HIV Self-Testing

HIV testing is the cornerstone of HIV prevention services. However, since the COVID-19 pandemic was identified in the region, limited HIV testing has serious implications for the Caribbean if not addressed in a timely and meaningful manner. The lack of or limited HIV testing has the potential to increase the level of new HIV infections in the region which already has an unacceptable rate of infection, especially among key populations. The inadequate uptake of testing for HIV in the Caribbean countries, especially among key populations (KPs) generally also presents a major challenge to universal access to treatment and care while preventing onward HIV transmission.

Given the current scenario in the Caribbean it is therefore vital to implement innovative testing strategies such as HIV Self Testing (HIVST), to expand access to testing in the region. HIVST can significantly contribute to the national and regional objectives of universal knowledge of HIV status and is an empowering and innovative way to help achieve the first 95–95–95 treatment targets by 2030. By extension it will support the achievements of regional targets articulated in CCH4 and the PANCAP Caribbean Regional Strategic Framework for HIV (CRSF). Importantly, the introduction of such innovative strategies as HIV ST was approved at the recent Council for Human and Social Development (COHSOD) of Ministers of Health of the Caribbean.

HIVST has several benefits which include but are not limited to:

• Expanding access to HIV testing services
• Increasing client’s autonomy
• Confidentiality and privacy
• Empowering individuals
• Convenience

HIVSThas been shown to be acceptable to many diverse population groups in a variety of settings. It is accurate when performed with regulated and quality tests. With appropriate policy, when provided in conjunction with adequate instructions for use and post-test support information, self-testing is highly effective. Evidence from various research and pilot projects has shown high acceptability and feasibility for oral HIV self- testing as well as high user-demand. Although evidence shows that these tests have high sensitivity (99.6%) and specificity (100%) it is important to note that HIVST does not provide a confirmed HIV positive result. All reactive self-test results must be confirmed using the recommended national HIV testing algorithm. Studies have shown that those who self-test can and do access additional testing for confirming HIV positive results and post-test counselling at civil society testing sites or health facilities.

Given the current COVID19 pandemic, the introduction of HIV ST is a key testing strategy to ensure the continuation of testing services for the general population and key populations during the situation of social distancing and “lockdowns”. Nevertheless, HIV ST as new technology for HIV testing should be sustained beyond the contingency response to COVID19 crisis as an innovative approach to reach undiagnosed individuals who do not otherwise access existing traditional testing services.

This training is intended to support a verification process for the introduction of HIV ST and to prepare persons to support the HIV ST initiative. The verification process will demonstrate the effectiveness and feasibility of self-testing as an urgent strategy to improve access to HIV testing, in the context of national testing strategies that are currently included within national HIV testing policies in the Caribbean.

Objectives of Training Workshop

The purpose of this training is to prepare participants to support the verification and feasibility assessment for implementing the HIVST in Trinidad & Tobago. The HIVST verification process will determine the accuracy of the test, and the utilization of such testing at health facilities and at the community level by individuals using these tests. The verification process will also evaluate the accessibility, acceptability and feasibility of HIVST. The process of verification and feasibility will take place among six OECS and five larger countries – Barbados, Belize, Guyana, Suriname, Trinidad & Tobago. The results of the verification and feasibility assessment will be analysed and information will support the roll out of the testing strategy in appropriate health facilities and at the community level by appropriate civil society organizations that have the capacity to implement and to provide linkage to care.  The information provided by the assessment will also seek to inform the Ministries of Health (MOH) on policy formulation concerning HIV self-testing as an additional testing strategy in the selected countries and the wider Caribbean.

The specific objectives of the training workshop are:

1. To provide guidance to participants on strategies for encouraging clients from key populations to conduct HIV self-testing using the Oraquick HIV ST
2. To provide participants with the skills to support clients from key populations to conduct HIV self-testing and to access post-test services as required
3. To prepare participants to support the pilot testing/evaluation of the Oraquick HIV ST with respect to performance and acceptability among civil society organisations and key populations as a prelude to the integrating HIV self-test into the national HIV testing strategy in Trinidad & Tobago.
4. To facilitate input by participants into the incorporation of HIV self-testing into the national HIV testing policy.

DAY 1

1. HIV Self-Test Workshop Agenda
2. Presentation Day 1 – HIV Situational Analysis in the Caribbean – Dr. Shanti Singh-Anthony – PANCAP
3. Dr. K Hatzold – Considerations and Opportunities for HIVST in the Caribean

DAY 2

1. Key Issues – DAY 1 – identified by participants
2. Overview of Process for Introducing Self-Testing in the Caribbean
3. WKP HIV ST Training – DO’s and Don’ts of self-testing
4. Uganda video for using Oraquick HIV Self-Test: #OraQuick HIV Self-Test kit
5. Quality and Safety Issues identified by participants
6. HIV ST PPT feedback

DAY 3

1. HIV Self-Test Information Manual
2. HIV Self-testing Information and Communication Materials Final
3. Presentation by Javier Gutman – Oraquick HIVST Training Slides
5. HIV ST PPT feedback

DAY 4

1. DAY 4 – Feedback from KP Focus Groups re HIV ST Introduction
2. Notes from discussion of DAY 4 – Managing Psychosocial issues
3. HIV ST Psychosocial Issues – WKP
4. Dr. Hatzold’s presentation – Psychosocial Issues

DAY 5

1. Appendix 2 – PANCAP HIV Self Testing Protocol
2. CMLF – Process for Pilot Phase 1
3. HIV ST site assessment Checklist
4. Participant information and consent form
5. Participant questionnaire
6. HIV ST PPT feedback

Communications Materials

1. Frequently asked questions (FAQs) about HIV Self-Testing
2. How to do the Oraquick HIV Self-Test
3. HIV Self-testing (PANCAP Series 1-4)
4. PANCAP/CMLF Collaboration Video

South Africa Communication Tools

1. South Africa Communication Tools
2. Self-Testing – The Last Mile
3. OraSure Demonstration – South Africa