Pocket Clinic: Simplifying Implementation of HIV Self-Testing in South Africa and Eswatini

In July 2022, Stats SA released the 2022 mid-year population estimates report that also highlighted the overall HIV prevalence rate among South Africans. 

By mid-year, South Africa’s statistics on people living with HIV (PLWHIV) were as follows:

  • About 8.5 million people in the country are living with HIV. 
  • An estimated 13.7% of the total population is living with HIV.
  • For adults aged 15-49 years, an estimated 19,5% of the population is living with HIV.
  • Almost a fourth of South African women in their reproductive ages (15-49 years) are living with HIV.

In May 2022, WFP Eswatini released a country brief. In Eswatini: 

  • 26% of the population is living with HIV. 
  • There is a very high HIV prevalence among people aged 15-49.
  • Life expectancy is 49 years.
  • 45% of children are orphaned or vulnerable due to HIV infection. 

According to these figures alone, the adoption of initiatives that simplify HIV-related healthcare and promote accessibility to HIV testing may be the solution to boosting HIV prevention efforts and the uptake of HIV-related care for those who are living with HIV. 

HIV-related mortality is still high among people who struggle to receive basic medical care. According to Frontiers, in South Africa, more adult women than adult males are receiving treatment for HIV, with 65% of adult women receiving therapy as compared to 56% of adult men. According to this study, multiple obstacles, such as stigma, cultural notions of masculinity and practical problems, such as inconveniences with clinic hours and transportation issues, make it difficult for South African men to receive healthcare.

It is against this backdrop that Aviro Health has positioned its Pocket Clinic as a digital healthcare solution that makes HIV testing simple, accessible and less intimidating while assisting healthcare professionals to carry out their duties effectively.

This is how we simplify HIV-related care for both clients and healthcare professionals:

1. From clients’ feedback, we have come to learn that the #1 reason that most people opt to use digitally supported healthcare is that it is convenient. On Pocket Clinic, clients have access to content that guides them through the HIV testing process in the privacy of testing booths. It’s a frictionless process that only takes 20 minutes of the client’s time, or less if using a faster self-test — no long queues and no need to wait for busy healthcare workers for long hours.

2. Our system makes it easier for healthcare professionals to keep track of patients’ records, gain quick access to helpful resources and have multiple clients testing at the same time while the healthcare professional is busy with other tasks.  

This year, we expanded our reach through successful partnerships and frequent updating of Pocket Clinic with new features. Upgrading Pocket Clinic has not been easy but it has certainly brought about greater results for our organisation as well as those of our partners. 

In February, we launched a new version of Pocket Clinic, which resulted in us helping over 10,000 users, identifying over 900 HIV-positive people and linking over 95% of them to care. It is this high linkage to care rate that fostered a need for new features on our platform, such as: 

  • Offline Capability
  • Location Capture
  • TB Screening
  • Content Update + New Languages 
  • Capturing Repeat Positives 
  • Option to Make HIV Journey Videos Mandatory 
  • Removal of Confirmatory Self-Test Action
  • Indicating Required Fields
  • Treatment Capture
  • Demand Generation Tracking
  • Offline Handling Improvements

We were able to adapt Pocket Clinic for different use cases because of our eagerness to listen to the needs of our clients and providers. 

One of our dependable partners, Health Systems Trust (HST), implemented a demonstration project on community-based antiretroviral therapy (ART) services to ascertain the health effects of community-based clinical care and to make it easier for patients to access quick, dependable, locally-based and patient-centred care as a crucial part of healthcare delivery. The ultimate goal was to decentralise the delivery of HIV services from crowded health centres to local sites.

With this, HST and Aviro saw the introduction of a new project — DoART. We piloted Pocket Clinic to support patients in their HIV testing journey, allowing them to manage more of the screening process themselves and for the healthcare workers to better manage the history of the patients and reporting. 

“I find APC very interesting to us as lay counsellor as it’s got pre- and post-test counselling. It makes our work much easier because we just summarise what is on the videos. From the youth perspective, it keeps them up to date with technology. On some days, we give them earphones [to use]. It [APC] introduces new things to them,” says Lindelwa Zondi, HST counsellor in  Indaleni Clinic, KZN. 

In September, we saw a new successful partnership with TB/HIV Care in the Eastern Cape. TB HIV Care is a registered non-profit organisation that puts integrated care at the heart of responding to TB, HIV and other major diseases. 

Aviro and TBHIV Care introduced booth-based and tablet-assisted testing through Pocket Clinic into TBHIV Care operations in order to:

1. Better support males and youth accessing testing services and care

2. Use treatment counsellors in addition to healthcare providers

3. Create dashboards with data related to # tests, yield, and ART initiation

On September 16, 2022, the program began with training at four clinics in the Eastern Cape. Full implementation followed three weeks later, on October 11, 2022.

Since then, these are our key findings:

  • In 2 months, over 1,000 users have led to 46 positives and 36 ART starts.
  • Positivity yield of 5.4%, slightly lower than the baseline target of 8%
  • 27% male users is in-line with baseline targets and male positivity yield of 8.7% is almost 2X program yield

“The Pocket Clinic is going to be very helpful for our facility because we are a high volume facility, which opens 24 hours, seven days a week. So, we usually have clients who come out of the clinic having not been tested and having not received the services [in] the normal way that is supposed to be done,” says Mrs. Kawe, TB/HIV Care Clinic Manager in Dutywa Clinic, Eastern Cape.

The fear and stigma around HIV are still very high in Eswatini and that is why Doctors Without Borders (MSF) Southern Africa decided to partner with Aviro to implement HIV self-testing through Pocket Clinic. 

MSF has recently placed a greater emphasis on diagnosing and treating STIs in high-risk populations, including sex workers, men who have sex with men (MSM), factory workers and other people who are already at increased risk. Intending to empower patients and enhance patient-centredness, there has been an increased interest in improving the standard of HIV and STI screening, diagnosis and care. To deliver an excellent HIV self-testing patient experience while minimising contact with healthcare professionals, MSF included Pocket Clinic in its HIV testing program. 

The objective of the initial Pocket Clinic rollout in MSF facilities is to:

  • Increase the number of HIV self-tests performed
  • Increase the positive yield and ART initiation capture
  • Improve access to testing services and care for men and youth

We are excited to pilot Pocket Clinic for virtually supported HIV self-testing in Eswatini, a country that has a high self-testing population. 

Client feedback from Eswatini

We have great expectations for the work we have already started doing with our partners as we collaborate to offer better and easier access to healthcare services for clients. Because we are a people-centered organisation, we will keep working to help our partners upscale their HIVST programmes through Pocket Clinic. We want them to know that Pocket Clinic offers them great value, clients are happy with the service because it uncomplicates healthcare; and healthcare providers feel that the Pocket Clinic simplifies their work and fosters more learning.

On November 30, 2022, Aviro Health hosted a webinar on implementing Aviro’s Pocket Clinic. The webinar was themed, Aviro Pocket Clinic: A cross-learning session on implementing Aviro’s adaptable digital health tool. The event's goal was to provide a forum for discussion about current and future Pocket Clinic implementation strategies. 

In attendance were the Aviro team as well as Aviro’s partners, stakeholders and supporters.

If you are interested in seeing Pocket Clinic in your programmes, reach out to us and we will get in touch with you. 

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