HIV Self-Testing to address the testing gap in Zimbabwe

Dr Owen Mugurungi Director AIDS and TB program

Ministry of Health and Child Care Zimbabwe

Status and Future for HIVST Meeting BMGF

Seattle , 27th of February 2015

Background

• Population: 12, 9m • 1, 39 m PLHIV including

170,717 children • HIV Prevalence: 15%, 15-49

yrs. – Female 18%– Male 12%

• General decline in HIV incidence from 1.42 in 2011, 1,07 in 2013 and 0.9 in 2016

• # PLHIV requiring ART in 2014– 1,207,175 (CD4 <500)– 101,106 children

HIV Prevalence by sex, age group 15-49

3Staveteig et al, DHS Comparative Reports, 2013

13% - 76%8% - 69%

In Zimbabwe, only 57% of adult women and 34% of adult men have ever had an HIV test and received results, according to the ZDHS 2010/11

Too few take a test and receive their result

HIV testing uptake

40% 36%57% 66%

0%

20%

40%

60%

80%

100%

120%

Early InfantDiagnosis

Males 15‐49yrs

Females 15‐49 yrs

PLHIV

Don’t Know StatusKnow HIV status

ZDHS 2010/11

Zimbabwe cascade of the UNAIDS 90-90-90 Targets

PLHIV

73%81%90%100%

1,400,000

1,260,000

1,134,0001,020,600

Identified

as Positive 

HIV Testing Models 

• 1.7 Million HIV tested annually

• PITC provided in 1445 (out of 1625) health institutions

• CITC provided through PSI’s 16 New Start centres & 25 mobile outreach contributing about 23% to the annual national HIV testing outputs

7

Home-Based

• Community through the Campaigns

• Index cases• Door to door• Self Testing

Campaigns plus (+) integration

• HTC + malaria, safe water, non-communicable diseases

Outreach (e.g. mobile)

• General populations

• Key populations

Institutions i.e. workplaces &

Schools• Reach out to

places with concentrated and easy to reach populations

Moving testing: Out of the facility & into the community

Community-Based HTC

National DataJan‐Sept 2014

Provincial Data Jan –Sep 2014

HIV Self-Testing Rationale • HIV Self‐testing to complement current HTC strategies (PITC and 

CITC)  to reach treatment goal • Specific questions/concerns around HIV testing and self‐testing:

• How to promote testing among key populations currently underrepresented in HIV testing and repeat testing

• How to encourage regular repeat testing• How to ensure that people who self –test access treatment and care 

services or are linked to HIV  prevention, such as Male Circumcision • Evidence to support use of self testing and explore how it could most 

usefully be implemented• Potential Social Harms • Cost‐effectiveness • Regulated access to self test kits • Policy support for HIV self‐testing 

HIV Self‐Testing Introduction  

• OraQuick Advance has been validated for use with oral fluids in Zimbabwe

• HIV Self‐Testing included in the new recently launched  HIV Testing and Counselling Guidelines 

• HIV Self‐Testing Steering Committee • HIV Self‐Testing pilot study collaboration with PSI/CeSSHAR/RTI – Acceptability – Feasibility – Accuracy – Linkage into care, treatment and prevention 

HIV Self‐Testing Study Aims and Methods

Study Timelines 

• Anticipate completion of supervised testing in February

• Observational study to start early March 

• Linkage to care data will be available in June 

• Results to feed into UNITAID HIV STAR PROJECT planned to start in June 

Thank You