JOHANNESBURG – A new agreement to slash the price of HIV self-tests in half could ultimately assist eight million people estimated to be unaware of their HIV status to know they are infected – and get them on treatment. 

The agreement announced on Wednesday between the Geneva-based international health agency, Unitaid, and the US-based global healthcare company, Viatris, will see poorer countries dramatically increase their access to the blood-based HIV self-tests made available for under $2 across 135 low and middle-income countries.

Unitaid said the deal follows a request for proposals launched by Unitaid and Population Services International (PSI) in 2020 to drive forward equitable access to these tests. 

The self-tests are seen as important tools to help people more easily discover their status and move towards the treatment they need, and thus reducing the HIV burden globally.

This is particularly relevant in poorer countries, where concerns around stigma and difficulties accessing healthcare can create significant barriers, said Unitaid.

“HIV self-testing is a crucial factor in helping people learn their status – it is one of the key ways in which the global goals for HIV will be achieved. This announcement today will have a concrete impact on the ability of countries to access affordable self-testing, a foundation of people-centred healthcare in which Unitaid has led the way,” said Unitaid Director of Programmes Robert Matiru.

Access to HIV- self-tests has been recognised as a key factor in meeting the global goal of 90% of people knowing their HIV status,” said the agency.

In just the past six years, that rate has nearly doubled, from 45% to 81%, it added.

However, achieving even higher testing rates has been hampered by the fact that the market for HIV self-tests in low- and middle-income countries have been dominated by a single affordable oral HIV test, the OraSure.

That test is sold in a limited number of poorer countries for $2, but elsewhere the price is higher, and other options have cost significantly more.

HIV Self-tests Deal Announced at the Right Time

The World Health Organization (WHO) welcomed the availability of the HIV self-testing kits to increase access to testing.

“This announcement is particularly timely now, as HIV self-testing has become an important choice during COVID-19, allowing people to test when other options are difficult to access or restricted,” Dr Meg Doherty, WHO Director of Global HIV, Hepatitis and STI said.

The self-test will be a vital tool in the fight against HIV/Aids in South Africa which has one of the largest burdens of HIV in the world with 7.9 million people living with HIV.

With over two years of implementing HIV self screening in SA, the country has seen the positive impacts of the intervention.

Said Dr Thato Chidarikire, Director of HIV Prevention Strategies at the National Department of Health of South Africa:  “We have managed to reach men, women between 19 and 24 years old, as well as [other] key populations.

Following on that, he said that the news of the price reduction “is very well-received by South Africa, as we are currently procuring the tests using domestic funding. Lower prices translate to more quantities and expansion of the programme to reach more untested and test-averse populations, contributing to the country reaching the 95-95-95 targets.”

Unitaid said another recently developed blood-based HIV self-test from US-based health care company Abbott Laboratories, which is currently undergoing regulatory review; it is also set to become part of the expanded Unitaid programme, which would see around one million self tests distributed “to stimulate in-country demand”.

How the HIV Self-test Works

HIV self-testing (HIVST) is a process whereby a person collects his or her own specimen using a simple rapid HIV test and then performs the test and interprets the results themselves.

An innovative WhatsApp interactive digital solution is used to support consumers by offering a platform to guide them through the HIVST experience with clear, concise and individualized instructions on how to properly administer the HIVST and accurately interpret the results. Based on the results, the WhatsApp platform informs the consumer of the appropriate next steps to link them to care and prevention services according to the outcome of their test.

Linkage to confirmative testing and care and treatment after an HIV positive self-test is crucial.

Over 3 million people in South Africa have used HIV self-test kits so far, either as oral fluid or blood-based kits.  SA’s Department of Health in collaboration with Unitaid and PSI’s  HIV Self-Testing Africa (STAR) Initiative project will further scale up HIVST to make it available wherever people want to access it, including through vending machines and online ordering or through peer-to-peer distribution.

To date, Unitaid investment has resulted in 5 million kits being distributed, with 21 million kits set to be procured by countries between 2020 and 2023. Additionally, self-testing protocols have been embedded in the health policies of more than 85 national governments.

Image Credits: ©PSI-Dogsontherunphotography, Dogsontherunphotography:.