HIV self-testing to take off in India: findings from the STAR Initiative

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13 March 2023 WHO Departmental news

WHO recommends HIV self-testing (HIVST) as an important approach to address gaps in HIV diagnoses including among key populations (sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prisons other closed settings). Globally, 98 countries now have policies supportive of HIVST and 52 are routinely implementing, yet many countries have not yet introduced HIVST as a routine approach.

A report launched at a national event held in New Delhi last year showed HIVST is acceptable to key populations and their partners in India. As part of Unitaid-funded STAR Initiative, PATH led the implementation of HIVST project in India. Between September 2021 and June 2022, 93 380 HIVST kits were distributed in 50 districts across 14 States. These kits were distributed using 5 different service delivery models including community-based, private practitioner, community pharmacy, workplace and virtual models using both oral-fluid and blood-based kits. Communities found HIVST convenient and easy to use, the intervention was feasible to implement and led to identification of previously undiagnosed HIV infections.

HIVST has helped many countries make testing accessible for those who do not otherwise test for HIV. HIVST can also generate demand for prevention services and facilitate service delivery for pre-exposure prophylaxis (PrEP). Evidence and experiences from HIVST implementation have informed guidance for other disease areas such as hepatitis C self‑testing and COVID-19 self-testing.

*Client taking a HIV self-test for the first time with support from a trained provider as assisted self-testing in India (© PATH India)*

Communities in India have voiced strong interest in accessing HIV self-testing as an additional option and desired continued access to HIVST after the STAR Initiative ends. “The study has been implemented through active participation of key populations and communities of people with HIV. Communities are very interested in this technology and demand continued availability of HIVST in the country,” said Ms Selvi Shanmugam, Chair of the Community Advisory Board for STAR Project.

WHO provided technical support to the project across 3 levels (headquarters, regional and country offices) throughout the design and implementation. “A systematic approach has been adopted to ensure that evidence generated translates into policy development and implementation. India has now extensive experience implementing HIVST and it is time to scale up this service in the country,” commented Dr Po-Lin Chan, Team Lead Communicable Diseases, WHO India Country Office.

India is among the countries that have not yet developed a national policy on HIVST. Given promising results and experiences of the STAR Initiative, the country plans to introduce HIVST as an HIV testing approach among key populations and their partners. “NACO has been at the forefront since inception of the STAR Initiative and has provided strategic leadership throughout the design and implementation. Communities have been at the centre of coordination, implementation and monitoring of this initiative. The STAR Initiative has generated critical local evidence and we are considering national policy development and implementation in the light of this evidence,” noted Dr Shobini Rajan, Deputy Director General, National AIDS Control Organization, India.

It is time now to move from evidence to implementation.