Page 189 - HIVMED_v21_i1.indb

Page 2 of 7 Original Research

to seek confirmatory testing by a trained healthcare Methods
professional. Furthermore, the independence of HIVST
12
presents considerable challenges surrounding the monitoring Study design
and evaluation (M&E) of HIVST programmes, which are This evaluation was a cross-sectional pilot study that ran for
required by public health stakeholders to understand the four weeks in July 2018. A convenience sample of 300
uptake and effectiveness. 13 consenting adults was recruited from inner-city Johannesburg,
South Africa. Recruitment was based around the Hillbrow
Strong mobile phone penetration in low- and middle-income Health Clinic by trained healthcare workers (HCW) who
countries (LMIC) 14,15 has led to the development of a variety went into the surrounding communities and spoke to the
of mobile health (mHealth) interventions to complement public about the current study. Those interested were
HIVST. These include telephone hotlines, short message screened against inclusion/exclusion criteria, then brought
service interventions, internet-based platforms and mobile to the Hillbrow Clinic to provide consent and complete the
applications (apps). 16,17,18,19,20 A Brazilian study conducted in study. Participants were included if they owned a mobile
2019 showed that an internet-based intervention targeting phone (feature phones, or higher, for app compatibility) and
men who have sex with men led to 21.4% of online could provide a valid mobile phone number, were 18 years or
participants self-reporting, whilst an interactive voice older, able to read English and able to provide written
response telephone line in South Africa was found to link informed consent. Participants were excluded if they did not
21
9.8% of participants to care. Whilst these platforms have meet the inclusion criteria, were currently on a pre-exposure
shown varied success, the introduction of mHealth prophylaxis (PrEP) regime or any HIV treatment medication,
interventions for linkage to care and M&E are in line with the could not provide valid identification or had any condition
South African National Department of Health mHealth that may have interfered with the testing process (such as
Strategy (2015), and should be explored further. 22 intoxication or poor vision).
TM
Despite data concerns in LMICs, recent trends are Development of the Aspect HIV-self-testing
23
towards the development of downloadable apps due to mobile app
their agility and scalability. The app interface also The Aspect HIVST app was designed for Android and
24
TM
provides developers with a malleable platform that can be deployed by SystemOne, LLC (Northampton, MA, USA),
tailored to individual users, allowing them to curate a a diagnostic connectivity and disease intelligence company.
collection of HIVST information, resources and guidance The Aspect HIVST app was designed to be integrated with
TM
for testers, whilst also capturing the HIVST result data. 19,20 the existing Aspect software platform, a system designed to
TM
Recently, HIVSmart , a Canadian app, was developed to integrate directly with diagnostic instruments in order to collect
TM
guide users through the testing process, link them to care, digital results for real-time monitoring and reporting via an
and store the HIVST result data. Preliminary evaluations operational dashboard. The Aspect API can also communicate
TM
in key Canadian populations, as well as healthcare workers with RedCap, an existing South African healthcare database,
in South Africa have shown the app to be feasible and and this application is already being used for reporting HIV
acceptable; however, neither HIVSmart , nor any other viral load results and early infant HIV diagnosis (EID).
TM
app, has been developed or tested for the general
population in LMICs. 9,20,25 The Aspect HIVST app was developed using Dimagi
TM
Commcare (Washington, USA), a common data-gathering
South Africa has shown previous acceptance of HIV-related platform. The app was structured to allow the self-tester to
mHealth interventions with SmartLink, an app that improved collect their own demographic information, provide the
linkage to care for clinic-based HIV testing in participants tester with instructions on how to perform self-testing, input
under 30 years of age. Another successful mHealth their interpretation of the test result, and capture a photo of
26
intervention, MomConnect, has been used by over 2 million the HIVST strip (Figure 1). Demographic data were collected
pregnant South African women with information regarding with one question per page and included the self-tester’s age,
their pregnancy, whilst also creating a national pregnancy
registry. 27,28

The Aspect HIVST app was developed to help strengthen
TM
and complement HIVST programmes by supporting self-
testers through testing, facilitating linkage to care and
digitising the reporting of HIVST results through an
operational dashboard for M&E. The specific objective of this
pilot study was to evaluate the acceptability and feasibility of
TM
the Aspect HIVST app for individuals from the inner city of
Johannesburg, in order to advise further scale-up. We present
the findings from this pilot. FIGURE 1: Screenshots of the Aspect HIV-self-testing mobile app. 29
TM
http://www.sajhivmed.org.za 181 Open Access