Skip to main content

Advertisement

Log in

HIV Self-Testing: a Review of Current Implementation and Fidelity

  • The Science of Prevention (JD Stekler and J Baeten, Section Editors)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Oral HIV self-testing is an innovative and potentially high-impact means to increase HIV-case identification globally. As a screening test, oral HIV self-testing offers the potential for increased adoption through greater convenience and privacy, and the potential to increase the proportion of the population who test regularly. Research on how best to translate the innovation of oral self-testing to high-risk populations is underway. Currently only one oral HIV self-test kit is FDA-approved (OraQuick In-Home HIV Test) and available for retail sale. In the present report we review recent studies on the dissemination, adoption, and implementation of oral HIV testing. Prior work has focused primarily on adoption, but recent studies have begun to identify methods for improving dissemination and problems associated with self-implementation. At present a major barrier to wider adoption is the relatively high retail cost of the oral HIV test kit. Significant but minor barriers are represented by overly complex instructional materials for some population segments, and dissemination programs of unknown efficacy. Theoretical and practical suggestions for conducting research on dissemination, adoption, and implementation of oral HIV testing are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Chang LW et al. Combination implementation for HIV prevention: moving from clinical trial evidence to population-level effects. Lancet Infect Dis. 2013;13(1):65–76.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Obama BH. The white house office of national HIV/AIDS Policy. National HIV/AIDS strategy for the United States. 2010. Retrieved from https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf.

  3. Vermund SH et al. Can combination prevention strategies reduce HIV transmission in generalized epidemic settings in Africa? The HPTN 071 (PopART) study plan in South Africa and Zambia. J Acquir Immune Defic Syndr. 2013;63 Suppl 2:S221–7.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kulkarni SP et al. Clinical uncertainties, health service challenges, and ethical complexities of HIV “test-and-treat”: a systematic review. Am J Public Health. 2013;103(6):e14–23.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bradley H, et al. Morbitidy and Mortality Weekly Report. 2014, Centers for Disease Control and Prevention. p. 1113–1117.

  6. Wejnert C et al. HIV infection and awareness among men who have sex with men—20 cities, United States, 2008 and 2011. PLoS One. 2013;8(10):e76878.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Marks G et al. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.

    Article  PubMed  Google Scholar 

  8. Viall AH, et al. Results of the expanded HIV testing initiative-25 jurisdictions, United States, 2007–2010. Morb Mortal Wkly Rep [serial on the Internet] 2011;60, June 24. Available from: http://www.cdc.gov/mmwr/PDF/wk/mm6024.pdf.

  9. Fortenberry JD et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hightow-Weidman LB. Missteps, misunderstandings, and missed opportunities: HIV testing among young African-Americans. Sex Transm Dis. 2009;36(9):592–3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hyden C, Allegrante JP, Cohall AT. HIV testing sites’ communication about adolescent confidentiality: potential barriers and facilitators to testing. Health Promot Pract. 2014;15(2):173–80.

    Article  PubMed  Google Scholar 

  12. Johns MM, Bauermeister JA, Zimmerman MA. Individual and neighborhood correlates of HIV testing among African-American youth transitioning from adolescence into young adulthood. AIDS Education and Prevention. 2010;22(6):509–22.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Joseph HA, Fasula AM, Morgan RL, Stuckey A, Alvarez ME, Margolis A, et al. “The anticipation alone could Kill You”: past and potential clients' perspectives on HIV testing in non-health care settings. AIDS Education and Prevention. 2011;23(6):577.

  14. Peralta L et al. Barriers and facilitators to adolescent HIV testing. AIDS Patient Care STDS. 2007;21(6):400–8.

    Article  PubMed  Google Scholar 

  15. Hamel L, Firth J, Hoff T, Kates J, Levine S, Dawson L. HIV/AIDS in the lives of gay and bisexual men in the United States. Henry J. Kaiser Family Foundation. 2014.

  16. Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Trepka MJ, Kim S. Prevalence of human immunodeficiency virus testing and high-risk human immunodeficiency virus behavior among 18 to 22-year-old students and nonstudents: results of the National Survey of Family Growth. Sex Transm Dis. 2010;37(10):653–9.

    PubMed  Google Scholar 

  18. Hall HI et al. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004–2005. J Acquir Immune Defic Syndr. 2008;49(3):294–7.

    Article  PubMed  Google Scholar 

  19. Centers for Disease Control and Prevention. HIV surveillance report. http://www.cdc.gov/hiv/pdf/statistics_surveillance_report_vol_22.pdf. (2010) vol 22. Accessed 8 Aug 2015.

  20. Swenson RR et al. Prevalence and correlates of HIV testing among sexually active African-American adolescents in 4 US cities. Sex Transm Dis. 2009;36(9):584–91.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen M, Rhodes PH, Hall IH, Kilmarx PH, Branson BM, Valleroy LA. Prevalence of undiagnosed HIV infection among persons aged= 13 years—National HIV Surveillance System, United States, 2005–2008. 2012. MMWR 15 Jun 2013;61 Suppl:57--64.61(02), 57-64.

  22. Whitmore SK, Kann L, Prejean J, Koenig LJ, Branson BM, Hall HI, et al. Vital signs: HIV infection, testing, and risk behaviors among youths—United States. Am J Transplant. 2013;13(2):510--515.

  23. Centers for Disease Control and Prevention. CDC Fact Sheet. HIV testing in the United States. 2015. http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/hiv-testing-us-508.pdf. Accessed 8 Aug 2015.

  24. Catania J. Dissemination of at-home HIV testing to high-risk urban African American youth: barriers and solutions. In: 141st APHA Annual Meeting: Boston. 2013.

  25. Dolcini M, Catania JA, Gandelman A. Translating research into practice: the influence of organizational and client factors on fidelity of an evidence-based program. New Orleans, Louisiana: Annual meeting of the Society of Behavioral Medicine; 2012.

    Google Scholar 

  26. Mavedzenge SN, Baggaley R, Corbett EL. A review of self-testing for HIV: research and policy priorities in a new era of HIV prevention. Clin Infect Dis. 2013;57(1):126--138.

  27. Meyerson BE, Ryder PT, von Hippel C, Coy K. We can do more than just sell the test: pharmacist perspectives about over-the-counter rapid HIV tests. AIDS Behav. 2013;17(6):2109--2113.

  28. Pai NP, Sharma J, Shivkumar S, Pillay S, Vadnais C, Joseph L, et al. Supervised and unsupervised self-testing for HIV in high-and low-risk populations: a systematic review. PLoS Med. 2013;10(4): e1001414.

  29. Fixsen DL, Naoom SF, Blase KA, Friedman RM. Implementation research: a synthesis of the literature. 2005. Available at: http://nirn.fpg.unc.edu/resources/implementation-research-synthesis-literature.

  30. Ogden T, Fixsen D. Implementation science: a brief overview and look ahead. Z Psychol. 2014;222:4–11.

    Google Scholar 

  31. Wisdom JP, Chor KHB, Hoagwood KE, Horwitz SM. Innovation adoption: a review of theories and constructs. Administration and Policy in Mental Health and Mental Health Services Research. 2014;41(4):480--502.

  32. Bronson H. Self testing initiatives. Conference on Retroviruses and Opportunistic Infections. Presentation, 2015.

  33. Marlin RW, et al. Piloting an HIV self-test kit voucher program to raise serostatus awareness of high-risk African-Americans, Los Angeles. BMC Public Health. 2014;14:1226.

  34. Catania JA, et al. Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African-American youth. Transl Behav Med, 2015: p. 1-12

  35. Myers JE et al. Rapid HIV self-testing: long in coming but opportunities beckon. AIDS (London, England). 2013;27(11):1687–95.

    Article  Google Scholar 

  36. Myers J. HIV testing in New York City, in Conference on Retroviruses and Opportunistic Infections. 2015.

  37. Bustamante MJ, Konda KA, Joseph Davey D, León SR, Calvo GM, Salvatierra J, Brown B, Caceres CF, Klausner JD. HIV self-testing in Peru: questionable availability, high acceptability but potential low linkage to care among men who have sex with men and transgender women. Int J STD AIDS. 2016. doi:10.1177/0956462416630674.

  38. Young SD et al. Acceptability of using electronic vending machines to deliver oral rapid HIV self-testing kits: a qualitative study. PLoS One. 2014;9(7):e103790.

  39. Klausner JD. Innovations in HIV self testing delivery. Presentation presented at: Conference on Retroviruses and Opportunistic Infections 2015. Seattle, WA. 2015. http://www.hivst.org/directory-list/2015/4/8/innovations-in-hiv-self-testing-delivery-vending-machines-vouches-and-us-mail. Accessed 10 Aug 2015.

  40. Katz D, Golden M, Hughes J, Farquhar C, Stekler J. HIV self-testing increases HIV testing frequency among high-risk men who have sex with men: a randomized controlled trial. Eighth Conference on HIV Pathogenesis, Treatment and Prevention. Vancouver, Canada. Abstract MOPDC0103. 2015. http://www.natap.org/2015/IAS/IAS_08.htm. Accessed 10 August 2015.

  41. Thirumurthy H et al. Acceptability and feasibility of a novel approach to promote HIV testing in sexual and social networks using HIV self-tests. Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Vancouver, Canada. Abstract MOAC0302LB, 2015. 2015. http://www.aidsmap.com/HIV-self-testing-may-help-the-hard-to-reach-learn-their-status-but-uncertainties-remain/page/2988143/. Accessed 10 August 2015.

  42. Wood BR, Ballenger C, Stekler JD. Arguments for and against HIV self-testing. HIV/AIDS. 2014;6:117–26.

  43. Lippman S et al. Home HIV testing among transgender women in San Francisco: a pilot feasibility and acceptability study. Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Vancouver, Canada. Abstract MOPDC0104, 2015. http://www.aidsmap.com/HIV-self-testing-may-help-the-hard-to-reach-learn-their-status-but-uncertainties-remain/page/2988143/. Accessed 10 August 2015.

  44. Krause J, Subklew-Sehume F, Kenyon C, Colebunders R. Acceptability of HIV self-testing: a systematic literature review. BMC public health. 2013;13(1):1.

  45. Figueroa C et al. Attitudes and acceptability on HIV self-testing among key populations: a literature review. AIDS Behav. 2015;19(11):1949–65.

  46. Petroll AE et al. HIV testing rates, testing locations, and healthcare utilization among urban African-American men. Journal of urban health : bulletin of the New York Academy of Medicine. 2009;86(1):119–31.

    Article  Google Scholar 

  47. OraSure Technologies. Where to buy. 2015. http://www.oraquick.com/where-to-buy. Accessed 8 August 2015.

  48. Frye V et al. Just because it’s out there, people aren’t going to use it. HIV self-testing among young, black MSM, and transgender women. AIDS Patient Care STDS. 2015;29(11):617–24.

  49. Katz DA, Golden M, Hughes J, Farquhar C, Stekler J. Acceptability and ease of use of home self-testing for HIV among men who have sex with men. Conference on Retroviruses and Opportunistic Infections 2012. Seattle, WA. http://www.hivforum.org/storage/documents/_2012NationalSummit_Posting/a_044_katz.pdf. Accessed 9 Aug 2015.

  50. Li J et al. Analysis on willingness to pay for HIV antibody saliva rapid test and related factors. Chinese J Epidemiol. 2015;36(2):132–5.

    Google Scholar 

  51. Xun H et al. Factors associated with willingness to accept oral fluid HIV rapid testing among most-at-risk populations in China. PLoS One. 2013;8(11):e80594.

  52. Han L et al. HIV self-testing among online MSM in China: implications for expanding HIV testing among key populations. J Acquir Immune Defic Syndr. 2014;67(2):216–21.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Xu Y et al. Willingness to use the oral fluid HIV rapid test among men who have sex with men in Beijing, China. PLoS One. 2013;8(5):e64652.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Nettleman MD, Brewer JR, Ayoola AB. Self-testing for pregnancy among women at risk: a randomized controlled trial. Am J Prev Med. 2009;36(2):150–3.

    Article  PubMed  Google Scholar 

  55. Plappally A, Chen H, Ayinde W, Alayande S, Usoro A, Friedman KC, et al. A field study on the use of clay ceramic water filters and influences on the general health in Nigeria. J Health Behav Pub Health. 2011;1(1):1--14.

  56. Ouattara AF et al. Transmission of malaria in relation to distribution and coverage of long-lasting insecticidal nets in central Côte d’Ivoire. Malar J. 2014;13:109.

  57. Kyu HH et al. Evaluation of the association between long-lasting insecticidal nets mass distribution campaigns and child malaria in Nigeria. Malar J. 2013;12:14.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Epstein J. Food and Drug Administration. OraQuick in-home HIV test. Summary of Safety and Effectiveness. 2012. http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/PremarketApprovalsPMAs/UCM312534.pdf. Accessed 1 Aug 2015.

  59. Gaydos CA et al. Use of tablet-based kiosks in the emergency department to guide patient HIV self-testing with a point-of-care oral fluid test. Int J STD AIDS. 2013;24(9):716–21.

  60. Nour S et al. Patients can accurately perform their own rapid HIV point-of-care test in the emergency department. Point of Care. 2012;11(4):176–9.

    PubMed  PubMed Central  Google Scholar 

  61. Hurt CB, Powers KA. Self-testing for HIV and its impact on public health. Sex Transm Dis. 2014;41(1):10–2.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Catania JA et al. Translation of “at-home” HIV testing: response to Katz et al. and Hurt and Powers. Sex Transm Dis. 2014;41(7):454.

    Article  PubMed  Google Scholar 

  63. Ng OT et al. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test. PLoS One. 2012;7(9):e45168.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Marley G et al. Introducing rapid oral-fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges. BMC Public Health. 2014;14:422.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Peck R et al. What should the ideal look like? Study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa. AIDS Behav. 2014;18:422–32.

    Article  Google Scholar 

  66. Bastian LA et al. Diagnostic efficiency of home pregnancy test kits. A meta-analysis. Arch Fam Med. 1998;7(5):465–9.

    Article  CAS  PubMed  Google Scholar 

  67. Hicks JM, Iosefsohn M. Reliability of home pregnancy-test kits in the hands of laypersons. N Engl J Med. 1989;320(5):320–1.

    CAS  PubMed  Google Scholar 

  68. Wallace LS, Zite NB, Homewood VJ. Making sense of home pregnancy test instructions. J Womens Health (Larchmt). 2009;18(3):363–8.

    Article  Google Scholar 

  69. Glasgow RE, et al. Comparative effectiveness research to accelerate translation: recommendations for an emerging field of science. 2012:72–93.

  70. Marshall BDL, Wood E. Toward a comprehensive approach to HIV prevention for people who use drugs. J Acquir Immune Defic Syndr. 2010;55(Suppl 1):S23--6.

  71. Catania JA, Dolcini MM, Gandelman A, Narayanan V, McKay V. Impact of the economic downturn on HIV/STI prevention program fidelity. Translational Behavioral Medicine: Practice, Policy and Research. 2014;4:34–45.

  72. Dolcini MM, Gandelman AA, Vogan SA, Kong C, Leak TN, King AJ, et al. Translating HIV interventions into practice: community-based organizations’ experiences with the diffusion of effective behavioral interventions (DEBIs). Social Science & Medicine. 2010;71(10):1839--1846.

  73. Gandelman A, Dolcini MM. The influence of social determinants on evidence-based behavioral interventions—considerations for implementation in community settings. Translational Behavioral Medicine. 2012;2(2):137--148.

  74. Remien RH et al. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities. AIDS Behav. 2003;7(1):61–72.

  75. Veniegas RC, Kao UH, Rosales R. Adapting HIV prevention evidence-based interventions in practice settings: an interview study. Implement Sci. 2009;4:76.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Hunn C, Catania J, Dolcini MM, McKayV,Ndyetabula A, Ndyetabula C. Adaption of a self implemented HIV test among adolescent youth in Tanzania. San Antonio, TX: Society for Behavioral Medicine; 2015.

  77. Grinsztejn B et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–290.

  78. Johnson C et al. Realizing the potential for HIV self-testing. AIDS Behav. 2014;18 Suppl 4:S391–5.

    Article  PubMed  Google Scholar 

  79. Hatzold K. Stimulating and shaping the market for HIV self-testing in Africa UNITAID/PSI HIV STAR Project. Presentation presented at The Bill and Melinda Gates Foundation. 2015. Available at: http://www.hivst.org/directory-list/2015/3/30/stimulating-and-shaping-the-market-for-hiv-self-testing-in-africa-unitaidpsi-hiv-star-project. Accessed 5 August 2015.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey D. Klausner.

Ethics declarations

Conflict of Interest

Kristecia Estem, Joe Catania, and Jeffrey D. Klausner declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on The Science of Prevention

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Estem, K.S., Catania, J. & Klausner, J.D. HIV Self-Testing: a Review of Current Implementation and Fidelity. Curr HIV/AIDS Rep 13, 107–115 (2016). https://doi.org/10.1007/s11904-016-0307-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-016-0307-y

Keywords

Navigation