Ground-breaking research on HIV-self-testing is underway in Malawi and with so far promising results. Researchers are investigating whether easy-to-use mouth swabs, which allow individuals to test themselves for HIV/AIDS in the privacy of their own homes, could help Malawi tackle the disease by improving detection and early treatment. Despite managing to reduce its HIV prevalence rate from around 26% to 10.6% since 1998, Malawi continues to be amongst the world's worst affected countries by the disease.
The five-year study into the effects and feasibility of self-testing kits is being led by Principal Investigator Liz Corbett of the London School of Hygiene and Tropical Medicine alongside researchers from the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and Malawi College of Medicine.
Speaking to Think Africa Press, Augustine Choko, data manager and statistician at the Malawi-Liverpool-Wellcome Trust, explains that the study is the first of its kind anywhere in the world and follows an evaluation in Malawi in 2010 which found oral supervised HIV-self-testing was highly accurate.
“What we found out [in 2010] was that there was so much enthusiasm and readiness. More than 95% of people participated and 92% accepted the offer to self test. Of those who accepted, 99% got their results right,” he says.
The new pilot study is investigating whether high uptake at the community level can be achieved by training local volunteers to distribute self-testing kits from their own homes, and if self-testing can be safely tied to counselling and care. Researchers are also on the look out for any unpredicted effects.
Choko explains: “This is a research study, and we are only allowing access to the kits to adult residents of 14 study neighbourhoods and their partners (about 18,000 people in total). This is because we have systems in place to monitor not just uptake of the test but also to pick up any unwanted effects. Also we need to be able to estimate how many of the people who have tested with us access our clinic services too”.
About 28 volunteers have been trained in HIV-testing and counselling by the Ministry of Health since the onset of the pilot study in February 2012. These volunteers have been responsible for providing kits with instructions to residents in the densely populated areas of in Ndirande, Chilomoni and Likhubula in Malawi’s commercial capital Blantyre.
Research participants are provided with OraQuick mouth swabs carefully designed to be as easy to use as possible. Choko explains, “You can still make mistakes, but most people can do the test correctly following a brief demonstration and will get the right results. Any positive result always has to be confirmed so we say this is a ‘provisional positive’ that needs confirmation in a health clinic by a finger-prick blood test”.
Participants are therefore also given advice and instructions on where to go to get confirmatory testing and HIV care.
The researchers are also hoping to ascertain whether HIV-self-testing could play a complementary role in helping health services reach sufferers earlier with treatment, which could help reduce the spread of the disease, and target groups that tend to be difficult to reach. HIV-testing strategies currently used in Malawi include door-to-door Voluntary Counselling and Testing (VCT) in which VCT teams test people in their homes or work places. Although one to two million Malawians are tested each year, men in particular go untested or untreated.
“We feel that self-testing has got a place in complementing the current strategies that we have at the moment because evidence has shown that the strategies we are using at the moment do not reach out to everyone”, says Choko. “We think that HIV self-testing has got a place in reaching out to some of hard to reach groups, for example men.”
He continues: “When women go to antenatal clinics, when they are expecting, they are usually tested and go back to their houses and ask the men to come and test, but usually don’t come forward. Self-testing brings with it convenience because a person can test at their own chosen time and place, so that offers convenience. But it also offers confidentiality.”
While many are optimistic about the prospects of self-testing, some are concerned that self-testing could lead to a rise in suicides around HIV given that individuals will not have access to immediate counselling.
“There are those fears”, says Choko, “but so far we have no evidence suggesting that self-testing will increase the rate of suicide. At the moment, we have done 5,238 tests and we have recorded no suicides.”
Choko suggested that the problems encountered in the study so far had been relatively minor. “Working in an urban setting you find that people are not at their homes because they are busy. When we just started we also did have some misperceptions about testing. But at the moment we are not finding any big challenges”.
He added, however, that the relatively smooth and successful running of the research was in part thanks to the setting up of a community advisory board, a group of people based in the communities, which passes on to the researchers some of the rumours and misconceptions around the project that could jeopardise the scheme.
The researchers are yet to decide if it will be necessary to extend the study to other parts of the country or Africa after its 2015 completion date in Malawi, and many hope that self-testing kits could prove to be a crucial and clever weapon in the fight against HIV/AIDS.
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