A pilot project to be rolled out in two phases in the Caribbean scheduled to conclude in mid-year 2021, if successful, will start the introduction of HIV self-testing in the Caribbean region.

The initiative was launched Monday during a virtual panel discussion, which included representatives from the UNAIDS collaboration with the Pan American Health Organisation (PAHO), the Pan Caribbean Partnership against HIV/AIDS (PANCAP), the President’s Emergency Fund for AIDS Relief (PEPFAR) and Caribbean Med Labs Foundation (CMLF) on an advocacy strategy in support of HIV self-testing.

According to panellist and director of CMLF, Valerie Wilson the pilot project was funded by the Global Fund Special COVID-19 allocation and formed part of the HIV/TB (tuberculosis) Elimination Project, a collaborative venture by key bodies inclusive of the Organisation of Eastern Caribbean States (OECS) and the Pan American Health Organisation’s (PAHO).

Together, the plan is to conduct verification and feasibility assessment for the introduction of HIV self-testing within the Caribbean, using World Health Organisation (WHO) approved self-test said to have a 95 per cent and beyond accuracy rateto do the pilot project, which awaits country approvals. The brand given the green light is OraQuick—an at-home HIV test manufactured by Orasure Technologies and approved by the United States Food and Drug Administration in 2012.

The HIV self-test as explained by Wilson will take on two formulations—testing by saliva and testing by blood.

The move is being made to fast track and expand, testing in the Caribbean region, but it also hopes to fight challenges at play in achieving access to health care—stigma and discrimination, financial straits, socio-cultural behaviours and gender-based violence, encapsulating the 2020 World Aids Days theme— Ending the HIV/AIDS Epidemic: Resilience and Impact”

In meeting the UNAIDS 90-90-90 target—a strategy it engaged to bring HIV testing and treatment to all by 2020 and to reduce the amount of HIV in their bodies to undetectable levels, the Caribbean was lagging behind the global average for testing, disclosed yesterday, by UNAIDS Team Lead and Senior Advisor, Guwani James.

Currently, the ratio of women to men in regards to testing and a reduction in diagnosis revealed men were also lagging.

It is with this in mind coupled with the challenges brought on by the COVID-19 pandemic regarding access and HIV testing that the panel felt there was no better time to engage HIV self-testing. It was revealed yesterday by co-panellist and PAHO’s HIV and STI, TB and viral hepatitis technical advisor, Sandra Jones, during the pandemic, particularly during the periods of lockdown there was evidence the pandemic affected the number of persons accessing HIV testing.

She said a survey that was conducted by PANCAP in collaboration with PAHO, showed approximately 69 per cent of the member states in the Caribbean which were surveyed, reported that COVID-19, had reduced the number of HIV testing services both at the facility and community levels, while 33 per cent, reported a reduction in new diagnosis.

Jones said the decline in testing meant the undiagnosed were not getting life-saving antiretroviral medication and continue to be unaware of their HIV status and potentially exposing others to the risk of HIV transmission. COVID-19 protocols at public health facilities was also now a deterrent to people getting tested or accessing treatment as it has taken away their privacy, Jones related.

Wilson explained: “The purpose of this pilot is to support the verification and feasibility of implementing HIV self-testing and it is intended to show and demonstrate the accuracy of the test and how the test can be utilised in health facilities and also at the community level by individuals using the test.

And the process would assess the accessibility, acceptability and the feasibility of HIV self-testing and the results of that process will be analysed so that the information can support the rollout of the testing strategy in the region of the Caribbean. But for any of this to be achieved, Wilson said ministries of health had to be on board.

“The context in which HIV self-testing is used is critical going forward, regarding where it would fit in the testing algorithm and how the Ministry of Health with its policies, embraced HIV self-testing as part of the strategy for engaging people who might be difficult to reach through other means.”

Phase one of the pilot project will deal with evaluating the test kits to assess their performance, and then determining the accessibility, usage and feasibility of the HIV self-test, within the community and assessing the process for confirming reactive results, to ensure persons who have a reactive result are brought into the standard protocols for the national algorithm to confirm their status and then go into care.

While phase two, if approved by countries will incorporate, the distribution of kits to users for themselves and distribution to their peers and partners through a secondary distribution process.

With the results of the pilot project, Wilson said they will inform ministries of health policies, for including HIV self-testing in the future beyond COVID-19, as it was a critical strategy for ensuring that the Caribbean could reach the 90-90-90 and eventually the 95-95-95 strategies.