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Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa
INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413877/ https://www.ncbi.nlm.nih.gov/pubmed/34475026 http://dx.doi.org/10.1136/bmjgh-2021-006032 |
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author | Pai, Nitika Esmail, Aliasgar Saha Chaudhuri, Paramita Oelofse, Suzette Pretorius, Marietjie Marathe, Gayatri Daher, Jana Smallwood, Megan Karatzas, Nicolaos Fadul, Mohammed de Waal, Anna Engel, Nora Zwerling, Alice Anne Dheda, Keertan |
author_facet | Pai, Nitika Esmail, Aliasgar Saha Chaudhuri, Paramita Oelofse, Suzette Pretorius, Marietjie Marathe, Gayatri Daher, Jana Smallwood, Megan Karatzas, Nicolaos Fadul, Mohammed de Waal, Anna Engel, Nora Zwerling, Alice Anne Dheda, Keertan |
author_sort | Pai, Nitika |
collection | PubMed |
description | INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services. With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. RESULTS: In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%). Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). CONCLUSIONS: Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide. |
format | Online Article Text |
id | pubmed-8413877 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-84138772021-09-22 Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa Pai, Nitika Esmail, Aliasgar Saha Chaudhuri, Paramita Oelofse, Suzette Pretorius, Marietjie Marathe, Gayatri Daher, Jana Smallwood, Megan Karatzas, Nicolaos Fadul, Mohammed de Waal, Anna Engel, Nora Zwerling, Alice Anne Dheda, Keertan BMJ Glob Health Original Research INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services. With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. RESULTS: In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%). Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). CONCLUSIONS: Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide. BMJ Publishing Group 2021-09-02 /pmc/articles/PMC8413877/ /pubmed/34475026 http://dx.doi.org/10.1136/bmjgh-2021-006032 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research Pai, Nitika Esmail, Aliasgar Saha Chaudhuri, Paramita Oelofse, Suzette Pretorius, Marietjie Marathe, Gayatri Daher, Jana Smallwood, Megan Karatzas, Nicolaos Fadul, Mohammed de Waal, Anna Engel, Nora Zwerling, Alice Anne Dheda, Keertan Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title | Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title_full | Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title_fullStr | Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title_full_unstemmed | Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title_short | Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa |
title_sort | impact of a personalised, digital, hiv self-testing app-based program on linkages and new infections in the township populations of south africa |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413877/ https://www.ncbi.nlm.nih.gov/pubmed/34475026 http://dx.doi.org/10.1136/bmjgh-2021-006032 |
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