Ugandan authorities concerned as HIV self-test kits hit the market
KAMPALA, 6 February 2013 (IRIN) – The sale of HIV test kits to the public by private chemists in Uganda is causing concern among health officials, who feel that HIV testing should remain in the hands of professionals and be accompanied by counselling.
A number of pharmacies in the capital, Kampala, are stocking HIV test kits imported from China, India and several European countries; they retail for as little as 3,000 Uganda shillings (US$1.12).
“There is high demand for the HIV test kits. People come to buy them here. We sell a Determine [brand] kit at 3,000 [shillings],” one dispenser at PlusMedic Pharmacy in Wandegeya, a suburb of Kampala, told IRIN.
“I personally buy the kits from the pharmacies. I do HIV self-testing monthly in order to know my status. I don’t trust my husband. I believe he cheats without taking consideration of HIV,” said Janat*, a local resident.
“The kits are available in several pharmacies. You just walk in and ask for them. I embrace my results, whether it’s positive or negative. Once the test shows positive, I will go for a confirmatory test in a health unit,” said Hillary, another resident.
However, while the Ugandan government is keen to have more people to know their HIV status – just 45 percent of men and 66 percent of women have ever been tested and received results, according to the latest AIDS Indicator Survey – senior health officials say they have not approved the private sale of self-test kits and would prefer the public to continue to use the health provider- or client-initiated HIV counselling and testing model recommended by the country’s national HIV strategy.
“People need to be careful of these kits. There are several mushrooming health service providers [pharmacies and other unqualified personnel], which are illegal, quack and not genuine at all. They are not approved by us,” Christine Ondoa, Uganda’s Health Minister, told IRIN.
|I do HIV self-testing monthly in order to know my status. I don’t trust my husband. I believe he cheats without taking consideration of HIV|
“Our policy is HIV counselling and testing. As a ministry, we are improving and strengthening our health laboratories services across the country for reliable and accurate results,” she added.
“All the HIV kits that enter Uganda through the normal channels meet the required international standards, but the danger of these test kits is misuse,” said Gordon Sematiko, the executive director of the country’s National Drug Authority (NDA).
“Self-testing is a complicated one. I am not sure whether those who buy the kits know how to use them,” said the Wandegeya drug dispenser. “Drawing blood samples and putting them in the strip to get correct results is a hard process. It’s better and advisable for the couples to go and test in a health facility.”
Sematiko notes that the NDA has concerns about counterfeit test kits being imported into the country. “It’s hard for us to test their quality,” he said. “Those who default the law, we shall take them to the professional bodies like Uganda Medical and Dental Practitioners Council, the Council of the Pharmaceutical Society of Uganda, and Allied Health Professionals Council of Uganda for disciplinary action.”
Some officials say HIV testing can be highly emotional and should be managed by trained professionals.
“There are usually sentiments depending on the outcome of the results. Imagine a person conducts an individual HIV test and gets a positive result – what happens without counselling?” said Godfrey Esiru, national coordinator for the prevention of mother-to-child transmission of HIV at the Ministry of Health. “Some people can end up attacking or killing their partners if the results show HIV positive.”
The country has seen a number of cases of people killing their spouses over HIV-positive test results, highlighting the need for proper counselling following HIV testing.
“HIV counselling offered along with testing has been demonstrated to be an effective intervention for HIV infected participants, who typically increase their safer behaviours and decrease their risk behaviours,” said Dan Travis, a spokesman for the US Agency for International Development (USAID), which supports HIV testing and counselling services in the country. “HIV testing without such linkage often confers little or no benefit to the patient.”
However, senior Ugandan policy makers said they would be open to the idea of self-testing down the line, as long as it was properly regulated.
“It’s important for people to know their HIV status in Uganda. I see science moving fast and making it easier for us,” said David Kihumuro Apuuli, director-general of the Uganda AIDS Commission. “If we are to reach many people in Uganda, we require more sophisticated means like self-testing. However, we need to regulate it.”