Extending reach of HIV testing services (HTS) through private-sector outlets: feasibility of offering HIV self-testing (HIVST) at pharmacies and alternative medicine centers (AMC) in Democratic Republic of the Congo (DRC)

BACKGROUND: 2019 data show only 56% of PLHIV in the DRC are diagnosed and on antiretroviral treatment (ART), indicating a need for novel models to reach vulnerable populations not currently accessing HTS. PATH, through the USAID-funded Integrated HIV/AIDS Project, tested a public-private model for HIVST at pharmacies and AMCs to extend HTS reach.
DESCRIPTION: Under this model, PATH trained pharmacists and AMC providers to screen clients for HIV risk or signs suggestive of HIV infection, and offer free, directly assisted HIVST to clients who screened positive. They also counseled clients with a reactive self-test result on the need for confirmatory testing, and contacted a project-affiliated community health volunteer to provide an accompanied referral to a public-sector facility for confirmatory testing. PATH supplied HIVST kits to pharmacies/AMCs, and pharmacists/AMC providers were provided $2 for each client confirmed HIV-positive. We piloted this model at 21 private-sector outlets (19 pharmacies; 2 AMCs) across five health zones of Lubumbashi, and used descriptive statistics to analyze HIV testing, referral, and ART initiation data from May through December 2020.
LESSONS LEARNED: 172 individuals (median age 34 years; 52% female) were offered HIVST. 97% (98% of males; 96% of females) accepted; all 166 individuals were first-time testers. 34% (57/166) of HIVST clients had a reactive result. 56 out of 57 clients with reactive results were successfully referred to a facility. 71% (40/56) were confirmed HIV-positive, with 100% linkage to ART. Overall HIV prevalence was 24%, with higher prevalence among females (29%) than males (19%). HIV testing yield among pharmacy/AMC clients was higher than the yield observed at routine project-supported HTS outreach during a similar period (24% versus 6.7%), highlighting the model's success in efficiently reaching and linking undiagnosed PLHIV to ART.
CONCLUSIONS: Our results show the feasibility and acceptability of using a public-private HIVST model to reach and link private-sector clients to public-sector facilities for diagnosis and ART initiation, and its success in identifying hard-to-reach PLHIV. We plan to extend this model to additional private-sector outlets to increase accessibility of HTS services to support DRC's efforts to reach epidemic control.