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The Role of Policies in Shaping HIV Self-Testing Implementation in the Private Sector

Authors: Fosca Tumushabe, Jude Oriokot, Deborah Kyamaggwa, Baker

Lukwago – PSIU, and Geoffrey Taasi – MoH Uganda

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BACKGROUND

Uganda subscribes to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 target in her fight against AIDS.

To achieve the first 95, the Ministry of Health (MoH) employed a strategic approach involving the introduction of HIV self-testing (HIVST) in the country.

It commenced the review of the existing guidelines and policies to provide a supportive environment for HIVST which was subsequently rolled out to the private sector in 2020.

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DESCRIPTION

In 2016, the National HIV Testing Services (HTS) policy was expanded to facilitate the strategy with revisions such as:

Enlarging target populations for HIV self-testing
Shrinking the linkage period from 30 to 14 days
Adding blood-based kits for self-testing services
HIVST PrEP using the blood-based kit,
Streamlining HIVST supply chain from parallel delivery to facility-warehouse order system, and
Revising national HMIS tools to include HIVST reporting.

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PSIU RESPONSE

Through a human-centered approach, PSI developed tools; a chatbot, a toll-free line, social influencers, and conceptual bundling to support demand creation and access to information and HIVST kits among consumers in the private sector.

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RESULTS

With the right policies, regulations, and technical guidance from MOH to all players,

18,004 HVIST kits were sold, highlighting a 20 times growth in volumes sold compared to the baseline volumes

56% reduction in volumes of non-approved HVIST kits sold from 639 in April 2022 to 283 in May 2023

1,805,764 individuals reached with HIVST information through digital channels.

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LESSONS

Persistent review and revision of policies to accommodate novel strategies, refine interventions, and facilitate their implementation for a substantial public health impact.
Amendment of the policies to allow other channels (vending machines, online pharmacies, drug shops)
Re-classification into a general sales list are paramount for increased access to HIVST and other essential products and services

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CONCLUSION

An enabling policy environment is catalytic for innovation to address the dynamic health needs of diverse populations effectively.
The remarkable success of HIV self-testing in Uganda demonstrates the power of self-care interventions when supported by forward-thinking policies and collective dedication to a shared vision of a healthier future.
Investment into policy review and development.
We encourage the government of Uganda to continue this trend in policy review to facilitate the attainment of UHC.