Few weeks ago, a childhood friend of mine contacted me via a social media platform that he needed help quite urgently. I advertently ignored the message for two reasons. First, for someone who hasn’t been in touch for decades, I found it quite awkward that our first interaction would be about a solicit for help of some sort. Secondly, and most importantly, knowing that I may not be able to help at the time, I had assumed that my friend needed financial assistance. I was wrong!
My friend, perhaps realizing that I read his message and ignored, persisted and messaged me that he needed some professional advice. He had heard from a mutual friend that I was a pharmacist. According to him, he put his head in a noose and had a fling with a lady she met at a night club couple of days prior. Fast forward, he self-tested HIV positive using a rapid diagnostic test kit (RDT) he obtained from a colleague at work. I immediately requested for his number and gave him a call. I assured him that the RDT test result is not definitive, and he needs to confirm from a laboratory. Besides, no HIV test can detect HIV immediately or few days after infection.
I am sharing this true incident to highlight some of the caveats associated with HIV-self testing. Reliable estimates suggest that a little over two-thirds of HIV-infected individuals are unaware of their infection mainly due to barriers to testing. Additionally, social stigma and discrimination continue to threaten acceptance of HIV testing services worldwide. HIV self-testing has been touted as the panacea to help address these challenges. Self-testing for HIV, however, has garnered controversy for years and the debate in Ghana has been stirred recently following the announcement of plans to roll out a point-of-care test for over-the-counter sale earlier this year. According to the Programme Manager of the National STIs and HIV/AIDS Control Programme (NACP), Dr. Stephen Ayisi Addo, “very soon, HIV self-test kits will be available at health facilities across the country for purchase to enable people to self-test to know their HIV status”. In addition, Self-test Ghana, in collaboration with WAPCAS is working to allow adults 18 years and over to be able to order HIV test kits online for use at their homes.
Ghana is not the first country to roll out such HIV self- testing mechanisms. The WHO reports that worldwide, 59 countries have adopted HIV self-testing policies. HIV self-testing in lower income countries like Ghana can have several advantages, including increased accessibility to testing, increased testing rates, privacy, and empowerment for self-care, and reduce incidence of stigma and discrimination. This will undoubtedly accelerate efforts geared towards the achievement of ’90-90-90’ initiative, with goals of 90% of all individuals with HIV knowing their diagnosis, 90% of those diagnosed on treatment and 90% of those on treatment achieving adequate viral suppression.
On the other hand, the healthcare architecture and social climate in Ghana means that we must proceed with caution in rolling out HIV-self testing.
Firstly, HIV self-testing may not provide the same level of counseling and support as traditional testing methods. In-person counseling sessions are essential for providing emotional support, guidance, and information on HIV prevention, treatment, and care. Without such support, individuals may face challenges in handling the outcome of their tests.
Secondly, the accuracy and reliability of self-tests depend on the quality of the test kits and the user’s ability to follow instructions correctly. Inadequate quality control and user errors can lead to false-positive or false-negative results, potentially leading to incorrect HIV status information and subsequent health risks.
Again, receiving an HIV-positive test result can have significant psychological implications for individuals. Without immediate access to counseling and support, the emotional impact of a positive result may be overwhelming for some individuals, leading to anxiety, depression, or other mental health issues. A related issue is linkage of testing to care. HIV self-testing alone does not guarantee linkage to appropriate care and treatment services. Without effective systems in place for referral and follow-up, individuals who test positive may face challenges in accessing necessary healthcare and support services, including antiretroviral therapy (ART) and ongoing HIV management.
All these challenges played out in the case of my friend. I managed to convince him, so we did a confirmatory test at a laboratory and his results came out negative. We did a repeat test with an RDT, and it was still negative. Curious to understand what is happening, I requested to know what brand of the RDT he used. Fortunately, he had kept the packaging in his apartment, and it turned out that the kit had expired for over seven months now.
In conclusion, HIV self-testing in Ghana can have several advantages, including increased accessibility, privacy, and empowerment. However, challenges related to limited counseling, accuracy, psychological impact, linkage to care must be carefully addressed to ensure the successful implementation and impact of self-testing programs. It is crucial to establish comprehensive support systems and quality control measures to maximize the benefits while minimizing the potential drawbacks of HIV self-testing in such contexts. It’s important to involve trained community actors, particularly community pharmacists and other healthcare practitioners within the communities to ensure that any implementation addresses the specific needs of Ghana’s population.
It is also crucial that a monitoring and evaluation system is implemented to track the uptake of HIV self-testing, identify any challenges, and measure the impact of the program. This data can help refine strategies and improve the effectiveness of the initiative.