Self-sampling and Self-testing

Self-sampling means that the client obtains a test kit (e.g. from a pharmacy), follows the instructions to take the sample (usually blood by finger-prick), and then sends it in for testing. The laboratory then communicates the results directly to the client (usually by SMS and/or telephone).

Self-testing means that the client obtains a test kit and follows the instructions to perform the whole test, including taking the sample (usually blood by finger-prick), adding it to the test solution and reading the results.

Self-Sampling and Self-Testing are becoming available in more and more European countries. In some countries they are a proving to be crucial in achieving higher testing rates among MSM. 

Swab2know was a Euro HIV EDAT pilot intervention to assess the acceptability and feasibility of an outreach intervention with MSM and migrants. Online communication of test results was implemented in 6 European countries (Belgium, Spain, Portugal, Denmark, Romania and Slovenia). It included two websites to deliver test results and for post-test counselling (www.swab2know.euand www.lapruebaencasa.com). These were translated into the languages of the participating countries. 

An detailed manual and report for this pilot study intervention is available at: Swab2know: Manual for the development and implementation of an HIV testing approach using outreach and home sampling strategies and online communication of HIV test results.The S.A.M. project developed by the Munich AIDS organisation and its partners offers a self-sampling service for HIV, syphilis, gonorrhoea and chlamydia across its four Bavarian Checkpoints. Clients attend a one-off counselling session at one of four regional centres and can then register to a test kit every 3, 6 or 12 months. This approach is particularly tailored to people living in rural areas. Clients receive their test kits in the post and take and send in their own blood and urine samples. Negative results are provided by SMS and positive results by an SMS requesting a call back. A medical professional is then available to advise on the results and next steps. More information (in German only) is available at: https://samtest.de/

Item Does your CBCVT have this in place? Is there a documented standard, guideline, plan, policy, procedure, contract or agreement? Is it adapted to local needs and conditions? Is it working as intended? Action
Client-centred information, recommendations and support for self-testing/self-sampling
Description

Description

Providing client-centred information, recommendations and support requires a good knowledge and understanding of the needs and preferences of the target group. It may include a dedicated website, face-to-face or online/telephone information and support provided by the CBVCT or other services. Knowledge includes the legal, ethical and technical aspects of the distribution and use of self-sampling/self-testing kits and, especially, how results are communicated and followed up. 

 

Guidance

Guidance

The CBVCT’s existing skills to provide information, recommendations and support to clients in a culturally sensitive and needs-oriented way can also be applied to this additional testing methodology. It is important to discuss and decide what role the CBVCT will play in the self-sampling/self-testing process and what level of support it can provide. Self-sampling and self-testing can also be integrated with the CBVCTs PrEP services. This may include online information and counselling as well as ‘assisted self tests’, where a counsellor is present online while the client performs the self-test. These decisions should thenbe reflected in internal guidance documents so that all staff and volunteers can provide clients with clear and consistent advice and support. The 

Swab2know: Manual for the development and implementation of an HIV testing approach using outreach and home sampling strategies and online communication of HIV test results.

contains guidance on outreach work and the use of websites to communicate results.

 

Adaptation

Adaptation

The role of the CBVCT in self-testing/self-sampling depends on how access to the testing kits is organised locally. They may be available by commercial online order, for sale at pharmacies and other health services, and/or from the CBVCT itself (including distribution through outreach activities). The involvement of the target group in deciding on the role of the CBVCT helps to ensure that the advice and support you give reflects local needs. If your CBVCT already uses feedback questionnaires, you may be able to include a few questions to investigate the acceptability and preferences of your clients regarding self-testing/self-sampling. Alternatively, a range of tools to consult with and involve the target group is available in the Participatory Quality Development (PQD) toolkit at www.qualityaction.eu

 

Quality improvement

Quality improvement

Because testing technologies and marketing strategies can change quickly, it is important to stay in close contact with manufacturers and distributors, as well as with the regulating agencies for medical products in order to provide up-to-date information to clients. Including a client feedback mechanism can also help ensure that the services provided by the CBVCT still match the needs and preferences of the target group.

 


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Confirmation tests and linkage to care
Description

Description

Self-testing and self-sampling tests are screening tests and not sufficient to provide a definite diagnosis. Access to confirmation tests in case of a reactive result or recent risk exposure is essential. More comprehensive STI screening may also be indicated. Linkage to treatment and care services in case of a new diagnosis is already one of the strengths of CBVCTs and also plays an important role in this context.

 

Guidance

Guidance

The only difference to the confirmation tests and linkage to carecarried out by the CBVCT in theordinary course of service provision is that clients who need these after self-sampling/self-testing may not have attended the CBVCT before. The challenge is to assist such clients with accessing these services. However, this is no different to the work the CBVCT already does. Please refer to the ‘guidance’ sections of the checklists on the topics ‘CBVCT Services and Organization Needs – Infrastructure’, ‘Counselling’ and ‘Linkage to Care’.

 

Adaptation

Adaptation

The following factors are relevant for adapting confirmation tests and linkage to care:

  • Where confirmation tests are available (e.g. at the CBVCT or at another health service)
  • The accessibility of testing/treatment services (e.g. making appointments on behalf of clients, accompanying clients to appointments, introducing clients personally to other providers)
  • The individual needs of the client, including other health or social needs
  • Data collection and evaluation systems (e.g. codes for referral and follow-up)

Please refer to the ‘adaptation’ sections of the checklists on the topics ‘CBVCT Services and Organization Needs – Infrastructure’, ‘Counselling’ and ‘Linkage to Care’.

 

Quality improvement

Quality improvement

The most important indicator for successful linkage to care is how many people who have been referred to other services actually attend and use those services. Coding systems and regular feedback from the services that clients are referred to can help identify any barriers along the client pathway. Team reflection and a range of structured quality improvement processes (see also www.qualityaction.eu) can help overcome these barriers. 

Please refer to the ‘quality improvement’ sections of the checklists on the topics ‘CBVCT Services and Organization Needs – Infrastructure’, ‘Counselling’ and ‘Linkage to Care’.

 


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Targeted promotion campaigns or collaboration with other providers
Description

Description

Targeted promotion of self-testing/self-sampling very much depends on the local availability of such services. Without promotion, their potential benefit on early detection of HIV infections cannot be fully realised. If the CBVCT does not have the capacity to conduct information campaigns, collaborations with other community-based MSM services or GLBTIQ* activist/advocacy groups can help to reach the target groups most likely to benefit from these additional testing options.

 

Guidance

Guidance

The main steps are to articulate clear goals for communication (e.g. ‘increase knowledge among particular MSM subpopulations’, ‘increase access to self-testing/self sampling’ etc.), define the audience(s) in detail (e.g. ‘MSM who test regularly, ‘MSM in rural areas’ …), develop key messages and then select the most appropriate communication channels. Key guiding questions from the audience’s perspective are:

  • What is self-testing/self-sampling?
  • Is it an option for me?
  • How and where can I get self-testing/self-sampling kits?
  • What does it cost?
  • What happens if the result is reactive?

See also the ‘guidance’ sections in the checklist for the ‘Communications’ topic in this toolkit.

 

Adaptation

Adaptation

Adapting campaigns to local conditions maximises their reach. This is especially relevant when the target group is a subgroup of MSM, such as rural MSM who don’t have easy access to checkpoints. 

See also the ‘adaptation’ sections in the checklist for the ‘Communications’ topic in this toolkit.

 

Quality improvement

Quality improvement

Promoting topics like self-testing/self-sampling to subgroups of MSM requires knowledge about their preferred sources of information. The participatory needs assessment tools contained in the PQD (Participatory Quality Development) toolkit, available at www.qualityaction.eu, e.g. a (online) focus group or rapid assessment can assist with ensuring that your campaign work responds to local preferences and needs.

See also the ‘quality improvement’ sections in the checklist for the ‘Communications’ topic in this toolkit. 

 


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Advocacy for the removal of structural barriers to self-testing/self-sampling
Description

Description

Self-testing/self-sampling may be restricted in different ways by structural and procedural barriers in the regulatory, health, pharmacy or even postal systems. CBVCTs are in a good position to facilitate access to self-testing/self-sampling despite these barriers. They are also experts who can advocate for the benefits of additional testing options for detecting HIV infections by reaching additional subgroups of MSM. 

 

Guidance

Guidance

As is the case with any other advocacy topic, success depends not only on the strength of the argument, but also on strategic relationships with advocates, access to decision-makers, and on the resources to sustain what may be a protracted process. Depending on where structural barriers to self-testing/self-sampling occur, advocacy may not only need to target political decision-makers, but also laboratory or pharmacy operators or their professional associations.

See also the ‘guidance’ sections in the checklist for the ‘Advocacy’ topic in this toolkit.

 

Adaptation

Adaptation

Timing, support from key stakeholders and the role of public attention and opinion are important local factors for the planning and success of advocacy efforts.See also the ‘adaptation’ sections in the checklist for the ‘Advocacy’ topic in this toolkit.

 

Quality improvement

Quality improvement

The success of advocacy, including advocacy for adding self-testing/self-sampling to the range of testing options available to MSM, can be influenced by external factors that the CBVCT cannot control (e.g. legal restrictions on the use of medical devices, lack of interest from laboratories). Improving the quality of advocacy therefore means reflecting on the processes and strategies used to advocate on a particular issue. Topics for reflection include the involvement and roles of different stakeholders, and the advocacy strategy or plan used to progress the issue. 

See also the ‘quality improvement’ sections in the checklist for the ‘Advocacy’ topic in this toolkit. 

 


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Self-sampling and Self-testing
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