Is HIV self-testing a sure bet in controlling spread?

Jackline Njoki, 36, a former sex worker, recalls how she discovered that she was HIV positive.

Njoki (pictured), who is also known as Kiki Wa Ngendo, started engaging in sex work at the age of 17 and her first encounter was with an elderly man.

“I discovered I was HIV positive at the age of 18 after my uncle’s wife suggested that I go for a test before I resume school,” she says.

She reveals that despite knowing her HIV status she never told her clients. But at one time a man who approached her came with HIV test-kits and condoms. They did the test and decided to use condoms.  

“You do not know me; I do not know you but you want to have sex with me. Why don’t you wear a condom or ask me for a test if I am comfortable; if I am not, let’s use a condom,” she says.

She recalls an encounter with a man who was visiting the country from abroad and despite opening up about her status, he did not use a condom.

Njoki warns that a self-test in itself is not enough.

“I have been battling genital warts and then there is always the danger of cervical cancer, which is why people should always wear a condom when they are away from their partners,” she advises.

Viral suppression

With the coming of self-testing for HIV two years ago, it is believed that this will go a long way in boosting the fight against the spread of the virus.

For as low as Sh250 one can buy the test kit from a chemist and do the procedure from the comfort of their home unlike before when this was performed in hospital or a voluntary counselling and testing centre.

For James, who has multiple sexual partners, the self-test kit comes in handy when he wants to know the status of anyone he relates with.

“I simply walk into a chemist shop and ask for the test kit and off I go and test at my convenience,” he says.

It is estimated that at least four in five people living with HIV know their status. In 2016, the World Health Organisation (WHO) launched guidelines on how a self-test can be conducted. Kenya is among the countries that implemented the policies.

It is estimated that 1.4 million adults and 180,000 children live with HIV in Kenya even as the government seeks to achieve the 90-90-90 UNAids target to have 90 per cent of the infected know their status; 90 per cent of those infected puts on medication and 90 per cent of those under treatment achieve viral suppression this year.

Experts argue that self-testing is a sure bet to achieving this. There are two types of self-test – directly assisted and unassisted tests. In Kenya, there are about 7,000 regulated pharmacies which are allowed to stock the test kits. 

In 2017, the National Aids and STI Control Programme (Nascop) came up with guidelines for self-testing.

Report their results

One of the requirements is that in case of a test turning positive or invalid, a confirmatory test should be undertaken in an approved health facility.

The pack also needs to have contacts which can be used by the person using the kit.

The kits must also have directions on how to conduct the test and interpret the results. Nascop, however, cautions that all reactive self-test results must be confirmed using the recommended national HIV testing algorithm. High uptake of self-testing has been reported among the youth, men and those who had tested before. 

A 2018 research by PSI International and GeoPoll found that four in five respondents who self-test are willing to report their results.

Fake testing kits

The proliferation of fake testing kits is a challenge to the fight against HIV and Aids. Research done last year using mystery shoppers found that there were test-kits not approved by the government but which were cheaper, thus compromising the validity of results.

“Providers tried to influence the choice of testing kit, for instance promoting a non-quality-assured kit, stating that it was cheaper and gave faster results than the quality-assured self-test,” noted the research by PSI.

Mary Mugambi of Nascop warned that this could lead to an undesired outcome as a wrongly-done or interpreted test could lead to false negative, a case where one is infected but gets a negative result.