The Ministry of Health is planning to introduce an HIV self-testing (HIVST) service to supplement existing testing services such as health facility-based or mobile voluntary testing and counselling.

HIVST is regarded as an innovative approach that can rapidly increase access to and uptake of HIV testing services, particularly among populations with the lowest coverage and highest risk.

This means that an individual who wants to know their sero status would buy the HIVST kit and perform a HIV diagnostic test and be able to interpret the result in private.

With the kit, people can use oral fluid or blood-finger-pricks to discover their status in a private and convenient setting.

Results are ready within 20 minutes or less.

Those with positive results are advised to seek confirmatory tests at health clinics, according to the Rwanda Biomedical Centre (RBC).

The World Health Organisation recommends that persons who test positive for the virus receive information and links to counselling as well as rapid referral to prevention, treatment and care services.

According to Beata Sangwayire, a voluntary counselling and testing (VCT) senior officer at RBC, self-testing should lead to more people knowing their sero status and being able to act upon it. 

"Once introduced, people will be diagnosed earlier by bringing the services closer to where people live, and create demand for HIV testing,” Sangwayire said.

This is particularly relevant for people facing barriers to accessing existing services or those who may find it difficult to access testing in clinical settings and might prefer self-testing as their method of choice.

An example of those that will benefit from the new methods, according to Sangwayire, include people with tight work schedules, groups at a higher risk of catching the virus mainly female sex workers and injectable drug users, among others.

Work in progress

Sangwayire said they are still at the initial phase working with different stakeholders looking at the feasibility of these new services, where it can be piloted, guiding messages on how to use the kit and where it will be found.

"It may take some time to get it introduced due to many aspects needed to be looked at, by mid of this year the service can possibly start with the pilot phase,” Sangwayire said.

According to RBC, the new service is among the innovative measures to achieve the  ‘90-90-90 targets,’ which aims at diagnosing 90 per cent of all HIV-positive people, providing antiretroviral therapy (ART) for 90 per cent of those diagnosed and achieving viral suppression for 90 per cent of those treated, by 2020.

It is also in line with the WHO’s new guidelines that call upon countries to consider self-testing services as one of the means to help countries meet the UN target of diagnosing 90 per cent of all people with HIV by 2020.

So far, 23 countries have adopted HIV self-testing policies, while many others are currently developing them.

Impact of self-testing

Self-testing has been shown to nearly double the frequency of HIV testing among men who have sex with men, and recent studies in Kenya found that male partners of pregnant women had twice the uptake of HIV testing when offered self-testing compared with standard testing.

According to statistics from RBC, Rwanda has succeeded in containing the HIV prevalence at 3 per cent in general population (15 – 49 years old).

In June 2016, Rwanda launched the Test-and-Treat-All programme.

Latest estimates indicate that about 80 per cent people in need of antiretroviral therapy treatment are getting it. Additionally, evidence shows that the transmission rate of HIV from mother to child is estimated at less than 2 per cent.

According to a new WHO progress report lack of an HIV diagnosis is a major obstacle to implementing the Organization’s recommendation that everyone with HIV should be offered antiretroviral therapy.

The report reveals that more than 18 million people with HIV are currently taking ART, while a similar number is still unable to access treatment, the majority of which are unaware of their HIV positive status.

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