Where We’ve Come and Where We’re Going with HIVST’s

By Liz Corbett, Professor of Tropical Epidemiology, London School Hyg Trop Med & MLW Research Programme

This blog post is the final piece in a series on the HIV Self-Test Africa (STAR) project, which works in Zimbabwe, Zambia and Malawi. The STAR team will be in Blantyre, Malawi, from June 27 to July 1, 2016 with PSI Global Ambassador Debra Messing to learn more about how HIV Self-Testing can contribute to achieving the UN’s 90-90- 90 targets. Follow @psiimpact to see what the team is doing during this week.

The UNITAID-PSI STAR project is more than just another project to me – as my heart is every bit as much engaged as my head!  To me this is the culmination of pursuing academic curiosity that first came to my attention following a consultancy during development of the “Treat, Train and Retain” Strategy for Health Workers that the World Health Organization and UNAIDS initiated to contribute to human resources for health in the early days of ART scale-up in Africa.   Many of the health workers who we interviewed in 4 different African countries (including Malawi) had tested themselves informally — rising up to the great majority of those with frontline access to HIV test kits. Very few expressed any regrets.  And if this was such a strongly preferred option for so many health workers, then why not consider self-testing for the general public too?

Malawi has a very special place in the world of HIV and TB — being uniquely willing to try out new ideas, to be the first in the field, and to “learn by doing” and open share results, good and bad, in a way that is second to now and has led to many big advances.  Within 12 months of my moving to Malawi in 2009, some years after the health worker study, my new research team was evaluating HIV self testing in Blantyre with the blessing and active collaboration of the Ministry of Health and District Health Office, and showing very promising results.  We soon moved on to a larger scale project – for which I can thank the Wellcome Trust for their willingness to fund novel strategies — and again showed very exciting acceptability and feasibility.

We have so far seen, thankfully, that African adults are indeed willing and able to test themselves, and able to cope well with and act appropriately upon the information in the overwhelming majority. From our work so far in Malawi we have the testimony of numerous women who have spent years trying to persuade their husbands to accompany them to testing services, as well as from men who can never get beyond the ever-pressing responsibilities of providing for their families to make time for their own health needs.

Moving on to the UNITAID-funded STAR project is another leap up in scale and sophistication for me as well as for self-testing.  We have a great team — almost all women(!) — leading the implementation research from a UK-University partnership led by London School, plus all of the collective drive, wisdom, technical expertise, know-how and organizational reach of PSI, WHO and the various supporting Ministries of Health.  One of the many things that I have learnt already is just how much multidisciplinary expertise is required to take promising interventions to scale, and especially when aiming to generate the “market dynamics” that UNITAID so uniquely enables and demands.

Testing yourself and being the first to see the results is very much a personal decision.  But for the many Africans, HIV remains an all too personal intrusion in day-to-day life — as a cause of worry, as a cause of illness, as a cause of death, as a cause of bereavement and as a cause of lasting grief. I have spoken to many, many ordinary Africans about how they feel about oral HIV self testing… The reaction is always the same — “Why don’t we know about this already?”  “We should all be provided with these tests to use for ourselves every year …”.  Of course, there are unintended consequences in every new innovation — and with that the need for research to anticipate and mitigate these.  Nonetheless, I am just so confident in the team, the product and the collective strengths of our participating communities that I just can’t wait to get all of our sub-studies started and get moving on planning for Phase 2!