Home testing

What is HIV home testing?
HIV home testing is available in some countries, and refers to two different types of test:

• Home collection - you collect the sample at home with a home collection kit and then send the specimen to a testing facility. Test results are then acquired telephonically.
• Home self-test - the test can be carried out entirely at home. The test instructions may advise the user to contact health care facilities should a positive result be obtained, but this is left up to the user.

Potential problems associated with home testing
Proponents of HIV home testing have argued that it would be an important means of improving access to testing for more people. They say that some people would prefer home testing to testing at a medical facility, because they would feel more secure that their confidentiality and anonymity would be maintained. These people might not otherwise get tested at all.

Other arguments in favour of home testing include the fact that HIV-negative persons would need only one test at home with little or no counselling, thus reducing costs.

Proponents of home testing also argue that pre-test counselling is not essential and post-test counselling could be provided more efficiently through telephone contact, which would be cheaper and guarantee anonymity.

However, there are major problems associated with home testing:

• Perhaps the major drawback to home tests is the fact that they do not come with appropriate pre- and post-test counselling. The implication of this is that people may not perform the test properly, and may not understand the implications of a positive or negative result. Counselling is vital for providing psychological support and guidance as to responsible behaviour once the person knows their HIV status. In many developing countries, telephone counselling would be impractical.
• Home testing kits have not been shown to be sufficiently accurate. The quality of the test at the time of use depends on several factors: the manufacturer, transport and storage at the sales venue and at home, and the quality of the sample collected.
• Opponents to home testing are also concerned about the potential abuse of home testing by institutions (employers, insurance companies, law enforcement, immigration control) and by sexual partners (especially men against women). Home tests could potentially be performed under threat or force, and the results not kept confidential.

The Pharmaceutical Council of South Africa has recommended to the Medicines Control Council that home tests be urgently evaluated, and, if found to be sufficiently effective, to be formally registered. The Council also has the standpoint that home test kits should only be sold at facilities where there are knowledgeable personnel, and where counselling is available.

Should people wish to use home test kits before this evaluation process has been completed, it is advised that they make sure that the test has at least been evaluated and registered in its country of origin. Many South African pharmacists have decided not to stock home tests, because of the doubts about their reliability.