We design and build digital health solutions
We work with people who believe in access to high-quality healthcare for everyone, regardless of where you come from. Our flagship product, Ithaka, helps patients navigate healthcare and locate support services. It is a concrete example of our commitment to these values.
Digital Solutions Boost Your Impact
We provide end-to-end consulting services for all those working in health: non-profit organisations, governmental public sector, and private sector businesses.
The number of adolescents living with HIV rose by 30% between 2005 and 2016 to 2.1 Million. AIDS is now the leading cause of death among young people in Africa. Estimates suggest that 740,000 additional youth could become infected by 2030. Surveys show that, between 2011 and 2016, only 11% of youth in sub-Saharan Africa had tested for HIV in the last 12 months. Increasing access to HIV Testing and Counselling (HTC) is vital to prevent further transmission. A study in South Africa found that HTC among youth meant 41% fewer cases of HIV transmission.
Youth are not targeted with age-appropriate HIV programmes and data about their vulnerability are not collected – partly as a result of their specific needs and the challenge of meeting these needs. Social media and associated technologies are already substantially integrated into the lives of youth. A digital intervention for testing, linkage to care, and adherence that fits into the already complex and challenging lives of youth, has great potential to strengthen youth’s ability to respond to and more effectively self-manage HIV.
Co-designed with youth, Aviro and MSF developed HIV counselling content tailored for youth that speaks to them and their existing knowledge, hopes and fears and made this available on Khetha, a platform specifically for youth built on the Ithaka platform mobile platform, that assists patients through testing, results reporting and next steps while integrating the values of autonomy, privacy and choice into the entire experience.
Using this platform, MSF and Aviro are looking to improve HIV support to youth and increase testing rates while also improving the data- and evidence- base around youth knowledge, attitudes and behaviours towards HIV testing and linkage to care in order to advocate for change in HIV programs and policies for youth.
HIV is the leading cause of mortality in Southern Africa, with HIV prevalence of 15-30% in the general population aged 15-49 years and only 45% of HIV+ people on Antiretroviral treatment (ART). HIV self-testing (HIVST) is a new approach that provides an opportunity to reach, test, and diagnose or prevent infection among hard to reach populations. Although HIVST has the potential to fill a gap in HIV testing modalities, it’s autonomous and private nature introduces challenges for ensuring that the individuals testing are supported and effectively linked into appropriate care. These challenges have made providers hesitant to support distribution of HIVST kits.
The Wits Reproductive Health and HIV Institute (Wits RHI) is a leading African research institute focusing on HIV, sexual and reproductive health (SRH). Wits RHI is a lead implementer in the UNITAID-funded Self-Test Africa (STAR) initiative programme and their main role is to guide the implementation and scale up of various potential distribution models in South Africa.
Aviro and Wits RHI piloted the use of the Ithaka platform to support HIV testers in inner city Johannesburg by providing a URL link to Ithaka when receiving their self-testing kit. and were assisted with registration to log into the app. 30% of those offered the tool reported results and accessed post-test counselling, and all those who tested positive were linked to facilities for care. This study demonstrated that people self-testing for HIV are willing and able to use a web app based support tool during testing, self-reporting and linking to services. Based on this study, Wits RHI and HSTAR are working with Aviro to include a blood-based HIV test on their platform; to expand the user offering into WhatsApp; and to extend the use of Ithaka as the tool to be used across multiple distribution channels in order to reduce barriers to testing and to increase uptake and linkage to care from HIV self-testing.
HIV testing is the crucial step to accessing HIV prevention and care, as only 62% of the seven million people living with HIV in South Africa know their status. For those living with HIV who are still undiagnosed, this means further delaying their access to treatment and maintaining a substantial risk of transmission to others. Limited access to HIV testing also prevents high-risk HIV negative individuals from accessing effective HIV prevention services such as voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis (PrEP). At present, HTS is implemented by clinicians recommending HIV testing during a patient encounter. However, due to limited clinic capacity, clinicians are selective about whom they recommend for HIV testing.
The Aurum Institute, in partnership with Johns Hopkins, is innovating in test delivery strategy to develop a feasible approach and to attract patients to test by offering HIV self-tests in health facility waiting areas. In order to improve the efficiency and anonymity of the offering, Aviro has made Ithaka available on tablets in 3 languages (English, Zulu and Sotho) in the booths to walk testers through the experience and to encourage them to seek services.
A recently conducted pilot showed a significant (13%) HIV positive testing rate among users of the service, of whom 60% were initiated on ART. Of the testers, a high proportion had never tested before or had not tested in over 6 months compared to the general population. Further, 20% of individuals who received standard HTS were men compared to 38% of those accessing self-testing in booths, indicating that digitally-supported HIVST may be a more attractive means of testing for those who would otherwise potentially not test.
96% (128 of 133) of those that completed an in-app survey agreed or strongly agreed that the tool was useful for them, easy to use and trust-worthy; and 30% of users with negative results entered their phone numbers for reminders to retest further indicating trust and perceived value of Ithaka.
Aurum and Aviro are working together on how to scale and benefit from these learnings.
Counselling and testing remain key components of HIV/AIDS prevention as they provide an entry point into prevention, care, treatment and support services. The current HIV counselling model in South Africa is however outdated and non-standardized. To address the issue of out-dated counselling modules and low human capacity for counselling, Aviro Health, with the support of The Foundation for Professional Development (FPD) is developing an open-sourced, digitized HIV counselling syllabus produced specifically with patients in mind and contextualized for various populations / scenarios, that can be easily consumed via mobile phone. Engaging with the NDOH and stakeholders, we are also developing a strategy for the implementation and dissemination of this open-source content to ensure uptake across multiple channels and partnerships.
Our goal is not to replace counsellors with the content and with digital distribution, but rather to empower them and to be able to manage more clients on a daily basis. By handing over the routine drudgery of the typical counselling session to a “digital counsellor”, counsellors will be able to focus on the atypical/concerning cases and to see more patients in a given day. A successful program will open up innovative ways to support the NSP 2017-2022 in that it will break the cycle of transmission by efficiently and effectively educating individuals (particularly at risk populations) via a medium with which they are already very familiar with. Most importantly, in a country like South Africa where there is a 68% mobile phone penetration rate, digitized and contextualized HIV counselling has the potential to reach more people with comprehensive and customized content.
The newly created content will be premiered at an Innovation conference in November 2019 and will be made available for health providers from January 2020.