HIV self-testing strategies have been recommended by the World Health Organization (WHO) since 2016, because they empower people to know their HIV status at their convenience. The home-based test equipment has not been approved for sale in Canada. However, a team from the Research Institute of McGill University Health Center (RI-MUHC) and collaborator from Clinique Medicale l & # 39; Actuel, in Montreal, evaluated a self-testing program without HIV supervision through a smartphone and tablet application called HIVSmart !, among population at risk (men who have sex with men). The findings of their study – the first in Canada – were published online this week at Journal of Medical Internet Research.
"To reach the first 95 of the so-called 95-95-95 targets set by UNAIDS * by 2030, it is very important that we help detect HIV in those who are not aware of their HIV status. The screening strategies that have the potential to reach undiagnosed ones are HIV testing alone, "said Dr. Nitika Pant Pai, the lead author of this study and researchers from Infectious Disease and Immunity in the RI-MUHC Global Health Program, and a professor of Medicine at McGill University. "HIVSmart! connect all gaps in the process of self testing; this works with an approved HIV self-test, facilitates testing and proactively notifies users. "
"By promoting screenings, HIVSmart! "it can help reduce the number of people living with HIV who don't know their status and allow them to start treatment early," Dr. Réjean Thomas, study co-author, who is also the founder and CEO of Clinique Médicale L & # 39; Actuel. ‘’ Applications like HIVSmart! improve accessibility to testing, especially outside big cities, where it is sometimes difficult to test because of confidentiality issues. "
HIVSmart! available for smartphones, tablets or web-based (Android, iPhone and iPad) confidential software applications developed by Dr. Pant Pai and his team at RI-MUHC. It informs, interprets and stores data confidentially, but most importantly, it connects users with counseling or treatment quickly and encourages users to remain vigilant. Initially developed with funding from the Grand Challenges Canada, HIVmart! evaluated in Montreal thanks to research funded by the Canadian Institutes of Health Research (CIHR).
HIVSmart! feasibility in Montreal
Between July 2016 and February 2017, researchers conducted a study of 451 men who had sex with men (sometimes referred to as MSM) aged 18 to 73 years who came to Clinique Médicale L & # 39; Actuel to be tested for HIV. They were offered a saliva-based HIV test at home and tablets equipped with HIVSmart! Application. The strategy mimics testing in an unattended home environment. By using HIVSmart!, Participants are guided through the process of self-testing, learning how to do and interpret tests, save results, and receive care quickly.
"Our research shows that HIVSmart! The strategy of appropriateness is accepted and favored by educated urban MSM populations in Montreal, "said Dr. Pant Pai. "As a strategy, it is appropriate for individuals who prefer to test themselves at their convenience in the comfort of personal spaces such as their homes, offices or kiosks. It's empowering! "
HIV self tests for populations at risk
In Canada, the HIV epidemic is disproportionately represented in key populations, such as MSM, injection drug users, indigenous people and immigrants from HIV-endemic countries. About 18 to 25 percent of the Canadian MSM population do not know their HIV-positive status, and the number may be proportionally higher for IDUs, Indigenous Peoples and immigrants, which underscores the need for accessible HIV self-test services.
"At present, we have all the means to eradicate HIV. The HIVSmart! Applications are a way to support patient autonomy, "Dr. Thomas. "Promoting screening reduces the number of people who don't know their HIV status, places HIV-positive people on treatment quickly so that their viral load becomes undetectable, and, ultimately, eradicates HIV."
Researchers plan to adapt HIVSmart! self-testing strategies for many at-risk populations in Canada and around the world, thereby maximizing the health impact of their communities. HIVSmart! strategies are also being tested in South Africa.
* UNAIDS Fast-Track Strategy to End AIDS in 2030:
By 2030, 95% of all people living with HIV will know their HIV status.
By 2030, 95% of all people with diagnosed HIV infection will receive ongoing antiretroviral therapy.
By 2030, 95% of all people receiving antiretroviral therapy will experience viral suppression.
- 84.7% educated outside of secondary school;
- 79.5% employed;
- 52.5% has been tested in the past 6 months.
- 99.3% from participants who tested negative counseling and who received themselves after their tests;
- 0.7% participants who tested themselves positive and confirmed positive with the lab related to the doctor on the same day;
- 98.8% the participants found that the application was useful;
- 94% the participants are willing to recommend it to friends or partners.
Pant Pai N, Smallwood M, Desjardins L, Goyette A, Birkas KG, Vassal AF, Joseph L, Thomas R
App-Optimized Smart App-Optimized Private Self Testing Program in Montreal, Canada: Cross-Sectional Study
J Med Internet Res 2018; 20 (11): e10258
DOI: 10.2196 / 10258
This work was funded by the Canadian Institutes of Health Research (CIHR) and Fonds de recherche du Québec – Santé (FRQS).
McGill University Health Center
julie [dot] robert [at] muhc [dot] mcgill [dot] ca