Why HIV self-testing can be a game-changer for Mizoram

Human immunodeficiency virus or HIV attacks the body’s immune system. If left untreated, HIV can lead to AIDS, a debilitating and deadly disease. However, modern antiretroviral therapy (ART) regimens can help people living with HIV live long and healthy lives. The virus is transmitted via contact with infected body fluids, often through sexual contact or contaminated needles (for blood transfusions, injecting drugs).

HIV burden in Mizoram

An estimated 25.44 lakh people live with HIV in India.

Among all states, Mizoram has the highest prevalence of HIV in the adult population. According to Sankalak (2024), the flagship publication of the National AIDS Control Programme, 2.73% of all adults in the state are infected with HIV — 13 times the national average. Nagaland (1.37%), Manipur (0.87%), Andhra Pradesh (0.62%), and Telangana (0.44%) complete the list of the five states with the highest HIV burden in the adult population.

According to the National AIDS Control Organisation’s ‘HIV Sentinel Surveillance Technical Brief 2016-17’, 19.8% of individuals in Mizoram who inject drugs were infected with HIV, as were 24.7% of female sex workers — also highest in the country.

“In Mizoram… the high prevalence among high risk groups points to an epidemic largely fuelled by injecting drug behavior but also supported through commercial exchange of sex,” the technical brief said.

The study & HIV self-testing

Mizoram witnessed an uptick in annual new HIV infections in 2017/2018, following which Pune-based ICMR-NITVAR planned a series of focussed investigations and “rapid situation and response assessments”, aiming to draw upon community voices. The latest study was one such assessment planned.

“The aim was also to investigate the potential of HIV self-test to reach individuals who otherwise might not access testing or anti-retroviral therapy,” study lead author Dr Amrita Rao, Scientist D, Division of Clinical Sciences, ICMR- NITVAR , Pune told The Indian Express.

HIV self-testing is a process in which individuals collect their blood and saliva specimens, and themselves interpret the results using a test kit. Such self-testing has been adopted by nearly 41 countries ever since the World Health Organization in 2016 released guidelines for the same. India is yet to introduce guidelines.

This is why, beyond simply making available self-test kits, the study looked at how implementation of a self-testing program may be done. Qualitative in-depth interviews were conducted with HIV program officials, religious leaders, community influencers, youths, and key population groups. Information gathered here guided strategic communication, community engagement, and the delivery of HIV self-test kits. Specifically, linkages were established with community-based organisations, church-based youth associations, college festivals, outreach sites at street corners, pharmacies, and community events.

First-time testers come forward

Published on February 5 in the journal Frontiers of Public Health, the study reported that some 2,101 youths in Aizawl came forward to take HIV tests in the six months when strategised HIV self-testing was implemented. As many as 1,772 of these (or 84%) were first-time testers.

A high proportion (85%) of youths aged 18-24 years who tested positive in the self-tests went on to take confirmatory tests, and were linked with ART.

“This highlights the appropriateness of the innovative intervention as compared to traditional awareness campaigns,” Dr Panda said. Early HIV testing plays an important role in early HIV detection followed by treatment, if necessary. “We realised that HIV self-testing played an essential role as a screening test,” Dr Rao added.

The study says that this model is replicable in other states as well.