanku.
The cultural considerations are complex. Taking testing out of the clinic and into the community via Haus Dur would be a positive step, and the presence of a healthcare worker would mean that should a positive result be returned on the spot, the person would have immediate access to counselling and treatment initiation. But there are some challenges to consider. “There was strong objection over saliva testing for a range of reasons, including the risk of undermining PNG’s HIV prevention and education efforts to date that have repeatedly emphasised that the risk of transmission via saliva is extremely low,” says Dr Bell. “We need to consider these factors alongside the logistics of rolling out community-based testing from financial, workforce and resourcing perspectives.”
Ultimately, however, the community consultation conducted for this report has revealed an opportunity to drastically improve HIV testing in PNG. The recommendations set out by Associate Professor Kelly-Hanku and Dr Bell provide a blueprint to begin to roll out such a program. “If Haus Dur HIV testing is implemented properly, with the close involvement of both the community and local health experts, it could fill a huge gap in HIV testing in PNG and set this country in greater stead to working towards the WHO 90-90-90 targets,” says Associate Professor Kelly-Hanku.
* PNG has the highest burden of HIV in the Pacific, and a concentrated HIV epidemic among key populations, with one in five female sex workers in Mt Hagen, for example, living with HIV.
Article updated on 11.11.2019.