HIVST

1-Policy uptake of WHO recommended HIV testing approaches 

Source: WHO, Unitaid, and UNAIDS meeting on HIV self-testing and innovative testing approaches in Asia and the Pacific Region: Country progress and plans, December 2020

Pakistan has partially adopted WHO guidelines recommendations on HIV testing services. The country today has a policy on HIVST and a policy making HIV testing provision free to all in the country. 

The conservatism of Pakistani society has had led the National AIDS Programme to partner with communities to offer services such as HIV testing. The country also has no law specifying HIV testing to be solely performed based on voluntary and informed consent

The legal aspects of the epidemic and frequent HIV outbreaks in different cities across the country are under discussion in the country. Pakistan’s Court has directed the national programmes and policy makers to develop a timebound action plan for enhancing the HIV response while taking into consideration the legal, human rights and policy reforms. HIV Bills are under consideration in the national and provincial assemblies of the country. Outcomes of the consultations and reviews include steps to increase uptake of HIV preventive and treatment services by key populations. There has been an increase to financial allocations by Provincial governments in their budgets for key population HIV prevention services as well as engagement of community members for programme implementation. This is expected to result in reduction in the disease burden as new HIV infections decline.

2-Implementation status

Despite the policy on HIVST, WHO Policy Data 2020 records that there are yet to be any pilot or implementation in the country. In December however, it can be seen that an HIVST demonstration project has started focusing on key populations and an HCV self-testing usability and feasibility study has also commenced.

As of December 2020, Pakistan’s plans include:

• Expansion HIVST implementation within Global Fund country grant with procurement of 7,000 HIVST kits focusing on men who have sex with men and transgender people. 

Inform implementation and national policy with the lessons learned from demonstration projects.

3-Product Registration and Costing of HIVST Kits 

HIVST kits are not registered in Pakistan, although product registration is planned. 
Excerpt from FGD with Key Population* 

Most MSM are thought to be affluent, closeted, married and with access to technology. They favored using internet, social media, video links, and group training sessions at the CBO on how to conduct the self-test, how to interpret the results and post-test follow-up. Participants felt that helplines are a useful tool for providing HIV information. Transgender participants, on the other hand, reported a preference for face-to-face interaction with a counsellor for HIVST.

Participants raised concerns about the psychological and emotional implications of doing a self-test and getting a reactive result. Both MSM and TG participants reported a concern about an increase in suicide if people test alone without professional help; some recalled receiving a positive result and feeling that they had nowhere to go.

The participants emphasized that HIVST should be available free of charge and through CBOs.

*Source: Guidelines on HIV Self-Testing and Partner Notification: Supplement to Consolidated Guidelines on HIV Testing Services, World Health Organization, 2016 (https://www.ncbi.nlm.nih.gov/books/NBK401666/)