A Canadian doctor who is a proponent of self-testing for HIV has received a boost for her plan to further legitimize it.
Dr. Nitika Pant Pai of McGill University and McGill Health Center in Montreal received $30,000 as part of the Accelerating Science Award Program, sponsored by the Wellcome Trust, the Public Library of Science, and Google. The award honored three people who used Open Access medical research to boost innovation.
Pant Pai performed a systematic review of previous research surrounding HIV testing, both supervised and unsupervised. She showed that self-tests are highly preferred by those who seek them. Still, she stressed the need for linkages—immediate support for those getting tested—which she believes must be improved for those who purchase self-tests.
Now, she has developed a smartphone application that would provide instant support to those using a self-test. Much work remains to be done on the app, including adding links to education, treatment, and support. Still, she hopes it will be rolled out in some form by the end of this year.
Most Don't Know They're Infected
In 2011, UNAIDS reported that 60 percent of people infected with HIV around the world don't know they have it. Pant Pai told Healthline that statistic is what drives her research.
“People don't wish to engage, they don't want to stand in line, don't wish to be seen,” she said of the vast numbers of people worldwide who opt not to take a supervised HIV test. “Let's go for a paradigm shift now, and for once, let us give our people what they want, not what we think will work for them.”
In some parts of the world, people take an entire day off of work to get tested, Pant Pai said, and still aren't seen because of high demand.
Many countries also prohibit over-the-counter HIV self-tests. The U.S. Food and Drug Administration approved OraQuick for this use last year, but stressed that positive results must be confirmed by a laboratory. OraQuick offers a 24-hour, toll-free support hotline which offers users resources based on their ZIP code.
A Way to Offer Anonymous Support
Pant Pai believes the hotline isn't good enough and feels a phone app would provide better linkages. She plans to have the app, to which McGill holds the copyright, offer support in many different languages. She said it is currently being programmed with linkages to education, counseling, and support resources in cities across the globe.
“We need comfort and we need counseling and we need it immediately,” she said.
She said she's not sure whether the app will be available and free to everyone via an app store, or if a password will be provided when someone buys a home-testing kit. So far, it only been developed for the Android platform.
She acknowledged that although her app aims to help people in poor, vulnerable communities, many of them cannot afford a smartphone. She said she's also developed a paper application and may find a way to integrate the app on less expensive phones. Such phones still offer video and text messaging, and are popular in some developing nations.
Concerns About Self-Testing
Many community-based HIV/AIDS organizations have expressed skepticism about home tests. Paul Lappin, a spokesperson for The Project of the Quad-Cities in Moline, Ill., told Healthline he believes community-based agencies are the best places to get tested. “The home tests allow great access, but essentially provide no support structure.”
Some people indicate they may do something irrational if they get a positive test result, Lappin said. “One thing we're taught is to sound out where they are emotionally. Some people say right off, 'I will not be able to handle this, I’ll kill myself.' Or, 'I'm going to go kill so-and-so who infected me.' In those cases, we don't give them the test. We refer them to a mental health center.”
His concerns go beyond how someone who is alone will react to a positive result. For example, counselors at The Project always talk to a person getting tested about safe sex as they wait 20 minutes for their results. This is invaluable, especially for people who might otherwise feel overly confident after receiving a negative result.
The results are considered highly accurate, according to research, but can miss recent exposures of 90 days or less. Pant Pai said that needs to be communicated to people who are tested because they fear a recent exposure to the virus.