Mobilising the potential of HIV self-testing: benefits and barriers

by Angus Molyneux | Policy Analyst, Australian Federation of AIDS Organisations (AFAO)

If Australia is to achieve its ambitious target of virtually eliminating new HIV transmissions by 2022, the ability to test for HIV frequently and easily will be paramount. Once a person knows that they have HIV, they are able to commence treatment, which stops the virus replicating and damaging the immune system. If an undetectable viral load is achieved (where medications stop the virus replicating and reduce the amount of HIV in the body to levels not detected by standard testing) treatment also prevents onward transmission.

In November 2018, the Therapeutic Goods Administration (TGA) approved the first HIV self-test for sale in Australia and the test became available for purchase in April 2019. This development will be a game changer for HIV testing and prevention as it increases access to HIV tests for those who may not use services such as general practitioners (GPs), sexual health clinics or community testing sites. We know that barriers exist for many accessing HIV testing, including cost, location, time as well as comfortability with HIV testing due to fears or misconceptions about the virus and what a positive diagnosis may mean.

In a study undertaken prior to TGA approval of the self-testing device, free HIV self-test devices were provided to gay and bisexual men at higher risk of acquiring HIV. The study showed that there was a two-fold increase in the frequency of HIV testing, and a nearly four-fold increase in testing among those who had gone more than two years without an HIV test (or had never been tested). The study also showed that there was no decline in people accessing more traditional forms of HIV testing and no decline in testing for other sexually transmitted infections (STIs). This study demonstrated that HIV self-tests can be a desirable form of HIV testing among specific groups of people at higher risk of acquiring HIV.

Cost may continue to be a barrier to HIV testing for some despite the approval of the HIV self-test. The approved HIV self-test will retail for AUD$25 (plus shipping and handling) which, for some potential self-testers, is an affordable price that testers will be willing to invest in. However, the previously mentioned study showed that only three quarters of the participants surveyed were willing to pay up to AUD$30 for a self-test. The approval of other HIV self-tests to create competition and potentially lower prices should therefore be encouraged. It will be some time before we know whether the cost of the HIV self-test will inhibit its uptake in the community.

The approval of the HIV self-test in Australia is also conditional on it being sold online or through specialist HIV organisations such as AIDS Councils and sexual health clinics. In order to make the test as accessible as possible, HIV self-tests should also be made available in pharmacies so that people who wish to have an HIV self-test do not require an internet connection and credit card to access this exciting testing technology.

GPs and sexual health physicians will also need to prepare themselves for the likelihood that patients will now present following a reactive result with an HIV self-test. Because the self-test is a screening test, follow up testing will be required to confirm a positive result. As such, these professionals will likely be the first point of contact following a reactive result with the self-test and will need to be prepared to provide information about what a reactive result means, confirmatory laboratory testing, as well as supporting the commencement of treatment if a confirmed HIV diagnosis is made.

The approval of the first HIV self-test is a watershed moment in our collective effort to end new HIV transmissions in Australia. However, relevant issues also need to be considered so that access to this exciting technology is easy, affordable and equitable and that it is targeted appropriately.