Self-test key to dealing with HIV testing?

Daniel Mwanyali, 33, of Malawi’s populous township Ndirande, Blantyre has known the importance of getting tested for HIV. However, his efforts to get tested together with his wife were unsuccessful because, he says, she was reluctant to do so.

Mwanyali says he did not think much about it, thinking she was just afraid.

But things changed when she got pregnant. Mwanyali says during the pregnancy, she never went to the hospital for prenatal treatment. Looking back, he says, it was all because of fear of getting tested.

“When she was due for delivery, we had no choice but to go to the hospital. Doctors recommended she gets tested and the results turned out positive. However, I tested negative,” Mwanyali says.

He says he was shocked to find that he was HIV-negative, and took numerous subsequent tests to verify his status.

However, Mwanyali adds that he felt betrayed by his wife, especially when the baby she delivered died five days later.

The attitude of Mwanyali’s wife towards testing is understandable given findings of new research titled Increasing the Uptake of HIV Testing in Maternal Health in Malawi by Dignitas International and College of Medicine. The research say fears of being marked with the stigma of HIV by peers and health-care providers leads women to devise strategies that allow them to receive care without disclosing their status.

Blood testing

Unfortunately, for some women like Mwanyali’s wife, the only strategy is to avoid blood testing.

This week, Mwanyali was part of the many Malawians who had their blood tested during the national HIV Testing and Counselling (HTC) week.

The Ministry of Health last year began to implement the 2010 World Health Organisation (WHO) guidelines by rolling out a “universal test and treat” strategy for pregnant women.

The strategy, called Option B Plus, uses immediate lifelong Antiretroviral Therapy (ART) for pregnant women who test positive and it has the potential to make advances towards eliminating paediatric HIV.

The United Nations Programme on HIV and Aids (UNAids) estimates that 20 percent of children born in sub-Saharan Africa, including Malawi, are exposed to HIV and among those children, 130 000 new HIV infections occurred in 2010.

This is why health experts say blood testing during the pregnancy stage seeks to enforce Prevention from Mother to Child Transmission (PMTCT) for the safety of the baby.

To avert reluctance cases faced by Mwanyali and others, the London School of Hygiene and Tropical Medicine and researchers from the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and College of Medicine are investigating the use of easy-to-use mouth swabs.

The feasibility of self-testing kits is being led by principal investigator Liz Corbett. The kits will allow people to test themselves for HIV and Aids in the privacy of their homes.

The team says the system could help Malawi tackle the disease by improving detection and early treatment. This research is being on a pilot phase covering most areas only in Blantyre.

Augustine Choko, data manager and statistician at the Malawi-Liverpool-Wellcome Trust, says the study is the first of its kind anywhere in the world and follows an evaluation in Malawi in 2010 which found oral supervised HIV-self-testing was highly accurate.

“What we found out [in 2010] was that there was so much enthusiasm and readiness. Over 95 people participated and 92 percent accepted the offer to self test. Of those who accepted, 99 percent got their results right,” he says.

Pregnant women

This answers demands based on research by Dignitas International and College of Medicine, whose fiindings reveal that despite the offer of HIV testing and counselling in the antenatal care clinic setting, many HIV-infected women give birth in health facilities without knowing their status.

It adds that pregnant women go for delivery in labour wards with unknown HIV statuses due to factors such as peer pressure, stigma surrounding testing positively, household power relations, lack of knowledge about HIV and other system-related barriers to access to care.

Felix Limbani, knowledge translation coordinator at Dignitas and one of the researchers say other people think testing is not needed if they had a negative test result in the past, or when they had a single sexual partner.

Limbani cited system-related, social and behavioural factors as reasons that pregnant women present themselves at labour wards without knowing their HIV status and without receiving HIV testing and counselling at an antenatal care clinic, during labour or following delivery.

“The success of Option B Plus, the new PMTCT programme in Malawi, depends on adequately organised health services and PMTCT service delivery. There is the potential to improve both by integrating cultural values and addressing current attitudes towards testing and perceptions associated with the consequences of test results,” he says.

Dignitas International has begun advocating policy makers to initiate education and counselling programmes to tackle the stigma of HIV and discrimination, address prevailing fears of testing, including issues regarding the receiving and sharing of test results.

Despite managing to reduce its HIV prevalence rate from around 26 percent to 10.6 percent since 1998, Malawi continues to be among the world’s worst affected countries by the disease.

Currently, about two million Malawians out of 14 million people have HIV, the virus that causes Aids. Out of the two million, close to half a million are on ART, according to the National Aids Commission (NAC).


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