HIV Self-Testing in Clinics

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 prevention services such as voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis (PrEP). At present, HIV testing is implemented by clinicians 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 by offering digitally-assisted 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 self-testing and to encourage them to seek services.

A recently conducted study showed:

  • 13% HIV positive testing rate among users of the service, of whom 80% were initiated on ART;
  • 12% of individuals who received standard HIV tests were men, compared to 30% men accessing self-testing in booths;
  • 96% of users agreed or strongly agreed that the tool was useful, easy to use and trust-worthy; and
  • 30% of users with negative results entered their phone numbers for reminders to retest.

Digitally-assisted, as compared to layperson-assisted testing, has the advantages of scalability in terms of costs and consistency of counselling; and improved user experience in terms of privacy/anonymity and tailored interactions to different languages and types of testers. Aurum and Aviro are working together on how to scale and benefit from these learnings.