The COVID-19 pandemic has driven home to all South Africans the importance of convenient and private access to testing, combined with clear and supported ways to take action based on the results. Innovative solutions to this problem are already being pioneered in HIV care. The Health Systems Trust (HST), in partnership with the KwaZulu-Natal Department of Health, have launched Aviro Health’s Ithaka, a digital HIV counsellor endorsed by the National Department of Health (NDoH) that offers people convenient and quick HIV self-testing in private booths at health facilities, and helps them to access health services depending on their test result. The service is being rolled out in KwaZulu-Natal, with plans for availability in 100 clinics early next year.

With this year’s theme for World AIDS Day being global solidarity and shared responsibility, Ithaka is highlighted as an innovation that brings together multiple stakeholders to strengthen access to, and uptake of, HIV services. The service was designed and built in close collaboration with users and health workers through a human-centered approach, with the involvement of government departments, public health experts, universities, funders and NGOs. The counselling content integrated on the platform is conveyed in multiple languages to broaden accessibility, using stories that centre on the real users’ experience and needs.

“The Health Systems Trust is thrilled to be partnering with the Provincial Health Department and Aviro Health on this innovation. As an institution working on research and evidence to strengthen health care access, we are excited to show how Ithaka’s evidence-based workflow can respond to patient needs and strengthen access to HIV services.”- Joselyn Walker, Program Manager, The Health Systems Trust.

In November, the intervention was soft-launched with HST and the KZN Department of Health in three clinics in UMgungundlovu District. Counsellors and healthcare workers were trained on using the digital tool, with guidance and support on-site to get the service running smoothly. Already, over 200 people have used the booths for self-testing, with 10 patients having been supported with services after testing positive, and the response from users and healthcare providers has been enthusiastic.

“HIV Self Screening is for those individuals that are test averse and are at the same time wondering if they may test negative or positive. This is the best way of knowing your HIV status first before anyone else. This will give you option to decide who is the next person that you are willing to trust with your result. Most of the time this is the person that will support you and not judge you according to your results. The major question is where do we get these people, since they may not be going anywhere near health facilities. All health care workers should be working towards finding these people and offer them the HIV test”, says Themba Ndabandaba, Acting Director: ACSM KZN Department of Health.

Since the launch of Ithaka in 2019, the digital counselling service has assisted over 20 000 users. “The endorsement from the National Health Department is an important validation of the evidence-based workflow and design of the tool,” says Dr Musaed Abrahams, CEO of Aviro Health, “which has proven to be effective in decreasing congestion in clinics, and in increasing HIV testing numbers as well as antiretroviral treatment initiation.In a study conducted by Johns Hopkins University, Ithaka’s digitally assisted booth-based self-testing solution showed very high user satisfaction, increased testing 40% in clinics, and was attractive to at-risk populations that would otherwise not be willing to use existing in-person HIV testing services.

COVID-19 and HIV

2020 has been a difficult year for the global health community. COVID-19 has diverted funding from other services and limited access to HIV care, from prevention to testing and adherence, posing serious and life-threatening challenges. To increase access, HIV self-screening is being promoted at all levels, including by the World Health Organization (WHO). Digital technology is a critical complement to self-testing for patients, providing support and guidance through the testing pathway, while retaining the convenience and privacy that is essential to the experience and to uptake and linkage to services.  By further limiting access to HIV services, COVID-19 has spurred uptake of innovative approaches to digitally assisted self-testing that can scale up improved access to private, convenient testing with fewer healthworker touch-points.

There is much that we can learn for the COVID-19 response from the collaborative and patient-first approach that the HIV community is adopting to enhance the convenience and uptake of testing − even in the midst of this crisis, with unprecedented constraints on funding and health-force capacity. The partnership with HST is part of a groundbreaking digital health technology movement enabling convenient and private self-care that aims to not only increase the number of clients who are tested, but also to maximise the quality of counselling for the duration of contact between the patient and the counsellor.