Evaluation of the practicability and virological performance of finger-stick whole-blood HIV self-testing in French-speaking sub-Saharan Africa

• Published in: PloS one Vol. 13; no. 1; p. e0189475
• Main Authors: Tonen-Wolyec, Serge, Batina-Agasa, Salomon, Muwonga, Jérémie, Fwamba N'kulu, Franck, Mboumba Bouassa, Ralph-Sydney, Bélec, Laurent
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.01.2018; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; AIDS; AIDS Serodiagnosis - methods; Biology and Life Sciences; Democratic Republic of the Congo; Education; Feasibility studies; Female; Fingers; Health care; HIV; HIV Infections - blood; HIV Infections - diagnosis; Human immunodeficiency virus; Humans; Infections; Low income groups; Male; Medical diagnosis; Medical tests; Medicine and Health Sciences; Physical Sciences; Research and Analysis Methods; Self Care; Social Sciences; Young Adult; Sub-Saharan Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0189475

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. Field experience with HIVST has not yet been reported in French-speaking African countries. The practicability of HIVST was assessed using the prototype the Exacto® Test HIV (Biosynex, Strasbourg, France) self-test in 322 adults living in Kisangani and Bunia, Democratic Republic of the Congo, according to World Health Organization's recommendations. Simplified and easy-to-read leaflet was translated in French, Lingala and Swahili. Forty-nine percent of participants read the instructions for use in French, while 17.1% and 33.9% read the instructions in Lingala and Swahili, respectively. The instructions for use were correctly understood in 79.5% of cases. The majority (98.4%) correctly performed the HIV self-test; however, 20.8% asked for oral assistance. Most of the participants (95.3%) found that performing the self-test was easy, while 4.7% found it difficult. Overall, the results were correctly interpreted in 90.2% of cases. Among the positive, negative, and invalid self-tests, misinterpretation occurred in 6.5%, 11.2%, and 16.0% of cases, respectively (P<0.0001). The Cohen's κ coefficient was 0.84. The main obstacle for HIVST was educational level, with execution and interpretation difficulties occurring among poorly educated people. The Exacto® Test HIV self-test showed 100.0% (95% CI; 98.8-100.0) sensitivity and 99.2% (95% CI; 97.5-99.8) specificity. Our field observations demonstrate: (i) the need to adapt the instructions for use to the Congolese general public, including adding educational pictograms as well as instructions for use in the local vernacular language(s); (ii) frequent difficulties understanding the instructions for use in addition to frequent misinterpretation of test results; and (iii) the generally good practicability of the HIV self-test despite some limitations. Supervised use of HIVST is recommended among poorly-educated people.