South Africa’s HIV testing programme has been a huge success over the last decade, largely due to the use of rapid tests. Now, the introduction of a new generation of rapid tests may offer some benefits over the current tests, but the picture is somewhat complicated and the Department of Health is not currently planning to use the new tests.
South Africa’s mass HIV testing programme has seen a great deal of success over the past 10 years, so much so that the country has almost hit the global target of 95% of people with HIV knowing their status. This success has largely been built on the use of many millions of rapid HIV tests.
The UNAids targets for 2030 are that 95% of people living with the virus know their status, 95% of those who are diagnosed are on treatment, and 95% of those on treatment are virally suppressed. According to Minister of Health Dr Joe Phaahla, South Africa has reached 94, 78, 89.
Now, new fourth-generation rapid HIV tests and a new testing algorithm may be able to push the country even closer to the 100% mark — where effectively all people with HIV have been identified and diagnosed.
But there are questions about the performance and high cost of the new tests that have so far prevented their wider adoption in South Africa. Some experts nevertheless believe there may be a place for them in certain contexts and in particular groups. Newer tests could, for example, help diagnose recently infected people in whom HIV is not yet detectable using the currently available tests. They might also help diagnose people who become infected while taking antiretroviral medicines to prevent HIV infection (called pre-exposure prophylaxis or PrEP).
Rapid tests
“Rapid tests are the main tool used to identify people with HIV in South Africa,” says Professor Adrian Puren, who is the Executive Director of the National Institute of Communicable Diseases.
He says this is based on the fact that roughly 80% of the South African population is uninsured and therefore relies on the public health sector. Rapid HIV tests can be done in any location and do not require sophisticated laboratory infrastructure or the high-level expertise of a lab technician or pathologist.
They are designed to be used by most people, yet not just anyone can perform them. There is a degree of training involved but, once trained, most lay people can conduct rapid HIV tests accurately ...