Testing Talking Points: Self-sampling vs Self-testing

The National HIV&STBBI Testing Working Group meets once a month via teleconference to discuss testing devices, innovative approaches and other issues related to increasing access to testing and care within Canada. Testing Talking Points provides a brief overview and investigation of the major themes that are discussed on these calls to encourage a broader conversation about issues surrounding HIV&STBBI testing in Canada.

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To help reach individuals not currently accessing standard HIV and STBBI testing approaches, the push to bring HIV and STBBI testing opportunities into communities is increasing. This often involves discussion about offering testing opportunities that does not require visiting a healthcare provider or a clinic. HIV self-testing, which would allow people to test at home, has long been the topic of conversation on the Testing Working Group calls, and involves discussion about Health Canada approval processes, populations that would benefit most from an approved self-testing device, and discussions about testing uptake in countries where an HIV self-testing device is approved.

Recently, a UK based company called LetsGetChecked, announced an opportunity for Canadians to purchase a self-sampling kit that can be used to test for up to 10 sexually transmitted infections, including HIV1. The cost of the kit increases depending on the number of tests the individual wants to add2. Samples that yield a positive result will trigger a follow-up from a member of the health team who will help the client navigate the resources and a linkage to care pathway in their area. As exciting as this news was, it did prompt some questions. Is self-sampling the solution to give power to people to test themselves? How did this enter the market when Canada still does not have an approved HIV self-testing kit? The answer to this may lie in the difference between self-testing and self-sampling.

With self-testing an individual purchases, or receives, a kit to take with them to a private setting, and conducts and interprets the result of this test themselves. The kit should be equipped with information that will help link the individual to confirmatory testing or other resources as needed.

Self-sampling, in contrast, requires only that the individual collect their samples themselves. After which, they are sent to a lab where the samples are run and results are read by a trained professional. Someone then follows up with the individual to discuss next steps.

The difference between the intended use of the device, and who is interpreting the results, will determine the types of approvals a device or kit would require before being introduced to the Canadian market. In the case of a self-testing device, for example, it is critical that the test be easy to preform, the test be as accurate as possible, and the results be easy to interpret by an untrained individual. For self-sampling, it only really requires that the client be able to collect the sample properly and the rest is left up to the professionals.

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Note: British Columbia has a similar program called Get Checked Online where users access a website, sign up and indicate the tests they want, then print and bring the lab form to a participating lab site to collect samples. An email is sent when the results are ready, and in the event that results comes back positive, a nurse then follows-up with the necessary next steps. Neither self-testing or self-sampling, but an interesting example of self-directed testing.

1You can now check yourself for STIs at home

2LetsGetChecked

Recommended Reading on Self-testing and Self-sampling

OHTN Rapid Response- The acceptability and use of HIV self-testing among men who have sex with men in high-income countries

HAUS: Feasibility and acceptability of self-sampling kits to increase the uptake of HIV testing among black Africans in the United Kingdom

CATIE- HIV home-based testing: potential benefits and ongoing concerns

Home-based self-sampling and self-testing for sexually transmitted infections: Acceptable and feasible alternatives to provider-based screening in low-income women in São Paulo, Brazil

 

 

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