Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study

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dc.contributor.authorPai, Nitika Panten_ZA
dc.contributor.authorBehlim, Tarannumen_ZA
dc.contributor.authorAbrahams, Lamezeen_ZA
dc.contributor.authorVadnais, Carolineen_ZA
dc.contributor.authorShivkumar, Sushmitaen_ZA
dc.contributor.authorPillay, Sabrinaen_ZA
dc.contributor.authorBinder, Ankeen_ZA
dc.contributor.authorDeli-Houssein, Ronien_ZA
dc.contributor.authorEngel, Noraen_ZA
dc.contributor.authorJoseph, Lawrenceen_ZA
dc.contributor.authorDheda, Keertanen_ZA
dc.date.accessioned2016-01-11T06:51:37Z
dc.date.available2016-01-11T06:51:37Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. METHODS: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. FINDINGS: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0-100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0-51.0). A majority of participants (78.1%) were females, aged 18-24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8-6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9-91.0); specificity:100% (95% CI, 98.1-100). Interpretation Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered.en_ZA
dc.identifier.apacitationPai, N. P., Behlim, T., Abrahams, L., Vadnais, C., Shivkumar, S., Pillay, S., ... Dheda, K. (2013). Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study. <i>PLoS One</i>, http://hdl.handle.net/11427/16249en_ZA
dc.identifier.chicagocitationPai, Nitika Pant, Tarannum Behlim, Lameze Abrahams, Caroline Vadnais, Sushmita Shivkumar, Sabrina Pillay, Anke Binder, et al "Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study." <i>PLoS One</i> (2013) http://hdl.handle.net/11427/16249en_ZA
dc.identifier.citationPant, P. N., Behlim, T., Abrahams, L., Vadnais, C., Shivkumar, S., Pillay, S., ... & Dheda, K. (2012). Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study. PloS one, 8(11), e79772. doi:10.1371/journal.pone.0079772en_ZA
dc.identifier.ris TY - Journal Article AU - Pai, Nitika Pant AU - Behlim, Tarannum AU - Abrahams, Lameze AU - Vadnais, Caroline AU - Shivkumar, Sushmita AU - Pillay, Sabrina AU - Binder, Anke AU - Deli-Houssein, Roni AU - Engel, Nora AU - Joseph, Lawrence AU - Dheda, Keertan AB - BACKGROUND: In South Africa, stigma, discrimination, social visibility and fear of loss of confidentiality impede health facility-based HIV testing. With 50% of adults having ever tested for HIV in their lifetime, private, alternative testing options are urgently needed. Non-invasive, oral self-tests offer a potential for a confidential, unsupervised HIV self-testing option, but global data are limited. METHODS: A pilot cross-sectional study was conducted from January to June 2012 in health care workers based at the University of Cape Town, South Africa. An innovative, unsupervised, self-testing strategy was evaluated for feasibility; defined as completion of self-testing process (i.e., self test conduct, interpretation and linkage). An oral point-of-care HIV test, an Internet and paper-based self-test HIV applications, and mobile phones were synergized to create an unsupervised strategy. Self-tests were additionally confirmed with rapid tests on site and laboratory tests. Of 270 health care workers (18 years and above, of unknown HIV status approached), 251 consented for participation. FINDINGS: Overall, about 91% participants rated a positive experience with the strategy. Of 251 participants, 126 evaluated the Internet and 125 the paper-based application successfully; completion rate of 99.2%. All sero-positives were linked to treatment (completion rate:100% (95% CI, 66.0-100). About half of sero-negatives were offered counselling on mobile phones; completion rate: 44.6% (95% CI, 38.0-51.0). A majority of participants (78.1%) were females, aged 18-24 years (61.4%). Nine participants were found sero-positive after confirmatory tests (prevalence 3.6% 95% CI, 1.8-6.9). Six of nine positive self-tests were accurately interpreted; sensitivity: 66.7% (95% CI, 30.9-91.0); specificity:100% (95% CI, 98.1-100). Interpretation Our unsupervised self-testing strategy was feasible to operationalize in health care workers in South Africa. Linkages were successfully operationalized with mobile phones in all sero-positives and about half of the sero-negatives sought post-test counselling. Controlled trials and implementation research studies are needed before a scale-up is considered. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pone.0079772 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study TI - Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study UR - http://hdl.handle.net/11427/16249 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16249
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0079772
dc.identifier.vancouvercitationPai NP, Behlim T, Abrahams L, Vadnais C, Shivkumar S, Pillay S, et al. Will an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility study. PLoS One. 2013; http://hdl.handle.net/11427/16249.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Pulmonologyen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the <a href=en_ZA
dc.rights.holder© 2013 Pant Pai et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherInterneten_ZA
dc.subject.otherCell phonesen_ZA
dc.subject.otherNursesen_ZA
dc.subject.otherPilot studiesen_ZA
dc.subject.otherSexually transmitted diseasesen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.titleWill an unsupervised self-testing strategy for HIV work in health care workers of South Africa? A cross sectional pilot feasibility studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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