Canada should integrate self-testing for HIV into the health system to help reduce the burden of the disease, argues a commentary published in CMAJ (Canadian Medical Association Journal.
Self-testing for HIV (HIVST) -- taking a saliva, urine or blood sample and interpreting the result, similar to a home pregnancy test -- is available in the United Kingdom, France, the Netherlands, United States, Latvia, Spain, Kenya and South Africa, but not in Canada.
"In Canada, we need rapid approvals of many HIV self-tests, alongside deployment of diverse, culturally sensitive HIVST strategies and development of HIVST-specific provincial or federal guidelines. Lack of funding, political will and widespread availability of conventional HIV testing through public health laboratories perhaps delayed introduction of HIV self-tests. It's 2020, and the time to invest in HIVST is now," says Dr. Nitika Pant Pai, Research Institute of the McGill University Health Centre, and McGill University, with co-author, Dr. Rejean Thomas, Clinique médicale l'Actuel, Montreal, Quebec.
The World Health Organization (WHO) recommends HIV self-testing as an alternative to regular laboratory testing. More than 250 studies indicate HIVST increases access to, and frequency of, testing by the tester as well as by partners and family members.
The authors outline 4 factors for successful introduction:
- Rapidly approve HIV self-tests that are already approved by the WHO
- Establish methods to easily link positive self-testers to HIV treatment, perhaps through clinics, mobile programs, pharmacies, apps and other means
- Address the costs of integrating HIVST into the health system to ensure sustainability
- Conduct large Canadian trials and cost-effectiveness studies
"Introduction of HIVST in Canada should lead to better detection of HIV in underdiagnosed populations who currently face barriers to testing and improve HIV management, bringing us closer to the UNAIDS 95-95-95 targets. This would be a historic milestone in the long journey toward controlling and ending the HIV epidemic in Canada," write the authors.
"Time for HIV self-testing in Canada: a vision and an action plan" is published November 2, 2020.
Canadian Medical Association Journal