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Call to expand access to self-test HIV kits

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The self-testing rate for HIV in Australia is low.

Despite the approval of a blood-based HIV self-test in November 2018, subsequent surveys of the Sydney gay community indicate that its uptake has been limited, with fewer than 1% of HIV-negative participants reporting that their most recent HIV test was self-done.

But rather than concerns over accuracy or usability, a new Australian study examining community sentiment to HIV-self testing suggests this lack of use is more likely to be associated with awareness and availability.

As part of the research, 170 gay, bisexual and other men who have sex with men (MSM) were offered self-two self-test kits – one blood-based and the other involving oral fluid – and asked to examine their ease of use and acceptability.

According to the authors, led by Dr Dana Lee and Associate Professor Jason Ong from Monash University’s Central Clinical School, 99% of participants deemed the oral fluid test easy to use, while the blood-based test returned a slightly lower approval rating (86%).

Overall, 58% preferred the oral fluid-test, which was again slightly higher than the 41% who preferred the blood-test (the rest had no preference).

However, while the respondents reported very few concerns related to using the test, Dr Lee and Associate Professor Ong wrote that there may be other factors limiting their uptake.

‘Until October 2021, the blood-based HIV self-test could only be bought online, as the TGA [Therapeutic Goods Administration] required that an instructional video be viewed prior to purchase,’ they wrote.

‘[Meanwhile], no oral fluid HIV self-test has yet been approved, reducing the choice for Australian men.’

According to the authors, even though the requirement to watch the video has been lifted and blood-based kits are now also available in pharmacies, ‘important’ further refinements are needed to make HIV self-testing easier and more reliable.

‘Online access makes HIV testing more available, particularly to people living in rural and remote areas,’ they wrote.

‘However, access to HIV self-test kits from a range of locations, as is the case overseas, is preferable.’

Previous studies have shown people born overseas are more likely to present with late HIV diagnosis. They are also more likely to face barriers such as lack of Medicare or health insurance, cultural stigmatisation and poor awareness or HIV testing locations.

The authors believe improving access to self-testing can help reduce some of these barriers.

‘Given the high late diagnosis rate for overseas-born men who have sex with men, HIV self-testing, coupled with other culturally appropriate approaches, should be a greater focus in our HIV prevention strategy,’ the authors wrote.

Fifty-seven per cent of participants in the Monash study were born overseas and they were three times as likely to want to use self-testing again as those born in Australia.

The oral-fluid HIV test manufacturer reports sensitivity as 99.3% and specificity as 99.8%. The blood self-test manufacturer reports sensitivity as 99.6% and specificity as 99.6%. Both tests check for HIV antibodies, as opposed to the virus itself.

Of the 170 participants in this study, none of the oral-fluid HIV self-tests returned an invalid result, while 1% of the blood-based HIV self-tests returned an invalid result.

Difficulties with the oral-based test include not swabbing both upper and lower gums and placing the oral fluid in the tube stand.

For the blood-based test, difficulties include filling the collection channel with enough blood and squeezing the finger firmly enough to generate a drop of blood.

Australian Federation of AIDS Organisations (AFAO) reports that HIV self-testing devices increase testing among infrequent testers and non-testers. In 2020, AFAO estimates 2610 people were unaware they were positive.

AFAO have a HIV self-test fact sheet with details on the current available blood-based test in Australia.

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