HIV self testing to become legal in the UK from April 2014

On 15 August, the UK Chief Medical Officer Professor Dame Sally Davies announced that from April 2014 the rules banning HIV self testing kits will be lifted, although tests will need to comply with new regulations. [1]

This is likely to be the result of a lobbying campaigns, principally by the Terrence Higgins Trust and National AIDS Trust, as a strategy to make testing easier to access, in the hope that this will reduce current rates of late diagnosis.

Whether this approach is successful has yet to be determined, given concerns that both taking an HIV test and learning the results requires a level of support that at the minimum should involve at least one other person. Even in the context of face-to-face HIV testing, some people do not remain within the health care setting and are lost to follow up for many years until they become symptomatic. It is difficult to understand how home testing will tackle this issue, even though a positive result with a home test kit includes “advice” to get a follow-up confirmatory test at an NHS clinic.

Clear information about how to interpret the result and what to do afterwards will be included with the kit.

Current rules prevent companies from selling HIV self-testing kits in England. Once these rules are lifted, all kits will be subject to strict regulatory control by the Medicines and Healthcare Regulatory Authority before they are authorised for sale.

BHIVA Chair, Dr David Asboe, welcomed the availability of regulated HIV self-testing kits, while noting two important caveats: “First, home tests can record negative results when a person first catches HIV at a time when they are usually highly infectious. False reassurance at this time could increase the risk of HIV transmission. Second, home tests also have significant rates of false positive results. It is therefore vital that home tests are not used as a substitute for the expanded testing currently available in healthcare and other settings, and that the transfer into high quality, specialist care of someone who tests positive is monitored.”

The statement, in a press release from BHIVA, also stated: “Psychological support and medical care are critically important. Furthermore, it is crucial that we evaluate the effectiveness of this policy in reducing undiagnosed infections without unwanted effects on behaviour, psychological wellbeing, and uptake of broader sexual health services.” [2]