Health centers in Africa organize door-to-door HIV self-test campaigns. The aim is to facilitate access to medical care in remote regions. For the first time, doctors are combining home visits with rapid oral tests. If these are positive, a specialist will then do a blood test for the final diagnosis. A health advisor from the village is then involved to look after those affected on site.
Prevent HIV with a self-test
Despite significant advances in prevention and therapy, millions of people become infected with the human immunodeficiency virus every year. In addition, the main burden of AIDS lies primarily in Africa. Innovative methods are needed to contain the epidemic. In this way, all those affected can be diagnosed at an early stage. Now, thanks to a self-test, a Basel research group was able to successfully identify HIV through test campaigns. In 2019, around 38 million people worldwide were infected with HIV. Two thirds of those affected live in Africa, mainly south of the Sahara. Therefore, to contain the epidemic, it is important that all infections are treated with antiretroviral therapy. In this way, the locals themselves can prevent the virus from being transmitted. However, this requires early diagnosis. This is especially true in remote regions that are far from clinics and test centers. In such cases, access to HIV testing remains a challenge.
A team led by Niklaus Labhardt, professor at the University of Basel and research group leader at the Swiss Institute for Tropical and Public Health (Swiss TPH), has now developed a strategy to improve test coverage by 20 percent. For the first time, the team combined the home visits so that they can diagnose HIV with the self-test. If the villagers are absent during the doctor’s visits, the team leaves self-tests with teaching material in the local language. Village health counselors trained in its use and assessment then collect the samples.
Simple approach with a big impact
The large-scale randomized study included over 150 villages with more than 7,000 inhabitants. The results of this simple approach speak for themselves. At 81 percent, the HIV test rate in the entire population in the intervention group was 20 percent higher than in the control group. The biostatistician Dr. Tracy Glass from Swiss TPH. In a partial study, the research team analyzed the strategy among young people and supplemented the research with interviews. Traditional HIV testing campaigns do not adequately reach young people, even though the rate of HIV infection among young women is high. This explains the first author Dr. Alain Amstutz. The HIV self-test in the intervention group meant that a 36 percent higher proportion of young people knew their status than in the control group.
The number of AIDS deaths has decreased worldwide since 2010. At the same time, there were 1.7 million new infections in 2019, half of them in Africa. In rural areas in particular, an alternative to traditional health campaigns is needed to achieve optimal test coverage. This strategy is another important building block for ending the HIV / AIDS epidemic in southern Africa.