Employers should take cognisance of the following aspects when implementing HIV self-testing programmes:
A process in which a person collects their own specimen and then performs a test and interprets the result.
HTS, including HIVST should adhere to the WHO 5Cs: consent, confidentiality, counselling, correct test results and connection. These guiding principles are found in the National HIV Testing Services Policy 2016[6].
| 7.3. | Benefits of HIV self-testing |
| i. | It is done in a private setting; |
| ii. | It provides an ability to reach those who are not able to go to health care facilities |
| iii. | First time testers, with possibly undiagnosed HIV can be reached |
| iv. | Employees can have an option to test; and |
| v. | Employers can ensure employees have ongoing access to the HIV self-testing services. |
| vi. | Employees are empowered to manage their health. |
| vii. | HIV self-testing reduces the number of times testers have to visit clinics and eliminates the need for individuals to travel distances or wait in long lines to access HIV testing. |
| viii. | There is an additional benefit by reducing the impact on limited government resources which can now be redirected to servicing those individuals with a reactive (positive) self-test result and who are in need of further testing, support and referral. |
| ix. | HIV self-testing is beneficial to people who are at ongoing high-risk exposure to HIV infection and for those who require regular retesting. |
| x. | HIV testing breaks down some of the traditional barriers that prevent individuals from going for an HIV Test. The self-test can be done in complete privacy, so there is absolutely no risk of being stigmatized. |
| xi. | HIV self-testing increases the opportunity for employers to reach those who usually do not go for an HIV Test to know their status. |
| 7.4. | Implementation methods/options of the HIV self-testing |
In undertaking HIV self-testing processes, two options are available:
| 7.4.1. | Directly assisted, whereby a trained provider or peer before or during HIVST will provide help in-person, by demonstrating on how to use the kit and how to interpret results. As part of this, directly assisted persons can access support via a telephone hotline, video, brochures, and referrals (if indicated). |
| 7.4.2. | Unassisted, whereby the individual performs an HIVST using the information package in the kit itself without any assistance from anyone. |
| 7.5. | Process to be followed in implementing HIV self-testing |
The recommended process to be followed in the implementation of the HIVST programme should be distribution and provision of information, including education and communication; counselling; distribution of the HIV self-testing kits; testing; interpretation of the results; following-up and responding to results.
| 7.5.1. | Information, education and communication. |
Information on self-testing should be made available in different forms and should cover the following but not limited to:
| (a) | Induction (training should include information of self-testing). |
| (b) | Primary health consultations (every consultation with health professional). |
| (c) | Occupational health consultations (medical surveillance examinations). |
| (d) | Health and Safety campaigns (wellness days, TB days, Cancer days, etc). |
| (e) | Meetings (health and safety committee meetings, management meetings, organised labour meetings, toolbox meetings, etc). |
| (f) | Employees to encourage their partners and acquaintances to know their status. |
| (h) | Information leaflets. |
| 7.5.2.1. | Pre-test information and/or counselling can be provided in a group setting. However, post-test counselling must be done on an individual basis. All persons should have the opportunity to ask questions privately. |
| 7.5.2.2. | In the context of HIVST, it is important to note that pre-test information and post-test counselling can be provided using a directly assisted approach (for example, in-person demonstration and explanation by a trained provider or peer) or using an unassisted approach (for example, use of manufacturer provided instructions), as well as a number of other support tools. The instructions on how to perform a self-test and how to interpret the self-test result, is provided in addition to the manufacturer-supplied instructions for use and other materials found inside HIVST kits. (End 27 Sept 2018). |
| 7.5.3. | Distribution of the HIV self-testing kits |
In distributing HIV self-testing kits, NDOH quality assured products that have been approved for use in South Africa, must be distributed using different distribution options.
| 7.5.3.1. | Distribution options |
This occurs when a self-screening kit is delivered directly to the end-user.
| (b) | Secondary distribution |
This occurs when one or more self-screening kits are given to an individual, not for their own use, but to distribute to their sexual partner, family member or anyone in their network.
| 7.5.3.2. | Methods for distribution |
The HIV self-testing kits can be distributed in the following manner:
| (a) | Community-based platforms which entails door-to-door delivery; |
| (b) | Clinic-based channel which aims to promote couple/partner testing; |
| (c) | Workplace programmes which can be used to reach those at high risk such as miners, truck drivers and their partners; and |
| (d) | Can be given directly to the end-user or partner delivery to sexual partner. |
When conducting HIV self-testing it is important to highlight that:
| (a) | Those on ARVs (HIV treatment and PrEP) should not do an HIV self-testing as they may get false non-reactive/negative results. |
| (b) | If a person is uncertain about how to correctly perform the self- test, or interpret the self-testing result, he or she should be encouraged to access the conventional facility or community-based HIV testing. |
| 7.5.5. | Interpretation of the results |
| 7.5.5.1. | It is important to note that HIVST does not provide a definitive HIV-diagnosis positive because as with all HIV testing a single rapid diagnostic test (RDT) is not sufficient to make an HIV positive diagnosis therefore HIVST is considered to be a screening test. |
| 7.5.5.2. | Interpretation of the results will be as per the manufacturer’s guide. If a person is uncertain about how to correctly interpret the self- test results, he or she should be encouraged to access the conventional facility or community-based HIV testing. |
| (a) | A reactive (positive) self-test result requires further confirmatory testing from a trained tester using a validated national HIV testing algorithm. |
| (b) | Those with a non-reactive (negative) self-screening result should retest if - exposed to HIV in the preceding six weeks, or high ongoing HIV risk. |
| 7.5.7. | Response to results |
In responding to the results gathered, counselling should have covered the following:
| (a) | A clear direction and action on how to respond to the testing results i.e. meaning and implications of a test result and contact numbers of the professional to assist with results interpretation and action thereafter. |
| (b) | A clinic address or a facility address to visit/contact to discuss and act on the results. |
| (c) | Confirmatory laboratory tests should be made available and re-enforcement of post-test counselling should be mandatory. |
| 7.6. | Monitoring, evaluation and reporting |
| 7.6.1. | The following have been proposed as minimum monitoring and evaluation during the initial roll-out of HIVST: |
| (a) | Periodical assessment of the hotline for HIVST related calls requesting information, assistance, counselling and support. |
| (b) | Reporting of adverse events to the national hotline, on dedicated web and social media platforms. |
| (c) | Post-marketing surveillance data of companies. |
| (d) | Linkage to care through e-health platforms. |
| 7.6.2. | The data needs to be collected and collated in a manner that will inform the data that goes into the DMR 164 Reporting Form. |
| 7.6.3. | Companies are encouraged to keep data at mine level to demonstrate the impact of HIV self-testing in relation to closing the testing gap. |
The roles players who are required in implementing the requirements of HIV self-testing include:
| i. | Health care professionals. |
