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Sandra Jones, PAHO’s Technical Advisor for HIV/STI, TB & Viral Hepatitis in the Caribbean.

A 69 per cent reduction in facility and community-based HIV testing services due to COVID-19 is putting people with undiagnosed HIV at risk of not getting lifesaving antiretroviral treatment potentially exposing others as they are unaware of their status.

This was the concern raised by Sandra Jones, PAHO’s Technical Advisor for HIV/STI, TB & Viral Hepatitis in the Caribbean, as she joined with other stakeholders in the region in calling for countries to adopt HIV self-testing.

During the virtual launch of the “In Your Hands” Caribbean HIV self-testing campaign yesterday, partners advocated for self-testing policies to be developed and implemented as part of a comprehensive strategy to ensure that HIV diagnosis does not decline during the COVID-19 pandemic.

The advocacy campaign is jointly endorsed by the Joint United Nations Programme on HIV/AIDS (UNAIDS), Pan American Health Organization (PAHO), Pan Caribbean Partnership against HIV and AIDS (PANCAP), President’s Emergency Plan for AIDS Relief (PEPFAR) and the Caribbean Med Labs Foundation (CMLF).

Even before COVID-19 the Caribbean was not on track to achieve the 90-90-90 testing and many of those on antiretroviral therapy were virally suppressed.

According to UNAIDS Caribbean Sub-regional Office Director, Dr James Guwani, it is particularly important to increase testing uptake among men who are more likely to be diagnosed late. In 2019, 85 per cent of Caribbean women living with HIV were aware of their status as compared to 72 per cent of men. There is also a need to increase testing coverage among members of key population communities who have reduced access to HIV services due to stigma and discrimination.

HIV self-testing is a process whereby a person collects a saliva or pinprick blood specimen, performs a test, and receives the result in private. The World Health Organization (WHO) recommends that HIV self-testing be offered as an additional approach to facility- and community-based services. Evidence shows that self-testing is safe and accurate and increases testing uptake among people who may not test otherwise. National policies should include a communication package with information to link testers to prevention and treatment services, as well as minimum standards for the procurement and distribution of HIV self-test kits in the private and public sectors.

At the launch, leaders from communities of people living with HIV and key populations endorsed the call for HIV self-testing. At the same time, they advised that increased investments are needed in post-test counselling and adherence counselling for the entire HIV response.

CMLF Director Valerie Wilson said under the Global Fund Project for the region and in collaboration with PANCAP, the Caribbean Vulnerable Communities Coalition (CVC), the Centre for Orientation and Integral Research (COIN), the Organization of Eastern Caribbean States HIV/TB Elimination Project and PAHO, work is underway to conduct a verification and feasibility assessment for the introduction of HIV self-testing within the region.

“HIV self-testing has the potential to be a high impact, low-cost intervention to reach population groups that are not testing and to increase the number of people living with HIV who are identified and have initiated treatment,” she said.