Oral HIV self-testing; why people should embrace it

Even with all the existing facilities for HIV testing in the country, experts say people still shun the process. However, a new HIV self-test kit has been introduced in the country to help people know their status. The HIV self-testing kit allows you to discreetly determine your HIV status at a time and place that is convenient for you, and it’s easy to use. It’s expected to help people know their status and thereafter, those found to be HIV-positive get free and immediate treatment and support at their nearest health facility. Dr Pacidie Umugwaneza, Director of the HIV/AIDS, STIs and other blood bone infections Division at Rwanda Biomedical Centre (RBC) says the oral HIV self-test kit is available now. “We do have strategies to increase access to HIV testing. Our team of health workers reaches out to the community level to mobilise people to voluntarily go for the test,” she says. However, she points out that the biggest challenge is that even with the services offered by health providers; people do not go for testing. IMPLEMENTATION AND DISTRIBUTION The programme, Umugwaneza says, will be implemented in phases; the first one has already started and is being carried out in Kigali. This is because of the number of people in the city as compared to other provinces. Through the experience from this first phase, they will be in a position to know how it will be carried out in other areas. So far, Umugwaneza says, they have seen a good number of people requesting for the kit, which is encouraging. She explains that one is supposed to swab the device on both upper and lower gingiva then put it into a solvent liquid and read results on the same device within 15 to 20 minutes. The way the documentation of self-testing is done; experts say that the person who uses the kit normally requests to be contacted after, to talk about the results and the way forward. However this is not mandatory. It’s on a voluntary basis because they don’t want to sabotage the initiative by needing many requirements. Also, most of the people requesting for the self-testing kits are those who do not turn up for free testing in health facilities. There is a hotline number (114) where people can call in and ask questions if they have any queries or problems regarding the results or self-testing kit itself. According to Dr Sabin Nsanzimana, the head of HIV, STI and other Blood Borne infections Division at RBC, they have targeted areas. For instance, for this first phase in Kigali, they are targeting work places, both public and private institutions. He says preferably those that have clinic services inside their institutions. This is because such places will have someone who can provide information on how to use the kit. “Before, we had already trained principal persons to give information about HIV self-testing, so that a person can be aware of how it works, if they can’t read the instructions indicated. But also, there is preliminary information that needs to be given as well, he adds. If one has been exposed to the virus just two to three months before the test, the test will not be able to detect the right information. / Net photo. WHY SELF-TESTING? Nsanzimana says that the HIV self-testing kit was introduced to make sure that people who are still reluctant to go for testing at least can have access to more private HIV tests. “We are doing it to make sure that everyone is aware of their HIV status, especially those who are HIV positive to be initiated on treatment, while those who are HIV negative can adopt the preventive measures to remain negative,” he says. If one tests positive, it is easier to get access to treatment which will help them live a long life. This can be achieved through self-testing which is easier than going to the hospital. “Knowing your status and getting the right information means you can protect yourself and others, and will help stop the spread of HIV,” he says. He adds that the benefits of self-testing are double and that through it, new HIV infections will be identified and treatment offered, thus other infections will be prevented. With self-testing, Nsanzimana says one can test themselves regularly, and not have to wait for some time to go to a health facility to get the assistance. “This kit is useful to everyone, especially those who are sexually active, even if they know they haven’t put themselves at risk of the virus. “By doing this regularly, you can help keep your mind at rest, and any surprises that do arise can be dealt with quickly,” he adds. Nsanzimana notes that this is a very useful tool to help people know their HIV status in strict confidentiality, which will reduce the number of people who don’t know they have HIV. “It’s a screening test, this means that if one does the test and they are HIV negative, they should another confirmatory test at the nearest health facility, which will give them the final results,” says Umugwaneza. On the other hand, she notes that if the results come out HIV positive, that is the final result and one has to be content with it. However, she points out that if one has been exposed to the virus just two to three months before the test, the test will not be able to detect the right information. Thus, a person will require visiting the health facility for clear results even if the results came out undesirable. She says that this is crucial and people should be aware of it, especially those doing self-testing. PROVIDING DATA ON HIV FREQUENCY According to Ernest Nyirinkindi, the in charge of information, education and behavioural change communication at RBC, an annual data collection exercise conducted by Rwanda Biomedical Centre indicates that new infections each year are at 0.27 per cent while 13 per cent don’t know their status. The occurrence rate is still at 3 per cent since 2005 and this has been achieved because of the numerous strategies in place. “Today, it is estimated that there is accessibility of free HIV testing services in more than 95 percent of public health facilities and all people in need of ARV treatment in the same health facilities have access,” he says. There is also availability of health facilities and community support for those initiated on treatment to stay on treatment. According to 2015 DHS, 24% per cent of men and 16 per cent of women have never had an HIV test, with a high percentage among youth aged 15 to 24 (67.2 per cent). However, he says this is expected to change and people are embracing the new self-test kit. Nyirinkindi points out that taking an example of the occurrence of 3 per cent, with this self-testing kit, it will help us help more people who are HIV positive and the remaining population will know their status as well. The Ministry of Health has already included HIV self-testing as part of national policies and guidelines. In fact, 20,000 self-test kits are already in the country of which 6,000 people self-tested in the last two months and the outcomes are encouraging. “We are now working with private pharmacies to avail these tests at affordable costs,” he says. Adding that more self-test kits are being procured, targeting high risk groups and hard to reach populations. It’s too new an initiative to point out challenges but the accessibility is still limited because it’s not yet on the private market. They are working with local suppliers to see how private pharmacies can get the kit so that they can be available to anyone who needs them. Your views Emmy Mirenge, Kabeza resident This method is more convenient and I am willing to get one. The reason why the youth avoid visiting health facilities to get tested by someone else is because of fear that people judge and stare at you when walking in and out of the testing room, even the one who counsels you. ----- Eliana Nsabimana, hotelier In the unfortunate event that the results come out as HIV positive, one can easily lose focus. If I do the test myself, I can have time to take it in and figure out the next step. Eliana Nsabimana Eliud Makuza, Kigali resident I applaud it because it’s easy and one can do it anytime. However, it should be made available in every pharmacy just like the testing kit for pregnancy so that everyone can get access to it. ----- Patricia Kabanda, Medical student The challenge is that people are reluctant to be tested, especially the youth, but with this new method, hopefully there will be more people willing to know their status. Also, the people distributing these kits need to be well acquainted with the process in order to convince people to get them. Patricia Kabanda editorial@newtimes.co.rw