Preferable - Studies have shown self-testing is
preferable to people at risk who have never tested (Spielberg JAIDS 2003)
Better Access - Self-testing is 25 times more
acceptable than home specimen collection, so access to acceptable testing
would be substantially improved (Spielberg JAIDS 2003)
Overcoming stigma - People with stigma who avoid
clinics may be more likely to test.
Likely safe - Post-Marketing studies of home
specimen collection showed that the vast majority of people with positive
test results accepted referrals or were already in care. (Branson JAMA
1998) No studies have shown increased risk of suicide with HIV testing.
With sensitivity > 80 % the benefits of an
OTC HIV test would outweigh the risks if for every one first-time tester
who tested positive using an OTC < 5 people with HIV switched from
clinic-based testing to OTC.
Conservatively assuming that >25% (HSC 49%, Branson,
JAMA 1998) of the testers will be first-time testers, there will likely be
a ratio of 1 new tester : < 4-5 switchers.
In the least favorable circumstances OTC
sensitivity was 94% so it is likely that the benefits will outweigh the
risks for an OTC rapid HIV test.