Will an Unsupervised Self-Testing Strategy Be Feasible to Operationalize in Canada? Results from a Pilot Study in Students of a Large Canadian University
Background. A convenient, private, and accessible HIV self-testing strategy stands to complement facility-based conventional testing. Over-the-counter oral HIV self-tests are approved and available in the United States, but not yet in Canada. Canadian data on self-testing is nonexistent. We investigated the feasibility of offering an unsupervised self-testing strategy to Canadian students. Methods. Between September 2011 and May 2012, we recruited 145 students from a student health clinic of a large Canadian university. Feasibility of operationalization (i.e., self-test conduct, acceptability, convenience, and willingness to pay) was evaluated. Self-test conduct was computed with agreement between the self-test performed by the student and the test repeated by a healthcare professional. Other metrics were measured on a survey. Results. Participants were young (median age: 22 years), unmarried (97%), and 47% were out of province or international students. Approximately 52% self-reported a history of unprotected casual sex and sex with multiple partners. Self-test conduct agreement was high (100%), so were acceptability (81%), convenience (99%), and willingness to pay (74%) for self-tests. Concerns included accuracy of self-tests and availability of expedited linkages. Conclusion. An unsupervised self-testing strategy was found to be feasible in Canadian students. Findings call for studies in at-risk populations to inform Canadian policy. 1. Introduction At the end of 2008, an estimated 65,000 Canadians were living with HIV, an increase of 14% since 2005 [1]. About 2,300 to 4,300 new HIV infections occurred in 2008 alone. Despite the availability of facility-based HIV testing and counselling [2], approximately 26% of all positive Canadians remain unaware of their HIV serostatus [1]. Systemic and social barriers, such as stigma, perceived discrimination, and the fear of social visibility and lack of confidentiality have long deterred uptake of conventional facility-based testing. In addition, fear of the test result and the belief that they are not at risk can also prevent some individuals from accessing testing. Furthermore, an increased anxiety associated with long wait times to receive test results and loss of work days associated with getting an HIV test have further impeded the uptake of facility-based HIV testing [3–9]. Conventional testing at a healthcare facility in Canada can be (a) nominal (i.e., the name of the person being tested appears on test forms, results, and medical records), (b) nonnominal (i.e., the test is ordered using a code, but
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