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Successful use of self-testing in rural Africa

Successful use of self-testing in rural Africa

 


HIV Epidemic: Successful Use of Self-Test in Rural Africa

In Africa, health centers are organizing “door-to-door” campaigns to promote remote healthcare access. Now, for the first time, home visits have been combined with an oral HIV self-test. If these tests are positive, a specialist will do a blood test for the final diagnosis. The involvement of village health advisors means that affected people can receive local care. Credits: University of Basel / Switzerland TPH, Alain Amstutz

Millions of people are infected with HIV each year, despite significant advances in prevention and treatment. The main burden of HIV / AIDS is in Africa. Containing the epidemic requires innovative methods that enable early diagnosis of all affected people. The HIV self-testing has helped Basel’s research group significantly improve the success of its “door-to-door” test campaign.

In 2019, about 38 million people worldwide were infected with HIV. Two-thirds of the affected people live primarily in sub-Saharan Africa. To contain the epidemic, it is essential to treat all infections with antiretroviral therapy to prevent viral transmission. However, this requires early diagnosis. Access to HIV testing remains a challenge, especially in remote areas far from clinics and testing centers.

Case study: Lesotho

In Lesotho, one in four adults is infected with HIV. Approximately 15% of infections in small mountainous countries at the southern tip of Africa remain undetected and are estimated to contribute to the further spread of HIV. For many Lesotho residents, the nearest clinic is within a few hours’ walk or an expensive taxi.For easy access And HIV testing, Hold “door-to-door sales” on a regular basis campaign. However, according to a survey, they reach only about 60 percent of the village’s population.

A team led by Niklaus Labhardt, a professor at the University of Basel and a research group leader at the Swiss Institute for Tropical Public Health (Swiss TPH), has developed a strategy to improve test coverage by 20%.For the first time, the team has joined With HIV self-test. If the villagers are absent during the home visit, the campaign team will leave a self-test using materials in the local language. Village health advisors trained in the use and assessment of self-tests will then collect self-tests.

Simple approach, big impact

A large randomized study included more than 150 villages with more than 7,000 inhabitants. The result of this simple approach is that “the HIV test rate for the entire population in the intervention group was 81%, 20% higher than in the control group,” said Dr. Tracy Glass, a biostatistician at TPH in Switzerland.

In the sub-study, the research team analyzed the strategy I supplemented the survey with an interview. “Although infection rates are high, especially among young women, traditional HIV testing campaigns do not reach young people well,” explains Dr. Alan Amstats, lead author of the Swiss TPH. “In the intervention group, self-diagnosis showed that 36% more adolescents were aware of HIV status than in the control group.”

The number of deaths from AIDS has been declining worldwide since 2010. At the same time, there are still 1.7 million new infections in 2019, half of which occur in Africa. “In particular , An alternative to traditional health campaigns is needed to achieve optimal test coverage. Our strategy is another key component in ending the HIV / AIDS epidemic in southern Africa, “says Dr. Labhardt.


HIV in Sub-Saharan Africa: Treatment improves when testing and treatment are started at home


For more information:
Alain Amstutz et al. Home oral self-test for absent and declining individuals during a door-to-door HIV testing campaign in rural Lesotho (HOSENG): Cluster Randomized Trial, Lancet HIV (2020). DOI: 10.1016 / S2352-3018 (20) 30233-2

Alain Amstutz et al. “If it remains, I will be easier to get tested”: Oral self-testing and use of community health workers to maximize the potential for home HIV testing among adolescents in Lesotho, Journal of the International AIDS Society (2020). DOI: 10.1002 / jia2.25563

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