HIV testing: Home Sampling vs. Home Testing, a primer for users (and others)
Home testing and home sampling are not one and the same and it is important for potential users and their providers to understand the key differences between the two.
HIV home testing is coming. Not right now, because none of the non-clinical commercial testing kits currently available are approved in the UK 1. However, “home testing” is already broadly advertised, though it is not currently home testing but home sampling 2. Both aim at detecting HIV infections but they differ on a number of points.
- Home sampling requires the individual to collect and send a sample of blood or saliva to a laboratory for analysis. Sampling has been legal for a number of years and can be a successful approach. Testing is performed by qualified laboratory personal, in a controlled and monitored environment.
- Home testing requires the individual to perform the test themselves and to read and interpret their own results. As of April 6, HIV home testing is legal. The approach has not been tested thoroughly in the UK and there is little data about its potential uptake and benefits 3.
This primer explores key differences between HIV home sampling and HIV home testing and put them in perspective with HIV testing in clinical or community settings. It will also offer a perspective to HIV testing for potential users, with a focus on gay men undecided about what options to go for when home testing will be available.
Three key factors should be taken into consideration when deciding to go for a HIV test: Accessibility, reliability and support. The table below compares these features and more for the three type of testing soon available.
Affordability should also be taken into consideration. Remember that HIV testing is free in the NHS and price as hefty as £300 have been seen for the very same test being performed in private settings. These are excluded from the table below (click to enlarge or download as PDF)
A point of view on HIV testing
The decision to take a HIV test is not always an easy one, but not necessarily a difficult or thorny one. It is often motivated by an interest in one’s personal health or because people believe they have been exposed to a risk of infection. Once the decision to go for HIV testing is taken, it is important to consider the options available and to be confident with the settings, technology and process of going through testing.
More than 900,000 HIV tests were performed in the UK in 2012, a number growing year-on-year. The very large majority of HIV testing is performed in clinical settings in particular in genitourinary medicine (GUM) clinics where it is highly acceptable (85% acceptability recorded). GUM clinics offer an environment which aim to provide safety, reliability and accurate testing and to maximise linkage to care for those who test positive. It is also an opportunity to provide further information to those who test negative to stay negative, and to perform testing for other sexually transmitted infections and more.
If you do not have any problem with visiting a GUM clinic and assuming one is easily accessible to you, then this is where you can get the best service available and for free. Alternatively, consider home sampling.
If for whatever reason you decide to opt for home testing, then consider carefully the following (adapted from the MHRA website)
When thinking about self-testing…
You can get free access to high quality tests through GUM clinics across the country. In London, 1 in 4 gay men test in a single GUM clinic, confirming the popularity of testing in clinical settings. Though still not enough, HIV testing is high amongst gay men and testing is a critical point of entry into care, which saves life. An HIV specialist or your GP can help you make decisions about testing and help you access further treatment or advice.
A negative home testing results can rarely completely exclude a HIV infection and may not be as helpful as a visit to a GUM clinic which will include further testing for other sexually transmitted infections.
Think about the possible results of the test and what you are going to do when you have the result – whether it is positive or negative.
If you decide to self-test, you should still follow-up with conventional testing to confirm the results and discuss your options if positive.
Before buying an HIV self-testing kit…
- Whether buying from the high street or online, only buy a test from a source that you trust.
- If possible ask a healthcare professional e.g. a pharmacist, practice nurse, GP to help you select the best test for you.
- Do not buy or use the test if it looks damaged or the seals are broken.
- Make sure the test has a CE mark. A CE mark means that the device meets the relevant regulatory requirements and, when used as intended, works properly and is acceptably safe.
- But remember – a CE Mark alone is no guarantee that a home test will be suitable for your needs.
- No test is 100% reliable.
Before using a HIV self-test…
- Be sure that the kit contains everything you need and make sure you have everything else you need.
- Don’t rush.
- You don’t have to test on your own if you are worrying about the outcome.
Read the instructions carefully:
- Make sure you perform the test according to the instructions.
- Make sure you know how the test should be stored if you don’t use it immediately.
- Make sure you know how to read the test result.
- Make sure you know what the results mean.
- Make sure you know how to dispose of the test after use, especially if you are concerned with privacy issues.
- Know who to consult for help if you need it when you know the result.
After using the test…
- Don’t rush (yes, again)
- Remember that no test kit is 100% reliable or accurate.
- Regardless of the result, you will need to seek confirmation of the result by attending a clinical service and have a confirmatory test performed by a laboratory.
- A negative result is not a license for unprotected sex.
More gay men need to test for HIV and they also need to test more regularly and more often. The decision is yours but once you have made it most of the hard work is done. There is a lot of support available out ether and you won’t be alone.
- Saving life: HIV transmission and HIV testing
- Aidsmap: HIV testing
- HIV Scotland: Key questions and good practice on instant result self-testing for HIV
- Public Health England guidance document: HIV Testing and Self-Testing – Answers to frequently asked questions.
Non exhaustive list of services offering free sampling kits
If you have suggestions to improve this article please get in touch.
07 apr 14: revised table (v2 & v3). Thanks to Roger Peabody for important feedback.
07 apr 14: revised table (v4 & v5) with added information.
|Notes:1 The lack of preparedness of both Department of Health and NGOs working in the field of HIV prevention resulted in HIV home testing being legal before being available. Medical tests are subject to an EU Directive called the In Vitro Diagnostic Medical Devices Directive. Self-test kits cannot be sold within the UK or the EU unless they have been CE but there is little indication that the MHRA is prepared to approve a test very quickly.2 Regrettably, NGOs are conflating Home Sampling and Home Testing, a decision which will most certainly lead to confusion amongst users.3 Early in April 2014, Public Health England finally produced a guidance document on HIV Testing and Self-Testing – Answers to frequently asked questions.