Self-testing technology increases equitable access to HIV testing

Self-testing kits increase access to HIV testing, especially among hard-to-reach, high-risk population groups, a new study by the Kirby Institute at UNSW Sydney shows. 

Gay and bisexual men are at increased risk of HIV, and frequent testing is crucial to drive down infections among this group. Self-testing kits - which allow individuals to test for HIV within their own home - have been proven to be very effective based on short-term studies, but Kirby Institute researchers are the first to measure their effectiveness over a long period time. 

The results were recently published in The Lancet Regional Health - Western Pacific. “Our research shows that access to free HIV self-testing kits increases the frequency of HIV testing over a two-year period, when compared to men who only had access to facility-based testing,” says Ye Zhang, who is the lead author on the paper. 

The researchers enrolled over 350 men into the FORTH trial, and randomised them to either the intervention arm, in which they had access to free self-testing kits, or the standard-of-care arm, in which they only had access to clinic-based testing. Men in both study arms completed surveys over the course of the study.

“We previously reported that in the first year of the study, men who had access to the self-testing kits tested for HIV at double the rate of those who only had access to clinic-based testing, bringing them up to four tests in a year,” says Professor Rebecca Guy, who is the senior author on the paper. “Four HIV tests a year is recommended for those at high risk, so the fact that access to self-testing helped people achieve this is encouraging.” 

The new findings show that in the second year of the study, when self-tests remained free and available to all study participants, there was a significant and sustained increase in the frequency of testing. “In the second year of the study, we found that testing levels were 80 per cent higher among men with access to the self-testing kits, than those only with access to clinic-based testing,” says Ms Zhang. “These results are very encouraging, suggesting there is long term interest in the technology.”

Currently in Australia, HIV self-testing kits are approved by the Therapeutic Goods Administration (TGA). However, they can only be purchased online or at specific locations like HIV community organisations. 

“These study results demonstrate why HIV self-testing kits should be more widely available in Australia,” said Adjunct Professor Darryl O’Donnell, CEO of AFAO, Australia’s peak HIV organisation. “In New Zealand, HIV self-tests are available at pharmacies and this has proven effective. The same policy is urgently needed in Australia.”

Targeted strategies for those most at risk
A recent Kirby Institute report found that HIV diagnoses are stubbornly persistent among migrant gay and bisexual men, compared to encouraging declines in Australian born gay and bisexual men. 

“We found a higher proportion of migrant gay and bisexual men used self-testing frequently, compared to Australian-born men, so making self-testing available particularly to these populations could be a crucial tool in driving down transmission rates,” says Prof. Guy.

The current commercially available test is AU$25 plus shipping costs, which may appear affordable, but the tests were supplied to participants for free throughout the study, which many migrants strongly preferred. 

“HIV community organisations have developed small projects in Australia to offer HIV self tests for free, with advice provided by trained and accredited peers. Expanding such models to support migrants and those on lower incomes would be justified,” says Mr Matthew Vaughan, Acting Director of the HIV and Sexual Health Division at ACON and an author on the paper.

The researchers say that HIV self-testing is an important tool to increase and sustain testing frequency for gay and bisexual men, especially for groups who are falling through the gaps, including migrants. “Expanding access should be an important part of our National HIV Strategy,” says Prof. Guy. “Ensuring equitable and broad access to regular HIV testing, combined with HIV prevention, will bolster Australia’s progress towards elimination of HIV transmission.” 

Date published: 
Monday, 6 September 2021

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