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PLoS ONEVolume 8, Issue 11, 27 November 2013, Article number e79772

Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study(Article)(Open Access)

  • Pai, N.P.,
  • Behlim, T.,
  • Abrahams, L.,
  • Vadnais, C.,
  • Shivkumar, S.,
  • Pillay, S.,
  • Binder, A.,
  • Deli-Houssein, R.,
  • Engel, N.,
  • Joseph, L.,
  • Dheda, K.
  • View Correspondence (jump link)
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  • aDepartment of Medicine, McGill University, Montreal, QC, Canada
  • bDepartment of Medicine, McGill University, Health Centre, Montreal, QC, Canada
  • cDepartment of Medicine, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
  • dGlobal Health, Department of Health, Ethics and Society at Maastricht University, Maastricht, Netherlands
  • eDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

Abstract

Background: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. Methods: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. Findings: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0-100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0-51.0). A majority of participants (78.1%) were females, aged 18-24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8-6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9-91.0); specificity:100% (95% CI, 98.1-100). Interpretation: Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered. © 2013 Pant Pai et al.

Indexed keywords

EMTREE medical terms:adultarticlecounselingcross-sectional studyfeasibility studyfemalehealth care personnelhighly active antiretroviral therapyHIV rapid testHIV testhumanHuman immunodeficiency virus infectionHuman immunodeficiency virus prevalenceimmunoassayInternetlaboratory testmalemobile phonepersonal experiencepilot studypoint of care testingpredictive valueprofessional secrecyself evaluationsensitivity and specificityseroconversionserodiagnosisSouth Africatest strip
MeSH:AdolescentAdultAIDS SerodiagnosisCross-Sectional StudiesFeasibility StudiesFemaleHealth PersonnelHIV InfectionsHumansMaleMiddle AgedOccupational ExposurePilot ProjectsSouth AfricaYoung Adult
  • ISSN: 19326203
  • CODEN: POLNC
  • Source Type: Journal
  • Original language: English
  • DOI: 10.1371/journal.pone.0079772
  • PubMed ID: 24312185
  • Document Type: Article

  Department of Medicine, McGill University, Canada
© Copyright 2014 Elsevier B.V., All rights reserved.

Cited by 55 documents

Pai, N. , Esmail, A. , Saha Chaudhuri, P.
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Kra, A.K. , Colin, G. , Diop, P.M.
Introducing and Implementing HIV Self-Testing in Côte d'Ivoire, Mali, and Senegal: What Can We Learn From ATLAS Project Activity Reports in the Context of the COVID-19 Crisis?
(2021) Frontiers in Public Health
Rivera, A.S. , Hernandez, R. , Mag-Usara, R.
Implementation outcomes of HIV self-testing in low- And middle-income countries: A scoping review
(2021) PLoS ONE
View details of all 55 citations
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