Are we ready for home-based, self-testing for HIV?

摘要

The idea of home-based self-testing for HIV has existed for over two decades; however, its implementation has not been without debate and controversy. With accurate, rapid point-of-care tests, newer, simplified and optimized antiretroviral regimens, and an imperative to widen HIV testing to the general population, the idea of providing individuals with a tool for home-based self-testing deserves renewed consideration. Although test results are rapid, some issues to consider are: test results are considered ‘preliminary positive’ and requiring confirmatory testing, obtaining accurate results consistently, particularly in low-prevalence populations is challenging, and risk of adverse psychological outcomes (i.e., stress and suicide) with erroneous test results is always a possibility. Barring one study, there has only been limited evaluation of the impact of self-testing for HIV. Thus, in the absence of evidence, is it plausible to think that these concerns could be overtly exaggerated? Is HIV self-testing too stigmatized and protected? In view of the advances in HIV treatment such as effective once-a-day dosing treatment options, isn’t it time to empower people with an HIV test? This editorial examines issues and challenges with the use of home-based HIV tests