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HIV self-testing
HIV self-testing is a process by which a person who wants to know his or her HIV status collects a specimen, performs a test and interprets the test result in private. It does not provide a definitive diagnosis; instead, it is a screening test for the presence of HIV-1/2 antibodies or the HIV-1 p24 antigen. Any positive HIV result must be confirmed by laboratory-based testing with a venous blood sample.
By providing an opportunity for people to test themselves discreetly and conveniently, HIV self-testing may provide people who are not currently reached by existing HIV voluntary counselling and testing (VCT) services with information about their HIV status.
Type of self-testing+
- Home self-testing:
This type of self-test requires users to perform the test and interpret the result all by his own. Instructions are usually given in the kits and on manufacturer websites, often with pictures or photos and sometimes even video demonstration. - Home sample collection:
This type of self-test involves the users collecting a blood sample on their own and then sending the sample to a designated laboratory. The test is of laboratory standard and thus the result is definitive. Today, US is having programmes of home sample collection HIV testing. More:
Type of sample+
Sample for HIV self-testing can either be blood or oral fluid. The use of different samples for testing will result in variation in the performance of the test, measured by sensitivity and specificity. The followings serve to give you an idea of different sample collection methods; users should follow the specific instructions given by the manufacturer of the test kit they intend to use.
- Blood: a blood drop is obtained from puncturing the finger-tip with a lancet and then milking out the blood, a collection device in the form of a pipette or a circular tube will then be used to transfer the blood drop to the reagents of the test kit.
- Oral fluid: a test stick with a pad at the end is used to swab the gums to collect the oral mucosal transudate; it is not the same as spitting out saliva.
HIV self-test kits recommended by World Health Organization+
Globally, there are eight approved HIV self-test kits recommended by World Health Organization. (Information as of July 2018)
| Brand name | Manufacturer | Generation | Sample | Sensitivity | Specificity | Approval agency |
|---|---|---|---|---|---|---|
| atomo HIV Self Test | Atomo Diagnostics, Australia | 3rd | Blood | 99.7% | 99.7% | CE |
| autotest VIH | AAZ-LMB, France | 2nd | Blood | 100% | 99.8% | CE |
| BioSURE HIV Self Test | BioSURE, United Kingdom | 2nd | Blood | 99.7% | 99.9% | CE |
| Exacto Test HIV | Biosynex Group, France | 3rd | Blood | 99.99% | 99.9% | CE |
| INSTI HIV Self Test | bioLytical Laboratories, Canada | 2nd | Blood | 100% | 99.8% | CE |
| OraQuick In-Home HIV Test | OraSure Technologies, USA | 2nd | Oral fluid | 100% | 99.8% | CE |
| OraQuick HIV Self Test | OraSure Technologies, USA | Not available | Oral fluid | 99.4% | 99% | WHO |
| SURE CHECK HIV Self Test | Chembio Diagnostic Systems, USA | 2nd | Blood | Not available | Not available | CE |
Source: Market and technology landscape: HIV rapid diagnostic tests for self-testing
Where to buy and pricing+
In Hong Kong, there is currently no legislation that regulates the manufacture, import, export, sale and use of medical devices (including HIV self-test kits). However, users are able to purchase self-test kits either over-the-counter in pharmacies or through various online platforms. The market price per HIV self-test kit ranges from HK$200 to HK$400.
Some HIV self-test kits may be of poor quality and provide incorrect results. Users should purchase self-test kits, if they choose to do so, from reliable sources; ; and test kits with either CE approval, FDA approval or prequalified by WHO are preferred.
How to do a self-test+
Preparation
- Taking high dose (10 mg or more per day) of biotin may affect many laboratory test results. If you are taking dietary supplements containing biotin, please stop taking it 48 hours before the test.
- Make sure the self-test kits remain in the temperature range specified by the manufacturer during transport and storage. Staying outside the temperature range for too long may cause damage to the test reagents and the results may not be accurate.
- Find a private and well lit place where you won't be disturbed for about 30 minutes.
- Prepare a timer or watch.
- Check that the package has not been tampered with or damaged.
- Check the expiration date.
- Read the instructions carefully before starting.
Procedures
Testing procedures vary from brand to brand; users should follow strictly the instructions given in the test kit. The followings only serve as a general tip.
- How to obtain blood from finger-prick:
- Wash your hands with soap and warm (not hot) tap water. Dry your hands thoroughly.
- The puncture site should be on the "soft" pad of the fingertip, preferably on the middle or ring finger.
- Clean the puncture site with alcohol swab and let it dry (or dry with gauze).
- Support the back of your hand on a table with the palm up. You may use the thumb of the same hand to "squeeze" the blood to the fingertip.
- Use the lancet on the puncture site.
- Milk the finger to let blood out through the puncture site until the amount is enough.
- Collection and transfer of blood vary with brands, please follow manufacturer's instructions.
- Please follow the manufacturer's instruction to read the result at the appropriate time.
- How to sample oral fluid by swabbing:
- Do not eat, drink or use oral care products (such as mouthwash or toothpaste) 30 minutes before the test.
- Remove dental products such as dentures or any other products that cover your gums.
- Gently swipe the test swab along the upper gums and the lower gums.
- DO NOT just spit out saliva.
- Transfer the test swab to the test reagents according to the manufacturer's instructions.
- Please follow the manufacturer's instruction to read the result at the appropriate time.
Interpretation of result
Result interpretation varies from brand to brand; users should follow strictly the instructions given in the test kit. The followings only serve as a general tip.
In general, there is a Result Reading Panel showing the test result. Right beside the panel are marked with "C" and "T".
First step : Look for the horizontal line at position "C".
The presence of a horizontal line means that the testing fluid has passed through the whole testing paper. The result is valid and ready to be read. Absence of the horizontal line at position "C" means that the result is NOT valid. You should use a new product to repeat the test
Second step : Look for any horizontal line at position "T"
Positive result: the presence of a horizontal line at position "T" means a positive result. A positive result suggests that HIV antibodies are detected, and it is very likely that you have been infected. However, this is only a preliminary result and you need to have further blood test for confirmation.
Negative result: the absence of a horizontal line at position "T" means a negative result. A negative result suggests that HIV antibodies are not detected, and it is likely that you are not infected. However, if the test is done within the window period, you need to re-test 3 months after the last exposure.
If the horizontal line at position T is vague and unclear, or you have any uncertainty about the test result, please call Gay Men HIV Testing Hotline 21171069 or one of the AIDS NGOs to arrange another test.
Linkage to care and follow-up
If you get a positive self-test result:
- Don't panic. Nowadays many HIV-infected people are living a normal life if they get diagnosed early and start treatment early.
- The next thing you should do is to get a confirmatory test. You may do one of the followings:
- Call the Gay Men HIV Testing Hotline 2117 1069, tell the nurse counsellor you have a positive self-test result so that you get an urgent appointment;
- Call one of the NGOs that provide confirmatory blood test, these include: AIDS Concern, CHOICE and Hong Kong AIDS Foundation；
- Or, you may consult your family doctor to have the confirmatory blood test.
- After confirmation, you may want to seek treatment in one of the public HIV specialist clinics in Hong Kong and seek support from NGOs with related services for people living with HIV.
If you get a negative result, you should continue practicing safer sex to reduce risk of HIV infection. If you have further exposure, regular testing every 6 to 12 months is recommended. The HIV test does not screen for other sexually transmitted infections (STIs), you may consider having other STI screening tests at the Social Hygiene Clinics.