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Accuracy of un-supervised versus provider-supervised self-administered HIV testing in Uganda: A randomized
Stephen Asiimwe1, James Oloya, Xiao Song
1Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus, 101 Buck Road, Miller Hall, Athens, GA, 30602, USA, asiimwes@uga.edu.
AIDS and Behavior
|April 3, 2014
Summary
Unsupervised HIV self-testing (HST) is feasible in rural Uganda. While not definitively non-inferior to supervised testing in all analyses, it shows promising accuracy for increasing HIV status knowledge.
Area of Science:
- Public Health
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Unsupervised HIV self-testing (HST) offers potential for increased HIV status awareness.
- However, the accuracy of unsupervised HST in real-world field settings remains largely unknown.
- High HIV prevalence in specific populations necessitates accurate and accessible testing methods.
Purpose of the Study:
- To estimate the diagnostic accuracy of unsupervised HST compared to supervised HST.
- To assess the feasibility and non-inferiority of unsupervised HST in a high-risk population in Uganda.
- To evaluate HIV testing strategies in resource-limited rural settings.
Main Methods:
- A non-blinded, randomized controlled non-inferiority trial was conducted.
- 246 high-risk fisherfolk in Uganda were randomized to unsupervised or provider-supervised HST.
- Intent-to-treat and per-protocol analyses were used to compare test sensitivity.
Main Results:
- In intent-to-treat analysis, unsupervised HST sensitivity was 90% vs. 100% for supervised HST (difference -10%, 90% CI -21%, 1%).
- Non-inferiority was not demonstrated in the intent-to-treat analysis.
- Per-protocol analysis showed a sensitivity difference of -5.6% (90% CI -14.4%, 3.3%), demonstrating non-inferiority.
Conclusions:
- Unsupervised HIV self-testing is a feasible approach in rural African settings.
- Unsupervised HST may be non-inferior to provider-supervised HST, particularly in per-protocol evaluations.
- Further research may be needed to optimize unsupervised HST protocols for maximum accuracy and uptake.
