An observed, prospective field study to evaluate the performance and acceptance of a blood-based HIV self-test in Canada

Acceptability, feasibility, and accuracy of blood-based HIV self-testing: A cross-sectional study in Ho Chi Minh City, Vietnam

HIV self-testing (HIVST) is an effective approach to increase testing uptake. While oral fluid-based HIVST has been rapidly scaled, use of blood-based HIVST remains limited. We evaluated the acceptability, feasibility, and accuracy of blood-based HIVST among lay users in Ho Chi Minh City (HCMC), Vietnam. We conducted a cross-sectional study among HIV testing clients at the HCMC Pasteur Institute from March 2019 to October 2020. Participants received one HIVST kit and performed the test in front of an observer. The observer used product-specific questionnaires to collect information on the HIVST process, test results, experiences. The participants' interpretations of HIVST results were compared to health staff's interpretations and gold standard laboratory EIA reference tests. Of 2,399 participants who accepted HIVST, 64.7% were men, 62.1% aged 25-49 years, 53.5% had a higher education level, 41.4% were employed, and 35.6% were first-time testers. The vast majority (94.4%) desired to use the test in the future, and 93.9% reported willingness to recommend the test. The majority (90.8%) of participants successfully completed the self-test. One factor associated with successful completion was higher education level (aOR = 1.85; 95% CI: 1.32-2.61); while participants self-testing with SURE CHECK (aOR = 0.21; 95% CI: 0.12-0.37), INSTI (aOR = 0.23; 95% CI: 0.13-0.39), and BioSURE (aOR = 0.29; 95% CI: 0.17-0.51) or being unemployed, retired, or doing housework (aOR = 0.45; 95% CI: 0.25-0.82) were less likely to perform the test successfully. Agreement of positive and negative HIVST results as interpreted by participants and health staff was high (98.1% and 99.9%, respectively). Sensitivity and specificity of the evaluated HIVST were 96.43% (95% CI: 93.62-99.23) and 99.9% (95% CI: 99.75-100), respectively. Our findings confirm that blood-based HIVST is highly acceptable, feasible, and accurate. This evidence informs scale-up of HIVST to increase uptake of essential HIV prevention and treatment services.

HIV self-testing in the real world is acceptable for many: post-test participant feedback from the GetaKit study in Ottawa, Canada

Background:

HIV self-testing is the latest strategy to improve access to testing, diagnosis and treatment. Such strategies are beneficial due to the improved individual- and population-level health outcomes that emerge from early HIV diagnosis.

Aims:

While most research shows that HIV self-testing is acceptable and feasible, yielding higher numbers of first-time testers and positivity rates, compared to clinic-based testing, little evidence exists outside low- and middle-income countries about such testing.

Methods:

We implemented GetaKit.ca, a website through which eligible participants could register for and obtain an INSTI® HIV self-testing to their home, and then report the result back.

Results:

Those who returned to the website were asked to complete a post-test survey, which had a low response rate (42%), but identified satisfaction scores of 92%. Notably, 5% of testers sought in-person care after ordering the self-test, and only 80% of participants agreed that the INSTI® HIV self-test was easy to use.

Conclusions:

Participants provided tangible solutions to improve this test, which we feel are easy to incorporate and essential to maintain HIV self-testing efforts.

Invalid Results in the GetaKit Study in Ottawa: A Real-World Observation of the INSTI® HIV Self-test Among Persons At Risk for HIV

ABSTRACT

HIV self-testing corresponds with more frequent testing, better user satisfaction, and higher positivity rates compared with clinic-based testing. We implemented an open cohort prospective observational study, which provided a website through which persons could do online HIV self-assessments and, if eligible, receive a free HIV self-test. We implemented this project on July 20, 2021 and used the bioLytical INSTI® test. Herein, we describe the number of tests participants reported as invalid, which started at a rate of one fifth of all ordered tests and decreased to 8% after we provided more instructions on completing the test. Our data suggest that a high rate of invalids occur with self-testing in the real-world. Although this has cost implications, we feel this rate is acceptable, considering that 25% of our cohort reported no previous HIV testing. Our take-away message is that HIV self-testing requires additional supports and resources to function as an effective testing intervention.