Are participants in a street-based HIV testing program able to perform their own rapid test and interpret the results?
OBJECTIVE
Availability of over-the-counter rapid HIV tests could improve access to testing those reluctant or unable to use current services. We aimed to evaluate the feasibility of HIV self-testing using a finger-stick whole-blood rapid test (Determine™ HIV Combo) to detect both antigen and antibody.


METHODS
Before being tested, 313 participants in a street-based testing program were given adapted instructions and a test kit, and performed the self-test without supervision. These participants, together with another 207 who performed supervised self-testing, received additional instructions on how to interpret the test results shown in six colour photos and filled out a questionnaire. Logistic regression and generalized estimating equations (GEE) were used in the statistical analysis.


RESULTS
About 8.0% (95%CI:4.8%-11.2%) obtained an invalid self-test. An invalid result was inversely associated with male participants who had sex with men (OR=0.3;95%CI:0.1-1.0). Of the 3111 photos interpreted,4.9% (95%CI:4.1-5.7) were incorrect. Only 1.1% (95%CI:0.3-1.8) of the positive results were interpreted as negative. Age 30 or older (OR=2.1; 95%CI:1.2-3.7), having been born in Latin America (OR=1.6; 95%CI:1.1-2.2),and not having university education (OR=2.1;95%CI:1.2-3.7) were associated with misinterpreting test results in the GEE. Participant's perceptions of both their proficiency when conducting the test and interpretation were related with actual outcomes. Most participants (83.9%) were more motivated than before to use the self-test in the future, and 51.7% would pay >10 Euros for the test if it was sold in pharmacies.


CONCLUSIONS
This is the first study showing that blood-based self-testing with current technology is feasible in HIV-negative participants demanding the test and without prior training or supervision. Bearing in mind that it was conducted under difficult weather conditions and using a complex kit, over-the-counter tests could be a feasible option to complement current diagnostic strategies. More studies are needed to accommodate technology, minimise interpretation mistakes and provide on-line support.
Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
Luis
L
de la Fuente
María Elena
ME
Rosales-Statkus
Juan
J
Hoyos
José
J
Pulido
Sara
S
Santos
María José
MJ
Bravo
Gregorio
G
Barrio
Sonia
S
Fernández-Balbuena
María José
MJ
Belza
D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D012648:Self Care