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Successful use of HIV self-tests in rural Lesotho

Niklaus Labhardt, President of SolidarMed, together with his team at the Swiss Tropical and Public Health Institute and employees of SolidarMed, has developed a strategy to increase HIV test coverage by 20 percent in the remote areas of Lesotho. In this strategy, home visits are combined with HIV self-tests.

"Door-to-door" HIV testing campaigns are a promising solution to fight the HIV epidemic. (Photo credit: Alain Amstutz)

Early diagnosis is important

In 2019, around 38 million people worldwide were infected with the HI virus. Around two thirds of those affected live on the African continent. Despite the great progress in prevention and therapy, millions of people are still getting infected with the virus every year. These new infections also emerge because many people are unaware of their own status and access to antiretroviral therapies is difficult. This is particularly the case in remote areas, where the way to test centers and clinics is long. To contain the epidemic, innovative methods are therefore needed to enable all those affected to be diagnosed early on. If they receive antiretroviral therapy at an early stage, further transmission of the HI virus can be prevented. SolidarMed President, Niklaus Labhardt, together with his research group and employees of SolidarMed, has now been able to significantly improve the success of "door-to-door" testing campaigns thanks to HIV self-testing.

Ntate Koloko explains to a villager how to use the HIV self-test. (Photo credit: Alain Amstutz)

Case study Lesotho

In Lesotho, every fourth adult is infected with HIV. It is estimated that about 15 percent of the infections in the small mountainous country at the southern tip of Africa remain undetected and thus contribute to the spread of HIV. For many inhabitants of Lesotho, the nearest clinic is a several hour walk or an expensive cab ride away. To facilitate access to health services and HIV testing, health centers regularly organize "door-to-door" campaigns. Studies have shown, however, that they only reach about 60 percent of the village population, because many of them have to work outside the home.

Niklaus Labhardt's team has now developed a strategy to improve test coverage by 20 percent. For the first time, home visits were combined with HIV self-tests. If villagers are absent during the home visits, the campaign team leaves self-tests with instructional material in the local language. Village health advisors, who have been trained in the use and evaluation of the self-tests, collect the self-tests again afterwards.

While an adolescent waits eagerly for his self-test result, Mme Mathato explains once again how an HIV-positive result can be identified on the self-test. (Photo credit: Alain Amstutz)

Simple approach, great effect

The large-scale, randomized study included over 150 villages with more than 7000 villagers. The results of this simple approach speak for themselves: At 81 percent, the HIV test rate in the entire population of the intervention group was 20 percent higher than in the control group.

The number of AIDS deaths has been declining worldwide since 2010. At the same time, there were still 1.7 million new infections in 2019, half of them in Africa. "Especially in rural areas, an alternative to traditional health campaigns is therefore needed to achieve optimal test coverage. Our strategy is another important building block on the way to ending the HIV/AIDS epidemic in southern Africa," said Prof. Dr. Labhardt.

Publication: The Lancet HIV

Publication: Journal of the International Aids Society