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PRACTICE COMMENT

‘HIV self-test kits are a step forward but questions remain’

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Robert Downes welcomes the lifting of restrictions on the sale of HIV self-testing kits, which, if not perfect, are better than no test at all

Restrictions on the sale of HIV self-testing kits were revoked in April 2014, so it is now legal to sell these kits to the public. Expert national organisations such as the Terence Higgins Trust have welcomed the move as a way to encourage early diagnosis and improve quality of life for people with HIV.

For self-testing to be successful, it is vital that experts lead the design of home-testing kits to ensure they are reliable, user friendly and the first step in a long-term care pathway for those in whom HIV is diagnosed by such a test.

Having worked as a community clinical nurse specialist in HIV since 1995, I have seen the treatment for HIV infection develop and deliver a dramatic improvement in morbidity and mortality for those who are fortunate enough to have access to treatment.

Early diagnosis and treatment of HIV infection remain key in terms of not only the morbidity and mortality of the infected individual but also using treatment as prevention to stop onward transmission of HIV infection to others.

When comparing the design of conventional and home-testing kits, I wonder whether the latter will be of the same standard as the former. The quality of the kits should be of paramount importance. They will be subject to Medicines and Healthcare products Regulatory Agency quality assurance standards, but robust regulation is needed to prevent poorer-quality alternatives becoming available.

Correct use of the kit is also a challenge to ensure results are gathered as safely and accurately as possible. I would welcome a step-by-step, user-friendly pictorial guide taking patients through the process.

Another concern surrounds patients’ immediate reactions should their test be positive. When telling patients they are HIV positive, I usually do this within their home which allows me to provide support for them to come to terms with what it means for their future and that of their loved ones. If a home test is reactive, how can we ensure the patients will approach local services for help?

Regulations state that in the instructions manufacturers must direct users to clinical testing services should they have a reactive result. This is essential for self-testing. The information should be clear, simple and robust enough to demonstrate a self-directed care pathway, leading to contact with a HIV clinician.

As with most aspects of life – including healthcare provision – one size doesn’t fit all. HIV self-testing kits allow people to test in a way that is meaningful and matters to them, with any form of testing, for some, being better than no test at all, particularly those at risk of acquiring HIV infection.

Reducing the number of late HIV diagnoses must be the overarching principle behind any change of approach to HIV diagnosis, treatment and care. The use of new technologies is a way forward and the same standards of device and level of patient care must be maintained.

Robert Downes is community clinical nurse specialist HIV, Liverpool Community Health Trust.

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