Learning from Market Assessment: HIV Self-Test
LEARNINGS FROM A MARKET ASSESSMENT
Despite the momentous achievements in the last couple of decades in terms of minimizing new infections of HIV among all age groups, there is still a 1% prevalence among adults 15–49 years of age that peaks to 3% in urban areas. While stats show that the infection rate (incidence rate) is growing slightly and that there is a slight rise in new infections, there are up to 1 million people living with HIV in Ethiopia. This coupled with a global initiative to accelerate universal access to HIV prevention, treatment and care have necessitated the adoption of HIV testing as one of the core strategies to accomplish the outlined goals by the ministry of health.
The HIV counseling and testing strategy of Ethiopia recognize the importance of testing and counseling as an entry point for the treatment and care options available for People Living with HIV (PLWHIV). This position of importance that HIV testing and counseling holds in the move to realize 95–95–95[1] by 2030. Ethiopia only attained 79–91–95 in 2021. This calls for looking into practical options as part of the mainstream strategy of counseling and testing for HIV. Unassisted HIV self-test is one of such initiatives that try to overcome certain challenges that pose an obstruction to the testing and counseling process.
Unassisted HIV self-test (HIVST) refers to all the techniques and amenities available to enable a person to perform HIV testing without needing to seek administration of the test by a trained health professional. The family of health products in this category requires the tester to introduce a sample of blood or oral fluid into the easy-to-administer testing apparatus calibrated to deliver results within a short period.
[1] This is part of a goal by UNAIDS to achieve 95% of people who are living with HIV to know their statuses through testing, 95% of diagnosed PLWHIV will get treatment and 95% of those receiving the treatment will have suppressed viral loads in 2030.
PSI GLOBAL EXPERIENCE
PSI has led, in Partnership with several agents working on health, the HIV Self Testing Africa Initiative launched in 2005. This initiative has the three core goals of “catalyzing the global market for HIV self-testing (HIVST), generating evidence for decision-making, and co-creating an enabling environment for HIVST scale-up.” The initiative has had success in expanding geographically, from three to thirteen countries, and in ensuring demand by facilitating the establishment of regulatory frameworks in Self Testing Africa So far, the initiative has distributed over 4.8 million test kits, supported 38 countries to actively implement HIV self-testing, directly supported 13 countries, and has increased WHO pre-qualified self-test kits to four. In its bottom line, STAR has helped increase uptake and frequency of HIV self-testing (HIVST) among priority population groups previously not reached. PSI/Ethiopia, as a major non-governmental player in health services solutions, has ventured into the HIVST category and has gained a few learnings in 2021 from a market assessment study. The assessment generally set out to understand the demand for the health product and explore the sentiments that consumers have.
The initiative has had success in expanding geographically, from three to thirteen countries, and in ensuring demand by facilitating the establishment of regulatory frameworks in STAR countries.
MARKET ASSESSMENT IN ADDIS ABABA
The HIVST assessment has involved a total of 40 access points (pharmacies) and 59 consumers from different segments of young and adult as well as an at-risk population. The market study confirms the prevalence of high sexual activity and unsafe sexual practices especially in age groups of 18- 45. Over 40% [2] of sexually active respondents in the study are intermittent condom users and have had sexual relations with more than one partner over six months. The study confirms that three distinct segments, High-risk men, Adolescent girls, and young women, and women engaged in transactional sex, are more vulnerable to HIV infections.
Health centers, hospitals, and clinics are the most frequented locations where respondents are tested for HIV. Reasons given for testing include being required by a partner to start a new ‘chapter’ in life such as marriage, as part of a pregnancy health routine checkup, the fear associated with unsafe sexual activities, and a recommendation recommendations a physician. Some challenges are mentioned by people who have tested in these mainstream assisted-testing locations. Queues and the ‘long wait’ consumers must endure getting the test are mentioned by many as unfavorable experiences. One of the most emphasized shortcomings was the lack of privacy and feeling of ‘shame’ when testing for HIV. A respondent describes this as follows,
“… I had to intentionally go to a clinic that was farther from my neighborhood… because some staff of the closest clinic is my neighbors. I don’t feel easy being seen in the HIV testing section or more importantly feel like they could find out about my status from their colleagues…” a female respondent, age 39
The shortcomings and challenges that were identified in health facility-based HIV testing seem to be addressed by the new category of HIVST product which was validated by the endorsements of consumers.
At the core of its theory of change, PSI holds that behavior change is demonstrated by how individuals can market products and services and make habits of making decisions to improve their health. In this respect, the assessment also investigated the sentiments consumers have to the new category of products that allow for autonomous HIV testing. Responses to the self-test kit were ‘astounding’ as most of the respondents indicated that they were new to the product and category.
“I am amazed by how easy they have made the testing for HIV. Too good to be true” female respondent, 26 years of age.
“I thought testing without health care workers was impossible. This is very innovative” male respondent, 35 years of age.
The HIVST product presented for the market research was met with highly positive first reactions. This was mainly shown by how the product was perceived to be ‘innovative’, and ‘disbelief’ that the category provides the functions of mainstream assisted testing without all the challenges that were identified by the respondents. The belief of respondents that testing for HIV is one of the main activities to prevent or treat HIV infection and the absolute importance of testing regularly are shared unanimously.
The following attributes of the HIVST product commanded a ‘96% willingness to try’ response.
• The product is highly private
• It is easy to use and can be used at any time of the day
• It can be performed frequently due to ease of use and the ability to make it accessible
• It saves time, doesn’t require me to queue for results, and has standardized the time one waits to get results
• The product uses oral fluid with a swab instead of blood which makes it less vulnerable to infections due to the use of needles.
In addition to these attributes, responses from the supply side (pharmacies) indicate that the self-test kits can relieve pressure on health facilities and professionals.
PSI/Ethiopia has learned the viability of the self-test kit and has put forward an effort to work on a pilot phase of introducing the product to the market. As part of this process, PSI/E is working on marketing and distribution strategies, branding as well as creating networks with supporting services to undergo the necessary vetting of the product with the concerned agencies.
“I am amazed by how easy they have made the testing for HIV. Too good to be true” female respondent, 26 years of age.
“I thought testing without health care workers was impossible. This is very innovative” male respondent, 35 years of age.
[2] Results provided here as part of the outputs of the assessment may be subject to a ±5% margin of error
