Introduction Opportunities for HIV testing could be enhanced by offering HIV self-testing (HIVST) in populations that fear stigma and discrimination when accessing conventional HIV counselling and testing in health care facilities.
Methods The Exacto Test HIV (Biosynex, Strasbourg, France) fullfilled the following criteria I) Capillary blood-based test detecting early HIV infection; II) Sterile safety lancet; III) Simplified blood sampling system; IV) Simplified buffer delivery system; V) Specimen presence control by blood deposit assessment and migration control band; vi) Results in 10 min; VII) Simplified and easy-to-read leaflet in French, Lingala, Swahili and Sango. The practicability of HIVST was assessed in 630 adults living in Kisangani and Bunia, Democratic Republic of Congo (n=330) and Bangui, Central African Repulic (n=300), according to WHO recommendations.
Results Design. Exacto self-test showed 100.0% sensitivity and 99.5% specificity. Practicability in lay users. 97.4% correctly performed HIVST and claimed the test was easy or very easy to carry out; however, 26.5% asked for telephone or oral assistance, and difficulty obtaining sufficient quantity of blood was observed in 2.6%; 47% used the notice in French, 10% in Lingala, 23% in Swahili and 20% in Sango. Overall, the results were correctly interpreted in 90.2%, the reading/interpretation errors concerned the positive (6.5%), negative (11.2%) or invalid (16.0%) self-tests. The notice was correctly understood in 78.5%.
Conclusion Our field experience with Exacto self-test implemented for the first time in a French-speaking African country demonstrates very satisfactrory success rate of performance and interpretation. However, the main obstacle for HIVST was clearly the educational level, associated with execution and interpretation difficulties in illeterates or very poorly educated people. Notice design with pictures and in vernacular languages is essential. Supervised use of HIVST should be essential in poorly-educated people.
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