Imagine walking into your neighborhood pharmacy, not just for a headache pill or cough syrup, but to take a step that could significantly alter your life and the lives of those around you. This is the reality that unfolded in Kisumu, Kenya, where a pioneering study is considering whether HIV self-testing can help bring other HIV prevention services to the heart of the community. A recent study published in the Journal of the International AIDS Society by Dr. Katrina Ortblad and her collaborators has shed light on the efficacy and impact of HIV self-testing kits available in private pharmacies. From March to June 2022, this study involved 20 pharmacies in Kisumu County, a region hard-hit by HIV. In a novel approach, pharmacy providers were trained to use blood-based HIV self-testing kits and to assist clients who were selected based on their purchase of sexual and reproductive health-related products and reported behaviors associated with HIV risk. These clients were not just numbers in a study; they were individuals taking brave steps towards knowing and managing their HIV status.
The study focused on comparing the performance of provider-delivered HIV self-testing with the standard rapid diagnostic test (RDT) used in PrEP (pre-exposure prophylaxis) delivery. The findings are encouraging. The sensitivity of HIV self-testing was impressively high, at 98.5% when interpreted by providers and 98.8% by clients themselves. The specificity was equally noteworthy, at 96.9% for provider interpretation and 93.8% for client interpretation. This high accuracy demonstrates that HIV self-testing, particularly blood-based testing, is a viable tool for supporting PrEP initiation and continuation in pharmacies and other community settings. An intriguing aspect of the study was the significant client reliance on provider assistance during the self-testing process. About 79% of clients sought help with steps like using the lancet, collecting blood, and adding the sample to the pad. This underscores the critical role of provider training and support in HIV self-testing implementation, ensuring that clients are confident and capable of accurately conducting the tests. Client perception towards HIV self-testing was overwhelmingly positive, with many finding the process acceptable and feeling confident in conducting the test and interpreting the results. This aspect of the study is crucial, as acceptability and confidence in use are key factors in the widespread adoption of any new health intervention.
The study's implications extend beyond its immediate findings. By demonstrating the effectiveness of HIV self-testing in private pharmacies, it opens up new avenues for HIV prevention and care. Pharmacies, often more accessible and less stigmatized than HIV clinics, could become critical points for HIV testing and PrEP delivery, especially in regions with high HIV prevalence. This approach could significantly reduce the stigma associated with visiting HIV clinics, leading to greater acceptance and normalization of HIV testing. Additionally, the study sheds light on the broader potential of self-testing in other health areas. The success of HIV self-testing in pharmacies suggests that similar models could be applied to other diseases, potentially transforming how healthcare is delivered, especially in low-resource settings.
This study received support through the Bill & Melinda Gates Foundation. Additional funding was provided by the National Institute of Mental Health.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium member Dr. Katrina Ortblad contributed to this study.
Ortblad, K. F., Kwach, B., Zhang, S., Asewe, M., Ongwen, P. A., Malen, R. C., Harkey, K., Odoyo, J., Gathii, P., Rota, G., Sharma, M., Were, D. K., Ngure, K., Omollo, V., & Bukusi, E. A. 2023. Measuring the performance of HIV self-testing at private pharmacies in Kenya: a cross-sectional study. Journal of the International AIDS Society. 26(10), e26177.