Can Investing in Rapid Self-Testing Disrupt the HIV/AIDS Mortality Curve?

People being aware of their HIV status is the first step to stopping the spread of disease. HIV testing is simple, but in many parts of the world, it's not so easy to access a health center offering testing. Traveling long distances for an HIV test may not exactly be on the to-do list of many people living in a place like sub-Saharan Africa, much less returning to get their results.

One answer is bringing the clinic, or at least the HIV test, to the people.

Earlier this year, the Global Health Investment Fund (GHIF) announced that it was making a $6 million loan to Atomo Diagnostics, a point-of-care diagnostics company improving rapid testing platforms. GHIF was established in 2013 by the Gates Foundation and JP Morgan Chase. Over the past few years, the fund has backed some serious projects in vaccines, late-stage therapeutics, and diagnostics targeting low-income populations around the world.

That loan would allow Atomo to scale its AtomoRapid testing products, which offer a quick and easy-to-use self-test for HIV and other infectious diseases. A portion of those funds were also earmarked to help the company commercialize its HIV self-test. Now Gates is once again backing Atomo’s work, this time through the foundation rather than GHIF with $2.6 million in grant funding.

Atomo will use the grant to further develop its rapid diagnostic test, focusing specifically on the development of affordable and accessible HIV testing. While the company did not disclose what countries it would target with its rapid testing equipment, it did announce that it would be commercially launching its products in “key” global markets with high HIV burdens. Sub-Saharan Africa certainly falls into that category.

This may not be the first time Gates has backed Atomo, but it is the first time it has awarded the company a grant. This also isn’t the first time the foundation has invested in point-of-care diagnostics.

Last year, the Gates Foundation, the Merck Global Health Innovation Fund and UNITAID invested a total of $8.4 million in Daktari Diagnostics, a Massachusetts-based company that pours its energies into solving the world’s most pressing health challenges. The total $8.4 million take broke down like this: Merck invested $5 million, UNITAID, $2.7 million; and Gates $600,000.

Gates' position on the low end of the funding spectrum isn’t all that surprising. The foundation awards around $150 million to $200 million in grants to support global HIV/AIDS efforts. However, very little of that funding has been dedicated to HIV self-testing. But the foundation’s interest appears to have been piqued.

In 2011, Gates awarded PATH a $1.1 million grant to “develop a target product profile for a future HIV self-test,” focusing on high-burden areas in sub-Saharan Africa. A few years later, Gates dipped its toes in the self-testing funding waters, though a bit more cautiously, awarding two grants for $200,000 to encourage individuals to use self-testing kits not only to screen themselves, but their current and future sexual partners.

With just $200,000 in grants in 2014, for a minute, it looked like Gates was losing interest in what could be a transformative solution to halting the spread of HIV. However, in 2015, it rallied and awarded over $7 million to support various global efforts to establish feasibility, offer guidance, and, increase usage rates for HIV self-testing. The main geographical focus of these grants predominantly remained on sub-Saharan Africa.

The Gates Foundation’s latest grant to support rapid self-tests for HIV, not only speaks to its goals to see a rapid decline in HIV infection, simply HIV treatments, and improve intervention methods to prevent new infections, but it also plays into UNAIDS 90-90-90 plan.

Launched in 2014, the 90-90-90 plan has three main goals: ensuring 90 percent of HIV positive people are aware of their status; making certain that 90 percent of those diagnosed with HIV are receiving antiretroviral therapy (ART); and working toward viral suppression for 90 percent of people receiving ART by the year 2020.

According to UNAIDS, should the 90-90-90 plan succeed, around 73 percent of people around the world living with HIV will be “virally suppressed,” which will be major step toward ending the AIDS epidemic by 2030. Again, though, the first step toward achieving those ends is ensuring that people know their HIV status, and this begins with diagnostics.