GUARANTEE PORTFOLIO

HIV self-test

In July 2022, we partnered with CHAI to execute a volume guarantee agreement with Wondfo to make its WHO prequalified HIV self-test available for $1.

The partnership

  • MedAccess has provided a volume guarantee to Wondfo, meaning we will make up any shortfall in sales.
  • Wondfo will produce and supply its blood-based HIV self-test, increasing availability and access to the product in 140 low-and-middle-income countries.
  • CHAI helped facilitate the volume guarantee agreement and will continue to support country adoption of HIV self-tests.

Through this partnership, Wondfo agreed to launch its newly prequalified test at $1 for public sector purchasers in low- and middle-income countries. The price is over 30 per cent below the current lowest-priced test and 50 per cent lower than the most widely used test. This makes Wondfo’s HIV self-test the most affordable World Health Organization (WHO) prequalified HIV self-test on the market.

Two sisters laughing together in South Africa

Development impact

The WHO recommends countries implement self-testing as part of a differentiated approach to HIV testing services. Self-tests give countries additional flexibility to meet the needs and preferences of their populations while increasing access to HIV testing and reducing the burden on healthcare workers who must otherwise individually administer each test.

MedAccess projects that improved access to self-testing through this partnership will increase testing and treatment coverage, leading to 8.1m additional people being tested for HIV. We also expect this to play an important role in catalysing access to and easing monitoring for critical prevention interventions such as PrEP.

Increased access to self-testing supports progress towards the UN’s 2030 target of 95% of people living with HIV knowing their status.

How we calculate the impact of this guarantee

Lives changed: Estimates for test uptake and linkage to care are based on a meta-analysis by Njau et al. Average HIV positivity rates for Africa reported by UNAIDS were applied to estimate people living with HIV identified through testing.

Money saved: Impact is based on comparing the negotiated price to the expected lowest priced equivalent HIV self-test.

Markets shaped: We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of impact.

See our development impact page and latest Annual Report for more information.

Components of the HIV self test

The product

The HIV self-test allows people to test themselves for HIV which is convenient, discreet and allows the individual to choose where and when they test.

It requires taking a pinprick blood sample which is tested in the device, giving a result in 15 minutes. If a person returns a positive test, they should seek a confirmatory test with a qualified health worker.

Although the first HIV self-test received WHO prequalification in 2017,  the lack of affordable prices for many low-income countries compared to HIV tests used at health facilities has limited their use. Under the terms of this volume guarantee, Wondfo has committed to launch its newly prequalified self-test at US$1.

Why we acted

UNAIDS estimates that approximately 6.1 million of the 37.7 million people living with HIV in 2020 did not know their status.

Self-testing can play an important role in closing the gap between the number of people living with HIV and those who know their HIV status. People who are undiagnosed are not on treatment, meaning they are at risk of passing the virus on.

For people not infected but at high risk, testing is the first step in accessing prevention interventions such as pre-exposure prophylaxis (PrEP).

Benefits of self-testing include:

  • Increasing access to HIV testing for priority populations such as men, adolescents, commercial sex workers, people who use drugs, transgender people, and men who have sex with men: Globally in 2020, 65 percent of new HIV infections were among people from priority populations and their partners. People from these groups often face stigma, discrimination, and even criminalisation if they seek an HIV test at a clinic. Self-testing can increase access to HIV testing for these groups. They can be distributed by a range of people including health workers, community leaders, peers, and partners, significantly expanding the channels for reaching people at risk.
  • Reducing demands on healthcare workers: Distributing HIV self-tests within health facilities can reduce the burden on providers at understaffed clinics. While provider-led testing is and will continue to be a cornerstone of HIV testing, self-tests can significantly increase the efficiency of and access to testing services by reducing the time required per person tested compared to conventional testing.
  • Increasing ease of HIV testing: Self-tests are safe, easy to use, and provide accurate results in less than 30 minutes. With expanded HIV self-testing, people will be able to collect HIV self-tests from more and more convenient locations and can then test themselves and read their results in private, when and where they want. This is especially valuable for people at risk of HIV who need more frequent testing as part of HIV prevention programmes. This is timely as WHO releases new guidance on the use of HIV self-testing to support greater access to PrEP services.