HIV self testing should not replace face-to-face diagnosis

People who are reluctant to get tested for HIV at a clinic may opt to use a new home test, but they will do so without professional support.

People reluctant to get tested for HIV clinic new home test without professional support

It is now possible for anyone in the UK who is concerned they might have contracted HIV to order a testing kit online for £29.95 and test themselves in the privacy of their own home. Sale of home testing kits has only been allowed in the UK since April 2014, before which it was illegal to advertise, sell or supply such a test for HIV infection. This first kit available to UK consumers is CE marked, a sign that the manufacturer BioSure conforms to the relevant European laws.

In October 2011, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) warned the public against buying test kits online and to check that kits for sexually transmitted diseases are CE marked. It was in August 2013 that England’s Department of Health announced its intention to legalise HIV home tests to encourage more people to get tested and treated early, a move welcomed by the HIV Pharmacy Association, a UK specialist pharmacist group. The group did raise concerns, however, about the implications for people who choose to self-test and the need for quality information and support to be readily available.

Dealing with uncertainty  

The BioSure kit tests for the presence of antibodies specific to HIV, but it takes time for these antibodies to become detectable in the blood; the test can produce a false negative result within the first three months of infection if a person has not yet seroconverted. False positive results are also possible with HIV antibody tests — three in every 1,000 tests performed give a false positive. The manufacturer recommends that anyone who tests positive should contact a healthcare professional to confirm the result.

Nowadays, most genitourinary clinics offer HIV tests that combine an antibody test with a test for p24 antigen, a HIV capsid protein, which can provide results a month after suspected infection.

Before performing an HIV test, sexual health workers normally ask what support network a person has at home in the event of a positive result. A test bought online offers no such assurance. People may be better off learning they have HIV in a healthcare setting where professional advice, support and treatment are available.

A systematic review published in PLoS 
Medicine[1]
 showed that HIV self testing — both supervised and unsupervised — is highly acceptable to people and more likely to result in partner self testing. But this review found that the quality of reporting in studies of self testing was generally poor; in particular there is a lack of data about uptake of counselling and treatment following a positive HIV test result at home. Further research is needed in this area. 

Improving access to HIV testing for people who, for whatever reason, are unwilling to see a health professional in person is to be welcomed. But home testing is no replacement for face-to-face services. More needs to be done by the NHS to encourage people at risk of HIV infection to be routinely tested for HIV, and normalising HIV testing within community settings, such as GP surgeries and pharmacies, would be a move in this direction. 

References

[1] Pant Pai N, Sharma J, Shivkumar S et al. Supervised and unsupervised self-testing for HIV in high- and low-risk populations: a systematic review. PLoS Medicine 2013. doi:10.1371/journal.pmed.1001414.

Last updated
Citation
The Pharmaceutical Journal, PJ, 9/16 May 2015, Vol 294, No 7861/2;294(7861/2):DOI:10.1211/PJ.2015.20068487