He opens the test kit and takes out the testing device. He then swabs his upper and lower gums for a saliva sample with the device, following which he places the device in a tube with a solution.
Moses Kumwenda, senior social scientist in the Self-Testing Africa-Malawi (Star-M) Cluster Randomised Trial (CRT), is demonstrating how the OraQuick HIV self-test works.
“The results will be ready in 20 to 40 minutes. One line will appear if the test is negative. But two lines indicate that HIV antibodies were detected and that you may be HIV positive,” says Kumwenda.
He is quick to add though, that once you get your results, a follow-up confirmatory testing is needed at a health clinic.
As he continues to explain how the OraQuick works, the results of his test are ready.
“What that result means is that further testing is needed to confirm your HIV status. Look at this as a first step in HIV testing. No test is perfect. So, if you get a result, it is very important that you see a health care professional for confirmation,” explains Kumwenda.
The Star-M CRT is being implemented locally by Malawi-Liverpool Wellcome (MLW) Trust and other partners including Population Services International (PSI) and the Ministry of Health.
After the trials, it is anticipated that if government approves this method of testing, it could provide improved access to HIV testing, thereby encouraging more people to know their sero-status.
As Kumwenda says: “This test targets people who would not otherwise be tested. There is a large group of people who are infected, and do not know it. And even if they are engaged in behaviours that would put them at risk of getting HIV, they may be reluctant to visit their doctor or a health care facility to be tested.”
The Joint United Nations Programme on HIV and Aids (UNAids) estimates that only 51 percent of people living with HIV globally know their status. This means the remaining 49 percent do not know their HIV status and hence they run the risk of passing on the virus to others.
In Malawi, it is mostly women that go for HIV testing, particularly during pregnancy as they take the test to prevent transmitting the virus to their unborn children.
About 1.7 million people of Malawi’s estimated 17 million population are HIV positive. Although there has been an increase in access to treatment, UNAids estimates that 42 000 people continue to contract the virus every year in the country, translating to five people every hour.
This, however, represents a 38.1 percent decrease compared to 69 000 new infections every year recorded in 2009.
Research shows that HIV self-testing is a great way to reach key populations for HIV testing such as men that have sex with men (MSM) who have never tested for HIV, and the youth.
UNAids Malawi country director Amakobe Sande said during the commemoration of World Aids Day last December that Malawi may not effectively deal with the epidemic if there are groups of people that are not able to access HIV-related services because they are either stigmatised and discriminated against because of their HIV status, gender, sexual orientation or age.
Sande further said Malawi loses about 33 000 people to Aids-related deaths every year, and that most of them are men.
Towards 90-90-90 target
Last year, Malawi adopted the World Health Organisation (WHO) 90-90-90 target aimed at eliminating HIV by 2030.
The ambitious target seeks to have 90 percent of all people living with HIV know their HIV status by 2020, 90 percent of all people with diagnosed HIV infection to receive sustained antiretroviral therapy by 2020, and 90 percent of all people receiving antiretroviral therapy to have viral suppression by the same year.
Kumwenda says the HIV self-testing is set to help meet the 90-90-90 targets as more people will know their status and thereby seek the necessary treatment.
“We know that the normal HIV testing method has failed to reach those targets, but this one [self-testing] is more flexible as it allows for confidentiality,” he says.
Through the Star-M CRT, over 2.7 million HIV self-testing kits will be distributed to communities in rural and peri-urban areas of four high HIV prevalence districts of Blantyre, Machinga, Mwanza and Neno. The Star-M is part of a larger Star trial being conducted in Zambia, Malawi and Zimbabwe.
According to MLW, after the trials,the test kits will be available for free in government medical facilities and for sale in selected shops and pharmacies.
The first phase of the trial starts in June this year and ends in 2017.
Among other things, the CRT will assess the acceptability of HIV self-testing, identify policy and regulatory barriers and enablers to the scale up of HIV self-testing.
Malawi has a 10 percent HIV prevalence rate, one of the highest in the world.