HIV Self-Testing Africa Project
Zambart, is part of a consortium of partners conducting the four-year HIV Self-Testing Africa (STAR) Study in fourteen urban and rural communities in Zambia. STAR is a three-country clinical research project comprising Zambia, Zimbabwe and Malawi, and aims to catalyse the market for HIV self-testing (HIV-ST) in urban and rural populations, and improve HIV testing through simple HIV-ST.
Zambart is conducting the clinical performance study (CPS) for which the study team has recruited over 1000 participants so far. Zambart is also conducting the Impact Evaluation (IE) assessment for which the baseline surveys are still ongoing and scheduled to be completed in December 2016. The CPS will determine whether the HIV self-test has good enough sensitivity and specificity to be used on a wide scale in groups with most urgent need, while the impact evaluation study will assess whether the use of HIV-ST increases uptake of testing and linkage to care.
Study Principal Investigator and Zambart Research Director Dr Helen Ayles, said HIV-ST can fill a gap that has been identified in many settings for HIV testing, and also contribute towards the achievement of first 90 targets. “The numbers of recruited participants for the CPS so far is already providing insights into the sensitivity and specificity of the tests as used by intended users,” she said.
Zambart is conducting the CPS in Kanakantampa and Mtendere communities in Lusaka Province, while the IE assessment is being carried out in Ng’ombe and Makeni communities also in Lusaka; Chankomo, Nkole, Saint Pauls, and Mpunde in Kapiri Mposhi, Central Province; Lubuto and Twapya in Ndola, Copperbelt Province, and in Mbabala, Mapanza, Sikalongo, and Batoka communities in Choma, Southern Province.
The STAR project is the largest evaluation of HIVST in Africa to date, the results of which will inform World Health Organisation normative guidance, support the establishment of appropriate policy, and encourage new manufacturers to enter the self-test market. It could potentially increase the uptake of quality assured HIVST among the general urban and rural population.
Zambart is implementing phase one of the STAR project in collaboration with Society for Family Health, Population Service International, London School of Hygiene and Tropical Medicine, and Liverpool School of Tropical Medicine. The STAR project is funded by UNITAID.
Dr Ayles said Zambia is keen to adopt the HIV-ST, but the high cost of the test kits could hamper this approach. “To invest in HIV-ST we need to be certain that it is safe, that people can get right result, that people know how to get confirmatory testing, and that people link in to prevention, treatment and care,” she said. The HIV-ST (which is a screening test only) currently costs more than three times the ordinary finger-prick HIV test.
Zambart has also begun to implement the 3ie HIV-ST within the on-going HPTN 071/ PopART study. “In the large PopART trial there are certain parts of the population that we are not reaching adequately using a strategy of door-to-door testing, for example, men. There are also certain people who have been seen twice now, but still do not want to test. We hope that HIV-ST could be useful in these groups.”
Dr Ayles said HIV counsellors within the PopART trial will be randomised to either carry routine test kits and HIV-ST, or routine test kits as they currently do now. “We hope to see a change in uptake of testing,” she said.