title: Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study.
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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine, McGill University, Montreal, Canada ; Division of Clinical Epidemiology, Department of Medicine, McGill University and Health Centre, Montreal, Canada.
authors: Nitika
authors: N
authors: Pant Pai
authors: Tarannum
authors: T
authors: Behlim
authors: Lameze
authors: L
authors: Abrahams
authors: Caroline
authors: C
authors: Vadnais
authors: Sushmita
authors: S
authors: Shivkumar
authors: Sabrina
authors: S
authors: Pillay
authors: Anke
authors: A
authors: Binder
authors: Roni
authors: R
authors: Deli-Houssein
authors: Nora
authors: N
authors: Engel
authors: Lawrence
authors: L
authors: Joseph
authors: Keertan
authors: K
authors: Dheda
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D010865:Pilot Projects; D013019:South Africa; D055815:Young Adult