The National AIDS Control Organisation (NACO) is considering promoting a HIV self-screening test among certain high-risk groups after a study revealed a great demand for the test. A qualitative study conducted by the Pune-based National AIDS Research Institute (NARI) among various groups — men having sex with men, Transgenders, truck drivers and young adults in Pune — found a high level of acceptability for the HIV self-assessment test. Dr Naresh Goel, deputy director general of NACO, told The Indian Express that they were deliberating on how the HIV self-assessment test could be promoted and introduced in the high-risk population groups. “This is one disease where pre and post-test counselling is rigorously followed at Integrated Counselling and Testing Centres. Entire information about the disease, how it occurs and other details, are provided, following which they are prepared to undertake the test. Self-testing can be done with doubtful efficacy. The issue is the counseling part. If that is not done properly and there are false negative or false positive reports based on just screening, then it can have an immense psychological impact,” he told The Indian Express.
NACO officials said they test about 5 crore people every year and nearly 1.8 lakh are diagnosed with the disease and put on treatment. “Six years ago, there were 6 lakh persons living with HIV (PLHIV) on treatment and the figure has more than doubled now. However, due to various reasons, some are lost to follow-up. There are an approximate 69,000 deaths per year. Our effort is to enrol the maximum number of people on ART (antiretroviral therapy),” said Dr Goel.
So, a World Health Organisation-supported NARI study on the acceptability of such a self-screening test has generated excitement among various PLHIV groups. “Certainly, our study shows there is a great deal of interest and excitement about this HIV self-assessment test,” Dr Samiran Panda, director of NARI, told The Indian Express.
“From our in-depth interviews and discussions with various community groups, we realised that there is a great deal of demand for this self-screening test for HIV… it is not a diagnostic test… some of the men having sex with men and Transgender groups were even appreciative of the fact that someone was asking about their opinion on such matters. The researchers were also given several suggestions on where these test kits should be made available and how they should be packaged,” said Dr Panda.
The study, which concluded recently, was designed to assess the performance and accuracy of an oral saliva test for HIV infection through a small-scale pilot investigation. The HIV oral saliva self test is an indigenous one and the NARI team had estimated the sensitivity and specificity of the test. “This is like a pregnancy test — the only difference being use of saliva rather than urine for this HIV self-screening — and the confirmatory test is done later on. These tests are available in USA and France and what was done at NARI was to examine the performance of an indigenously-developed oral saliva test for HIV infection,” explained Dr Panda.
The NARI director admitted that there were apprehensions that some would consider it to be a diagnostic test and would have suicidal thoughts if it was positive. Dr Panda, however, said that such an easy to use and cost-effective approach would help increase HIV screening rates and subsequently enable an early diagnosis and further linkage to treatment.
Active engagement of the community groups in such endeavors and seeking their suggestions would be of great help in mitigating such potential negative impacts, suggested Dr Panda.