What would the perfect DIY HIV test look like? Not like this, says new research backing easier-to-use oral tests delivered to your door step.

The future of take-away? I'll take a large pizza - and an HIV test - for delivery

Laura Lopez Gonzalez
Home is where the heart is, they say – it could also be the future of HIV testing.

Each year, health researchers converge for a marathon of science. The  Conference on Retroviruses and Opportunistic Infections (CROI) packs the results of hundreds of studies into just 72 hours.

If you’re into infectious diseases then CROI is one of the world’s premier events to be at.

Despite its decidedly unsexy name, the conference’s gathering of minds yields some of the most influential findings on everything from herpes to Zika, not to mention HIV and its deadly twin, tuberculosis (TB).

TB is not only a leading killer of people living with HIV but also the world’s  most deadly infectious disease, says the World Health Organisation.

We slogged through the deluge of science at this year’s CROI to bring you three studies likely to shape our world.

A shorter, kinder cure for TB’s deadliest forms is on its way
You may remember it from such headlines as “‘True outbreak’ of TB superbug at Tugela Ferry” but extensively drug-resistant (XDR) TB never really left South Africa after a deadly rash of cases in rural KwaZulu-Natal propelled it into the spotlight.

Today, the country diagnoses more than 1 500 cases annually of the illness, which is resistant to both of the most commonly used anti-TB drugs and at least half of standard second-line medicines.

University of Cape Town research shows that more than half of XDR-TB patients will die. Up to a third of those who live to see treatment will lose their hearing to the daily injections that form part of a gruelling two-year course, according to Francesca Conradie, a clinical adviser with the nonprofit organisation, the Right to Care.

Now, two pills pioneered in South Africa may hold the key to better treatment. Research presented at CROI found that pairing an experimental drug, pretomanid, with the existing medicine bedaquiline as part of treatment cut the need for hearing-stealing injections. It also slashed treatment times by two-thirds and reduced patients’ daily burden of pills from about 20 to just five.

Speaking to Bhekisisa from the conference, Conradie, who is leading the research, said the results now pave the way for the new drug regimen to be offered to more patients in South Africa as part of the study.

HIV testing could be delivered to your doorstep
South Africa approved the sale of do-it-yourself HIV testing kits last year and is now one of just about two dozen countries that advocate the use of self-testing in national guidelines. The catch? South Africa — and the world — is still trying to figure out the best way to offer DIY testing.

A new study conducted among about 1 300 people in Malawi found that people preferred self-tests to traditional diagnostics administered by health professionals.

The oral tests, which use cheek swabs instead of blood, were most popular when they were delivered to people’s homes instead of being collected at facilities or mobile clinics. And they had to be free.

The  research presented at CROI found that even a fee of as little as seven US cents was enough to put people off testing.

The study found that people didn’t really care about pre-test counselling but wanted more substantial post-test advice than a simple package insert.

Currently, the international humanitarian organisation Doctors Without Borders (MSF) is piloting the distribution of DIY HIV tests at Khayelitsha health facilities. It is also considering handing out free kits at private pharmacies and through patient groups, MSF’s South Africa head of mission Rodd Gerstenhaber told Bhekisisa in November.

Quicker results are better for baby
A health technology revolution has quietly been brewing in Mozambique. The country has been an early adopter of new types of diagnostics that can take complicated tests out of scarce central laboratories and into rural clinics.

Most HIV tests detect the presence of HIV antibodies — proteins produced by the body in response to HIV infection. Babies born to HIV-positive mothers will have inherited these antibodies but not necessarily the virus itself.

Special polymerase chain reaction (PCR) tests are needed to look 
for the actual virus to diagnose HIV in infants. These are usually only available at district laboratories, and clinics often wait months to get the results.

In 2015, only half of the more than one million babies born to HIV-positive mothers accessed this type of testing, which is needed to start babies on life-saving antiretroviral treatment, says UNAids.

Mozambique recently conducted a  study among almost 4 000 infants to see what would happen if complicated tests could be carried out at local health facilities.

The trial used a  small battery operated machine recently approved by the World Health Organisation.

Conducted by the ministry of health, the research found that clinics with PCR testing available on site were able to return test results to about 80% mothers within 60 days.

Less than 60% of mothers attending clinics without machines received their baby’s results within the same period.

Babies who were diagnosed earlier with the machines were more likely to start treatment than those diagnosed in conventional ways.

Without antiretroviral treatment, a third of HIV-positive babies will die before their first birthday and more than half will never see the age of two, according to a 2004 study published in The Lancet medical journal.

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