Are Participants in a Street-Based HIV Testing Program Able to Perform Their Own Rapid Test and Interpret the Results?

Objective: Availability of over-the-counter rapid HIV tests could improve access to testing those reluctant or unable to use current services. We aimed to evaluate the feasibility of HIV self-testing using a finger-stick whole-blood rapid test (Determineâ„¢ HIV Combo) to detect both antigen and antibody. Methods: Before being tested 313 participants in a street-based testing program were given adapted instructions and a test kit and performed the self-test without supervision. These participants together with another 207 who performed supervised self-testing received additional instructions on how to interpret the test results shown in six colour photos and filled out a questionnaire. Logistic regression and generalized estimating equations (GEE) were used in the statistical analysis. Results: About 8.0% (95%CI:4.8%-11.2%) obtained an invalid self-test. An invalid result was inversely associated with male participants who had sex with men (OR = 0.3;95%CI:0.1-1.0). Of the 3111 photos interpreted4.9% (95%CI:4.1-5.7) were incorrect. Only 1.1% (95%CI:0.3-1.8) of the positive results were interpreted as negative. Age 30 or older (OR = 2.1; 95%CI:1.2-3.7) having been born in Latin America (OR = 1.6; 95%CI:1.1-2.2)and not having university education (OR = 2.1;95%CI:1.2-3.7) were associated with misinterpreting test results in the GEE. Participants perceptions of both their proficiency when conducting the test and interpretation were related with actual outcomes. Most participants (83.9%) were more motivated than before to use the self-test in the future and 51.7% would pay >10 Euros for the test if it was sold in pharmacies. Conclusions: This is the first study showing that blood-based self-testing with current technology is feasible in HIV-negative participants demanding the test and without prior training or supervision. Bearing in mind that it was conducted under difficult weather conditions and using a complex kit over-the-counter tests could be a feasible option to complement current diagnostic strategies. More studies are needed to accommodate technology minimise interpretation mistakes and provide on-line support.