1. Self-testing: an effective means of increasing HIV-testing and status awareness
Hazel Ann Moore, MB ChB, MFam Med
MSF, Khayelitsha, Cape Town, South Africa
Authors: A. Moore, T. Cassidy, S.J. Steele, A. Shroufi, N. Mdani, C. Metcalf, T. Ellman, E. Goemaere, L. Trivino Duran
“No conflicts of interest to declare”

2. Background
WHO goals – does oral self-testing increase HIV testing and status awareness?
Khayelitsha, South Africa
peri-urban
500,000 inhabitants
60% informal dwellings
33% ANC HIV prevalence
2 study sites

3. Methods March 2016 – March 2017 Accept HIVST Clinic 1 Clinic 2
All attending offered routine HCT
Clinic 2
All enquiring about HIVST offered HCT first
Refuse HCT → offer HIVST
Accept HCT
Refuse HIVST
Accept HIVST

4. Pictorial Guide 1 .

5. Pictorial Guide 1 .

6. Methods – mHealth follow up
Clients asked to text their test result to a
toll-free number
Clients asked to return to clinic for confirmatory HCT
Reminder texts sent daily for 7 days, then weekly x 3
Clients not responding were called every week for 3 weeks

7. Results 95% of testers were female
Median age 28 years but age tested
No identified risk of social harm or adverse events
No use of the study phone number for queries or assistance

8. Results
88%
73%
83% 7%
41%

9. Results – reasons for refusing HIVST
744 offered a self-test → 655(88%) accept
89 refused HIVST after explanation
Reasons not to test
Reverted to HCT
20%
Tested HCT recently 3%
No phone 2%
Not ready/scared
40%
Scared to test alone 6%
Other/ study-related 7%
No reason
21%

10. Results –self-reported positive
34 report positive HIVST
17 (50%) newly diagnosed positive
17 (50%) known positive
12 (71%) diagnosis confirmed
4 (33%) known to have started ART

11. Results – self-reported negative
448 report negative
4 recently diagnosed
All linked to care
21 found to be positive
17 known positive
8 unable to trace
9 known to be in care after HIVST

12. Conclusions
HIVST increased the proportion of individuals aware of their sero-status
HIVST increased HIV testing coverage
HIVST increased linkage to care
Males remain a problem group to reach and to link to care
mhealth component was effective and acceptable to most participants

13. Recommendations
Facility based, directly assisted HIVST represents a viable delivery model to scale up HIVST and to increase HIV testing coverage
Clear HIVST instructions (pictorial) are likely to decrease the need for hotline support
Clear messages must be given about possible false negative results with oral HIVST when on ART
SMS technology is a useful tool in assessing HIVST results and linkage to care
Other delivery models are needed to reach target populations - men and youth
More studies are needed on effective linkage to care

14. Acknowledgements
Western Cape Government Health MSF Khayelitsha staff Co-authors