As always happens around the new year, my news feed is filled with many projections for 2018 — from the economy to politics to entertainment. They got me thinking about what we might expect in the global effort to end HIV/AIDS, and at the risk of being cliché, I offer a few projections for the new year. These projections are more than my own hunches — they are based on the growing consensus that I observed at the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Abidjan, Côte d’Ivoire in December. The conference was a rich source of clinical, scientific, and policy information about where things are going in prevention and treatment of HIV/AIDS. Following are four trends to watch, as well as the supply chain implications of each.
1. HIV self-testing will move from a mostly pilot stage in developing countries in 2017 to a speedy roll out in 2018. According to the World Health Organization (WHO), as many as 39 countries will begin rolling out HIV self-testing by the end of the year. From a supply chain perspective, this will obviously mean much higher volumes procured. Countries will be faced with choices around which tests to procure, challenges in forecasting needed volumes, and decisions about how best to distribute the tests. The most interesting thing I learned at ICASA was the results of a study done by Population Services International in Kenya that found a notable preference for blood-based self-tests. I had always assumed people would prefer the oral swab over blood-based tests due to the ease of swabbing the inside of one’s mouth versus pricking one’s finger. However, the study showed that participants (rightly) assumed that blood-based tests can be considered more accurate, so chose accuracy over ease of use. The fact that people are open to both oral swab and blood-based tests is good news for the self-testing market. Only one (oral swab) test is currently approved for PEPFAR-supported programs, but at least one other oral swab and several blood-based tests are in the pipeline. The potential for procuring two types of products from several suppliers holds the promise of healthy competition, lower prices, and many options for people who want to self-test.