A pi­lot project to be rolled out in two phas­es in the Caribbean sched­uled to con­clude in mid-year 2021, if suc­cess­ful, will start the in­tro­duc­tion of HIV self-test­ing in the Caribbean re­gion.

The ini­tia­tive was launched Mon­day dur­ing a vir­tu­al pan­el dis­cus­sion, which in­clud­ed rep­re­sen­ta­tives from the UN­AIDS col­lab­o­ra­tion with the Pan Amer­i­can Health Or­gan­i­sa­tion (PA­HO), the Pan Caribbean Part­ner­ship against HIV/AIDS (PAN­CAP), the Pres­i­dent’s Emer­gency Fund for AIDS Re­lief (PEP­FAR) and Caribbean Med Labs Foun­da­tion (CMLF) on an ad­vo­ca­cy strat­e­gy in sup­port of HIV self-test­ing.

Ac­cord­ing to pan­el­list and di­rec­tor of CMLF, Va­lerie Wil­son the pi­lot project was fund­ed by the Glob­al Fund Spe­cial COVID-19 al­lo­ca­tion and formed part of the HIV/TB (tu­ber­cu­lo­sis) Elim­i­na­tion Project, a col­lab­o­ra­tive ven­ture by key bod­ies in­clu­sive of the Or­gan­i­sa­tion of East­ern Caribbean States (OECS) and the Pan Amer­i­can Health Or­gan­i­sa­tion’s (PA­HO).

To­geth­er, the plan is to con­duct ver­i­fi­ca­tion and fea­si­bil­i­ty as­sess­ment for the in­tro­duc­tion of HIV self-test­ing with­in the Caribbean, us­ing World Health Or­gan­i­sa­tion (WHO) ap­proved self-test said to have a 95 per cent and be­yond ac­cu­ra­cy rate­to do the pi­lot project, which awaits coun­try ap­provals. The brand giv­en the green light is OraQuick—an at-home HIV test man­u­fac­tured by Ora­sure Tech­nolo­gies and ap­proved by the Unit­ed States Food and Drug Ad­min­is­tra­tion in 2012.

The HIV self-test as ex­plained by Wil­son will take on two for­mu­la­tions—test­ing by sali­va and test­ing by blood.

The move is be­ing made to fast track and ex­pand, test­ing in the Caribbean re­gion, but it al­so hopes to fight chal­lenges at play in achiev­ing ac­cess to health care—stig­ma and dis­crim­i­na­tion, fi­nan­cial straits, so­cio-cul­tur­al be­hav­iours and gen­der-based vi­o­lence, en­cap­su­lat­ing the 2020 World Aids Days theme— End­ing the HIV/AIDS Epi­dem­ic: Re­silience and Im­pact”

In meet­ing the UN­AIDS 90-90-90 tar­get—a strat­e­gy it en­gaged to bring HIV test­ing and treat­ment to all by 2020 and to re­duce the amount of HIV in their bod­ies to un­de­tectable lev­els, the Caribbean was lag­ging be­hind the glob­al av­er­age for test­ing, dis­closed yes­ter­day, by UN­AIDS Team Lead and Se­nior Ad­vi­sor, Guwani James.

Cur­rent­ly, the ra­tio of women to men in re­gards to test­ing and a re­duc­tion in di­ag­no­sis re­vealed men were al­so lag­ging.

It is with this in mind cou­pled with the chal­lenges brought on by the COVID-19 pan­dem­ic re­gard­ing ac­cess and HIV test­ing that the pan­el felt there was no bet­ter time to en­gage HIV self-test­ing. It was re­vealed yes­ter­day by co-pan­el­list and PA­HO’s HIV and STI, TB and vi­ral he­pati­tis tech­ni­cal ad­vi­sor, San­dra Jones, dur­ing the pan­dem­ic, par­tic­u­lar­ly dur­ing the pe­ri­ods of lock­down there was ev­i­dence the pan­dem­ic af­fect­ed the num­ber of per­sons ac­cess­ing HIV test­ing.

She said a sur­vey that was con­duct­ed by PAN­CAP in col­lab­o­ra­tion with PA­HO, showed ap­prox­i­mate­ly 69 per cent of the mem­ber states in the Caribbean which were sur­veyed, re­port­ed that COVID-19, had re­duced the num­ber of HIV test­ing ser­vices both at the fa­cil­i­ty and com­mu­ni­ty lev­els, while 33 per cent, re­port­ed a re­duc­tion in new di­ag­no­sis.

Jones said the de­cline in test­ing meant the un­di­ag­nosed were not get­ting life-sav­ing an­ti­retro­vi­ral med­ica­tion and con­tin­ue to be un­aware of their HIV sta­tus and po­ten­tial­ly ex­pos­ing oth­ers to the risk of HIV trans­mis­sion. COVID-19 pro­to­cols at pub­lic health fa­cil­i­ties was al­so now a de­ter­rent to peo­ple get­ting test­ed or ac­cess­ing treat­ment as it has tak­en away their pri­va­cy, Jones re­lat­ed.

Wil­son ex­plained: “The pur­pose of this pi­lot is to sup­port the ver­i­fi­ca­tion and fea­si­bil­i­ty of im­ple­ment­ing HIV self-test­ing and it is in­tend­ed to show and demon­strate the ac­cu­ra­cy of the test and how the test can be utilised in health fa­cil­i­ties and al­so at the com­mu­ni­ty lev­el by in­di­vid­u­als us­ing the test.

And the process would as­sess the ac­ces­si­bil­i­ty, ac­cept­abil­i­ty and the fea­si­bil­i­ty of HIV self-test­ing and the re­sults of that process will be analysed so that the in­for­ma­tion can sup­port the roll­out of the test­ing strat­e­gy in the re­gion of the Caribbean. But for any of this to be achieved, Wil­son said min­istries of health had to be on board.

“The con­text in which HIV self-test­ing is used is crit­i­cal go­ing for­ward, re­gard­ing where it would fit in the test­ing al­go­rithm and how the Min­istry of Health with its poli­cies, em­braced HIV self-test­ing as part of the strat­e­gy for en­gag­ing peo­ple who might be dif­fi­cult to reach through oth­er means.”

Phase one of the pi­lot project will deal with eval­u­at­ing the test kits to as­sess their per­for­mance, and then de­ter­min­ing the ac­ces­si­bil­i­ty, us­age and fea­si­bil­i­ty of the HIV self-test, with­in the com­mu­ni­ty and as­sess­ing the process for con­firm­ing re­ac­tive re­sults, to en­sure per­sons who have a re­ac­tive re­sult are brought in­to the stan­dard pro­to­cols for the na­tion­al al­go­rithm to con­firm their sta­tus and then go in­to care.

While phase two, if ap­proved by coun­tries will in­cor­po­rate, the dis­tri­b­u­tion of kits to users for them­selves and dis­tri­b­u­tion to their peers and part­ners through a sec­ondary dis­tri­b­u­tion process.

With the re­sults of the pi­lot project, Wil­son said they will in­form min­istries of health poli­cies, for in­clud­ing HIV self-test­ing in the fu­ture be­yond COVID-19, as it was a crit­i­cal strat­e­gy for en­sur­ing that the Caribbean could reach the 90-90-90 and even­tu­al­ly the 95-95-95 strate­gies.