Self-testing is now available for a number of health conditions, but what does instant diagnosis mean for patients and the healthcare system?
Since the first home pregnancy test in the 1960s, self-testing kits for diseases and conditions such as human papilloma virus (HPV), diabetes and high cholesterol have emerged online or in pharmacies.
Meanwhile, in many areas of the UK, home-testing kits for chlamydia, gonorrhoea and others have become available as free locally-commissioned healthcare services.
Self-diagnosis goes beyond a vague internet search; it is becoming the norm. Pharma will be keeping its own finger on the pulse as increased diagnosis leads to greater demand for products.
Dr Clare Morrison, GP at online doctor and pharmacy MedExpress says: “These tests will probably cause more pressure on primary care, as patients will want to ask about abnormal results with an expert, but they aren’t necessarily a bad thing for patients. If a patient knows that they are positive for HPV, for example, they can make sure they get regular cervical smears to pick up abnormalities.”
Although self–testing can be of benefit, there can be other factors at play that may affect test results. “Glucose testing isn’t a bad idea if you have reason to suspect diabetes, perhaps because of excessive thirst or a strong family history, but bear in mind the fact that it will be affected by anything you have eaten recently,” cautions Dr Morrison.
“Just because you test negative, it doesn’t necessarily mean that you are entirely safe. High cholesterol and diabetes are more common as you age and gain weight, so testing when you’re young and slim may not detect it,” adds Dr Morrison. Go to medexpress.co.uk
Superdrug pharmacist Tim Morgan urges patients to follow up: “In crude terms, some tests are more accurate than others and most home tests do not boast 100% accuracy. Although home-testing kits increase accessibility, if there is no process behind the test that allows the patient to receive advice around, for example, safe sex and STI prevention, then the test itself is not encouraging behaviour change.”
Self-testing kits for conditions such as diabetes are readily available online, however, charity Diabetes UK does not recommend their use to diagnose the condition. Douglas Twenefour, Deputy Head of Care for Diabetes UK, advises: “We would not recommend people to use a self-diagnosing kit if they are worried they have diabetes. Self-diagnosis results might not be accurate, as blood glucose levels vary in all individuals during any given day and people might be falsely reassured,” he explains.
“In addition, a positive diagnosis can only increase anxiety if someone does not have access to information and advice provided by a trained healthcare professional.”
The Terrence Higgins Trust (THT) is in favour of HIV self-testing, Dr Michael Brady, THT Medical Director, says: “One in seven people living with HIV do not know they have it. Testing puts you in control and, thanks to treatment, will stop you from getting seriously ill, enable you to live a normal lifespan and prevent you from passing the virus on to anyone else,” he explains. “It’s so important that we continue looking for new ways to make HIV testing more accessible.”
The Trust launched a self-testing pilot in July 2016, then a further scheme in May 2017. The pilot offered people the chance to find out their HIV status privately, by taking an HIV self-test and getting their results in just 15 minutes. The scheme targeted men who have sex with men and black African people in the UK – the two groups most affected by HIV – and was promoted through targeted social media, including Grindr.
“Our pilot scheme was a real success in terms of developing our plans for increasing HIV testing in the future, but was also important for the people who took it who may not otherwise have known their status,” Dr Brady says. “Self-testing, alongside other HIV testing strategies, gives us the opportunity to test for HIV at the scale needed to really impact on the epidemic.”
Dr Brady advises that although tests are highly accurate, with a clinical sensitivity of 99.7%, patients should always follow up HIV self-diagnosis with a healthcare professional. “We advise anyone who does receive a reactive [positive] result to contact a local sexual health clinic for confirmatory testing and encourage them to call our helpline.” Go to tht.org.uk or call THT Direct on 0808 802 1221
Test of time
While pressure on primary care services continues to pile up, more people may turn to self-testing.
“As technology continues to rapidly advance, it is inevitable that the use of home or portable testing will become readily available. There are already products being developed that allow for blood testing through smartphones and this could prove the most convenient way for people to get quick and accurate tests without having to access the GP,” says Tim Morgan.
Dr Morrison urges people to seek advice from a healthcare professional, whatever the outcome of a home test. “For something straightforward, a pharmacist is the best starting point. If necessary they will advise you to see a doctor anyway,” she counsels. “If my patients have a health worry I would urge them to see an expert. We are here to help, not make judgements, and everything is entirely confidential.”
Michael Nugent, 33, Glasgow
“I first found out about the THT self-testing pilot for HIV in 2016, when I noticed a pop-up post on Grindr. It was free and offered a result within 15 minutes. The last thing on my mind was that it would come back positive. I’d had a full STI and sexual health check in 2015 and it was all clear, and I didn’t think I’d done anything in the meantime to contract HIV.
The test looked so simple. It just involved pricking my finger and blood being sucked up into a little valve. Two lines meant a positive result. When the lines appeared, I was shocked and devastated. My first thought was that it must be wrong. I wanted to put it in the bin and pretend it had never happened. I was on my own and was terrified.
The advice with the test said that if the result was positive, you need to go to your local sexual health clinic for confirmation. I didn’t have a clue where to go and felt completely lost. I tried going to the local sexual health clinic, but I couldn’t get an appointment with them for two or three days. Then I showed my doctor the test. I still had my hopes up that the result was a mistake. He sent me to a sexual health clinic, where I had a full STI check. Two days later the test came back positive.
Once diagnosed, I thought that was it for me. My main fear was that I would transmit the virus to someone else, like my partner. When I told my family, they gave me 100% support. I now take one tablet of Genvoya a day, which can control the virus.
Having the option of self-testing gives people the opportunity to get the test as easily as a pregnancy test. Since taking it myself, loads of my friends have taken it, gay and straight, male and female. I would advise anyone who wants to know, to do a self-test.”