A 69 per cent re­duc­tion in fa­cil­i­ty and com­mu­ni­ty-based HIV test­ing ser­vices due to COVID-19 is putting peo­ple with un­di­ag­nosed HIV at risk of not get­ting life­sav­ing an­ti­retro­vi­ral treat­ment po­ten­tial­ly ex­pos­ing oth­ers as they are un­aware of their sta­tus.

This was the con­cern raised by San­dra Jones, PA­HO’s Tech­ni­cal Ad­vi­sor for HIV/STI, TB & Vi­ral He­pati­tis in the Caribbean, as she joined with oth­er stake­hold­ers in the re­gion in call­ing for coun­tries to adopt HIV self-test­ing.

Dur­ing the vir­tu­al launch of the “In Your Hands” Caribbean HIV self-test­ing cam­paign yes­ter­day, part­ners ad­vo­cat­ed for self-test­ing poli­cies to be de­vel­oped and im­ple­ment­ed as part of a com­pre­hen­sive strat­e­gy to en­sure that HIV di­ag­no­sis does not de­cline dur­ing the COVID-19 pan­dem­ic.

The ad­vo­ca­cy cam­paign is joint­ly en­dorsed by the Joint Unit­ed Na­tions Pro­gramme on HIV/AIDS (UN­AIDS), Pan Amer­i­can Health Or­ga­ni­za­tion (PA­HO), Pan Caribbean Part­ner­ship against HIV and AIDS (PAN­CAP), Pres­i­dent’s Emer­gency Plan for AIDS Re­lief (PEP­FAR) and the Caribbean Med Labs Foun­da­tion (CMLF).

Even be­fore COVID-19 the Caribbean was not on track to achieve the 90-90-90 test­ing and many of those on an­ti­retro­vi­ral ther­a­py were vi­ral­ly sup­pressed.

Ac­cord­ing to UN­AIDS Caribbean Sub-re­gion­al Of­fice Di­rec­tor, Dr James Guwani, it is par­tic­u­lar­ly im­por­tant to in­crease test­ing up­take among men who are more like­ly to be di­ag­nosed late. In 2019, 85 per cent of Caribbean women liv­ing with HIV were aware of their sta­tus as com­pared to 72 per cent of men. There is al­so a need to in­crease test­ing cov­er­age among mem­bers of key pop­u­la­tion com­mu­ni­ties who have re­duced ac­cess to HIV ser­vices due to stig­ma and dis­crim­i­na­tion.

HIV self-test­ing is a process where­by a per­son col­lects a sali­va or pin­prick blood spec­i­men, per­forms a test, and re­ceives the re­sult in pri­vate. The World Health Or­ga­ni­za­tion (WHO) rec­om­mends that HIV self-test­ing be of­fered as an ad­di­tion­al ap­proach to fa­cil­i­ty- and com­mu­ni­ty-based ser­vices. Ev­i­dence shows that self-test­ing is safe and ac­cu­rate and in­creas­es test­ing up­take among peo­ple who may not test oth­er­wise. Na­tion­al poli­cies should in­clude a com­mu­ni­ca­tion pack­age with in­for­ma­tion to link testers to pre­ven­tion and treat­ment ser­vices, as well as min­i­mum stan­dards for the pro­cure­ment and dis­tri­b­u­tion of HIV self-test kits in the pri­vate and pub­lic sec­tors.

At the launch, lead­ers from com­mu­ni­ties of peo­ple liv­ing with HIV and key pop­u­la­tions en­dorsed the call for HIV self-test­ing. At the same time, they ad­vised that in­creased in­vest­ments are need­ed in post-test coun­selling and ad­her­ence coun­selling for the en­tire HIV re­sponse.

CMLF Di­rec­tor Va­lerie Wil­son said un­der the Glob­al Fund Project for the re­gion and in col­lab­o­ra­tion with PAN­CAP, the Caribbean Vul­ner­a­ble Com­mu­ni­ties Coali­tion (CVC), the Cen­tre for Ori­en­ta­tion and In­te­gral Re­search (COIN), the Or­ga­ni­za­tion of East­ern Caribbean States HIV/TB Elim­i­na­tion Project and PA­HO, work is un­der­way to con­duct a ver­i­fi­ca­tion and fea­si­bil­i­ty as­sess­ment for the in­tro­duc­tion of HIV self-test­ing with­in the re­gion.

“HIV self-test­ing has the po­ten­tial to be a high im­pact, low-cost in­ter­ven­tion to reach pop­u­la­tion groups that are not test­ing and to in­crease the num­ber of peo­ple liv­ing with HIV who are iden­ti­fied and have ini­ti­at­ed treat­ment,” she said.