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Accuracy and User-Acceptability of HIV Self-Testing Using an Oral Fluid-Based HIV Rapid Test

Author

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  • Oon Tek Ng
  • Angela L Chow
  • Vernon J Lee
  • Mark I C Chen
  • Mar Kyaw Win
  • Hiok Hee Tan
  • Arlene Chua
  • Yee Sin Leo

Abstract

Background: The United States FDA approved an over-the-counter HIV self-test, to facilitate increased HIV testing and earlier linkage to care. We assessed the accuracy of self-testing by untrained participants compared to healthcare worker (HCW) testing, participants’ ability to interpret sample results and user-acceptability of self-tests in Singapore. Methodology/Principal Findings: A cross-sectional study, involving 200 known HIV-positive patients and 794 unknown HIV status at-risk participants was conducted. Participants (all without prior self-test experience) performed self-testing guided solely by visual instructions, followed by HCW testing, both using the OraQuick ADVANCE Rapid HIV 1/2 Antibody Test, with both results interpreted by the HCW. To assess ability to interpret results, participants were provided 3 sample results (positive, negative, and invalid) to interpret. Of 192 participants who tested positive on HCW testing, self-testing was positive in 186 (96.9%), negative in 5 (2.6%), and invalid in 1 (0.5%). Of 794 participants who tested negative on HCW testing, self-testing was negative in 791 (99.6%), positive in 1 (0.1%), and invalid in 2 (0.3%). Excluding invalid tests, self-testing had sensitivity of 97.4% (95% CI 95.1% to 99.7%) and specificity of 99.9% (95% CI: 99.6% to 100%). When interpreting results, 96%, 93.1% and 95.2% correctly read the positive, negative and invalid respectively. There were no significant demographic predictors for false negative self-testing or wrongly interpreting positive or invalid sample results as negative. Eighty-seven percent would purchase the kit over-the-counter; 89% preferred to take HIV tests in private. 72.5% and 74.9% felt the need for pre- and post-test counseling respectively. Only 28% would pay at least USD15 for the test. Conclusions/Significance: Self-testing was associated with high specificity, and a small but significant number of false negatives. Incorrectly identifying model results as invalid was a major reason for incorrect result interpretation. Survey responses were supportive of making self-testing available.

Suggested Citation

  • Oon Tek Ng & Angela L Chow & Vernon J Lee & Mark I C Chen & Mar Kyaw Win & Hiok Hee Tan & Arlene Chua & Yee Sin Leo, 2012. "Accuracy and User-Acceptability of HIV Self-Testing Using an Oral Fluid-Based HIV Rapid Test," PLOS ONE, Public Library of Science, vol. 7(9), pages 1-8, September.
    • Handle: RePEc:plo:pone00:0045168
    DOI: 10.1371/journal.pone.0045168
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    1. Augustine Talumba Choko & Nicola Desmond & Emily L Webb & Kondwani Chavula & Sue Napierala-Mavedzenge & Charlotte A Gaydos & Simon D Makombe & Treza Chunda & S Bertel Squire & Neil French & Victor Mwa, 2011. "The Uptake and Accuracy of Oral Kits for HIV Self-Testing in High HIV Prevalence Setting: A Cross-Sectional Feasibility Study in Blantyre, Malawi," PLOS Medicine, Public Library of Science, vol. 8(10), pages 1-11, October.
    2. Weinhardt, L.S. & Carey, M.P. & Johnson, B.T. & Bickham, N.L., 1999. "Effects of HIV counseling and testing on sexual risk behavior: A meta- analytic review of published research, 1985-1997," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1397-1405.
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    1. Sean D Young & Joseph Daniels & ChingChe J Chiu & Robert K Bolan & Risa P Flynn & Justin Kwok & Jeffrey D Klausner, 2014. "Acceptability of Using Electronic Vending Machines to Deliver Oral Rapid HIV Self-Testing Kits: A Qualitative Study," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-5, July.

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