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July 26, 2018
There is a point of debate about the risks badociated with the possibility of false negative and false positive results in the context of HIV self-evaluation.
A significant number of people affected by the human immunodeficiency virus (HIV) are still undiagnosed, of which approximately 20% in the United States and 60% in the world. 1 Although the Centers for Disease Control Prevention recommends HIV testing for all people aged 13 to 64, many barriers to HIV testing in health facilities have been identified, including the lack of access and fear of stigma and discrimination.
In recent years, HIV self-tests in the United States, France and the United Kingdom have been hailed as an important step in closing these gaps 3 However, although care generally seem to support the availability of self-test, various concerns have also been noted. For example, the cost can still be prohibitive for those who need the most tests, an American survey indicating that about 41% of those most at risk would be unable to pay the test. 4 Other studies found that most participants did not want to pay more than $ 20 for a self-test. 1
Self-badessment also disrupts traditional links with care and prevents other transmitted infections. Another point of discussion is the risks badociated with false positive and false positive results in this context. 1.3
"The potential of self-tests to empower individuals and standardize" We should not ignore screening, "wrote the authors of a 2014 article that dealt with these questions 1 "We hope that the efficiency of the tests will improve and that additional badyzes will become available on the market and reduce the costs and inconvenience of the tests. addressed, this strategy will prevent " 1 the millions of new infections that occur each year.
For Further Perspectives on HIV Self-Screening, Infectious Disease Advisor spoke with the following experts: Jeffrey D. Klausner, MD, MPH, Professor of Medicine in the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA and Professor of Public Health at the School of Public Health Fielding UCLA, and Susan J. Little, MD, Professor of Medicine in the Division of Infectious Diseases and the Global Public Health at the University of California San Diego School of Medicine and co-director of the UCSD Antiviral Research Center.
Infectious Disease Attendant : Are you generally supportive or opposed to HIV self-diagnosis? Why or why not?
Dr. Klausner: HIV self-testing is a great way for people who generally do not have access to health care or who are concerned about stigma for getting screened. Many young adults, badual minorities and people with certain risk behaviors are not tested. Because HIV is easy to treat, it's very important that people learn their status, and anything we can do to make testing easier is welcome. Currently in the United States, [there is a significant portion] people living with HIV who do not know their status. They should learn more about HIV self-testing, especially young adults and those who have not seen a doctor in the past year.
Dr. Little: I support HIV self-testing because it offers a test option for people who would otherwise not be willing to be tested for HIV. There are people who might want to be tested for HIV, but who may feel uncomfortable going to the community or health care clinics available for this service. In addition, people who are already in testing may be willing to test more regularly if the automatic test makes the process easier and more convenient.
Infectious Disease Counselor: What was your experience with patients who used the self-test?
Dr. Klausner: I provided HIV self-tests to several hundred people through coupons, coupons, online correspondence orders and vending machines. Everyone who used the test liked it and found it easy to use. More importantly, all those who tested positive received confirmation tests and medical care.
Dr. Little: I personally have no patient, to my knowledge, who uses the self-test. I'm running an HIV testing program, so the people I see are looking for more traditional HIV testing options
Infectious Disease Advisor: For clinicians, what are the most relevant implications for HIV testing? self-tests?
Dr. Klausner: If HIV self-testing was to take off in the United States, we could see an increase in the number of people infected with HIV who would receive care. Plus, once people know that they have an infection and that they are following a treatment, they are much less likely to transmit the infection. HIV self-testing could dramatically increase the number of people treated and reduce the current epidemic.
Dr. Little: I believe the biggest challenge of self-badessment kits is the interpretation of positive results and the willingness of a person who has just gotten a positive result of making a follow-up appointment. A positive HIV test result after rapid antibody testing requires further confirmatory testing before making a definitive diagnosis of HIV. All self-badessment kits provide resources to ensure that post-test counseling and confirmatory testing is available if the test is positive.
However, the same obstacles and stigma make some people uncomfortable to get tested. The site can also make this person uncomfortable by ordering follow-up care for a positive HIV test result. If the person doing the test has a trusted provider, they can contact their provider to receive this follow-up. Thus, practitioners should provide information on HIV self test kits to their interested patients and should provide follow-up services for clients with positive tests or referral to appropriate resources in the community. medical community.
Infectious Disease Counselor : What other areas of research on this topic require further investigation?
[19459013DrKlausner: A major obstacle is cost. There should be more policy research showing the cost-effectiveness of self-tests and research on how decision-makers such as state and local governments could offer free HIV self-tests. There is also a need for better tests that could detect those who have an infection even earlier. Current tests detect the infection after 3 months, which is adequate for the majority of people. However, a simple and affordable self test that could detect the infection within a week would be a breakthrough.
Dr. Little: I believe that self-test research should focus on the following three areas: Assay kits that detect HIV RNA (similar to a test for HIV). viral load) rather than antibodies; test kits that are inexpensive, disposable safely and do not require special handling, such as refrigeration; and [kits with] automated electronic notification of positive results. The reason being to focus on the test kits that detect HIV RNA is the ability to detect people at the earliest and most infectious stages of HIV infection. HIV. People with acute HIV infection have not yet developed antibodies against HIV and [they] have therefore obtained a negative result in rapid HIV antibody testing, but the HIV RNA screening test would be positive.
The disadvantage of a self-test kit that detects HIV RNA would be that such a test could "miss" someone who was infected with HIV. HIV but whose immune system controlled their infection so that their HIV viral load was undetectable. An ideal self-test kit would detect both HIV RNA and anti-HIV antibodies. Despite this, I believe that the research priority should be the development of a self-screening kit that detects HIV RNA in order to identify people at risk of transmission of HIV. viruses and the people who are most in need of antiretroviral therapy.
The second priority of the research [further] is the development of test kits that can be used more widely, including in low- and middle-income countries. Access to inexpensive, disposable and safe kits that do not require special handling, such as refrigeration, would help to achieve this goal.
The third area of research concerns the ability to monitor the self-test result and transmit the results electronically to a designated provider. In this way, each positive test result is badured of a call and setting up follow-up care.
References
1. Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV AIDS (Auckl) . 2014; 6: 117-126.
2. Branson BM, Handsfield HH, MA Lamp, et al; Centers for Disease Control and Prevention (CDC). Revised guidelines for HIV testing of adults, adolescents and pregnant women in health care settings. MMWR Recomm. Rep. 2006; 55 (RR-14): 1-17; questionnaire CE1-4
3. Gagnon M, French M, Hébert Y. The debate on the HIV self-test: where are we? Human Rights of BMC Int Health . 2018; 18: 5.
4. Myers JE, Bodach S, Cutler BH, CW Shepard, Philippou C, Branson BM. Acceptability of home self-tests for HIV in New York, 2006. Am J Public Health . 2014; 104 (12): e46-e48.
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