Background HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. Methods We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. Findings 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77–97%), preferred over in-person and hybrid options by more first-time testers (47–48%), highly feasible (93–95%), and were overall effective in supporting linkage to care (53–100%). Social media and app-based innovations also had high acceptability (87–95%) and linkage to care proportions (80–100%). SMS innovations increased kit return rates (54–94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54–93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. Interpretation HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally.
HIV self-testing has the potential to improve test access and uptake, but concerns remain regarding counselling and support during and after HIV self-testing. We investigated an oral HIV self-testing strategy together with a mobile phone/tablet application to see if and how it provided counselling and support, and how it might impact test access. This ethnographic study was nested within an ongoing observational cohort study in Cape Town, South Africa. Qualitative data was collected from study participants and study staff using 33 semi-structured interviews, one focus group discussion, and observation notes. The app provided information and guidance while also addressing privacy concerns. The flexibility and support provided by the strategy gave participants more control in choosing whom they included during testing. Accessibility concerns included smartphone access and usability issues for older and rural users. The adaptable access and support of this strategy could aid in expanding test access in South Africa. ResumenEl autotest del VIH puede mejorar su acceso y uso, pero, existe inquietud sobre el asesoramiento y apoyo al paciente durante y después del autotest. Investigamos una estrategia de autotest oral con una aplicación para teléfono/tableta para observar cómo proporcionaría asesoramiento y apoyo, e influenciaría el acceso al test. Este estudio etnográfico fue anidado en un estudio de cohorte observacional en curso en Ciudad del Cabo, Sudáfrica. Recogimos datos cualitativos de participantes y personal del estudio empleando 33 entrevistas semiestructuradas, una discusión de grupo focal, y apuntes de observación. La aplicación proporcionó información y orientación, abordando inquietudes sobre privacidad. La flexibilidad y apoyo al paciente proporcionaron a los participantes más control sobre quién involucraban en el test. Problemas de accesibilidad incluyeron acceso y uso de Smartphone en usuarios mayores y residentes rurales. El acceso adaptable y apoyo de esta estrategia podría ayudar a expandir el acceso al test en Sudáfrica.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Mobile health (mHealth) technologies for HIV care are developed to provide diagnostic support, health education, risk assessment and self‐monitoring. They aim to either improve or replace part of the therapeutic relationship. Part of the therapeutic relationship is affective, with the emergence of feelings and emotion, yet little research on mHealth for HIV care focuses on affect and HIV testing practices. Furthermore, most of the literature exploring affect and care relations with the introduction of mHealth is limited to the European and Australian context. This article explores affective dimensions of HIV self‐testing using a smartphone app strategy in Cape Town, South Africa and Montréal, Canada. This study is based on observation notes, 41 interviews and 1 focus group discussion with study participants and trained HIV healthcare providers from two quantitative studies evaluating the app‐based self‐test strategy. Our paper reveals how fear, apathy, judgement, frustration and comfort arise in testing encounters using the app and in previous testing experiences, as well as how this relates to care providers and test materials. Attending to affective aspects of this app‐based self‐testing practice makes visible certain affordances and limitations of the app within the therapeutic encounter and illustrates how mHealth can contribute to HIV care.
Background Programmes that introduce rapid molecular tests for tuberculosis and tuberculosis drug resistance aim to bring tests closer to the community, and thereby cut delay in diagnosis, ensure early treatment, and improve health outcomes, as well as overcome problems with poor laboratory infrastructure and inadequately trained personnel. Yet, diagnostic technologies only have an impact if they are put to use in a correct and timely manner. Views of the intended beneficiaries are important in uptake of diagnostics, and their effective use also depends on those implementing testing programmes, including providers, laboratory professionals, and staff in health ministries. Otherwise, there is a risk these technologies will not fit their intended use and setting, cannot be made to work and scale up, and are not used by, or not accessible to, those in need. Objectives To synthesize end‐user and professional user perspectives and experiences with low‐complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance; and to identify implications for effective implementation and health equity. Search methods We searched MEDLINE, Embase, CINAHL, PsycInfo and Science Citation Index Expanded databases for eligible studies from 1 January 2007 up to 20 October 2021. We limited all searches to 2007 onward because the development of Xpert MTB/RIF, the first rapid molecular test in this review, was completed in 2009. Selection criteria We included studies that used qualitative methods for data collection and analysis, and were focused on perspectives and experiences of users and potential users of low‐complexity NAATs to diagnose tuberculosis and drug‐resistant tuberculosis. NAATs included Xpert MTB/RIF, Xpert MTB/RIF Ultra, Xpert MTB/XDR, and the Truenat assays. Users were people with presumptive or confirmed tuberculosis and drug‐resistant tuberculosis (including multidrug‐resistant (MDR‐TB)) and their caregivers, healthcare providers, laboratory technicians and managers, and programme officers and staff; and were from any type of health facility and setting globally. MDR‐TB is tuberculosis caused by resistance to at least rifampicin and isoniazid, the two most effective first‐line drugs used to treat tuberculosis. Data collection and analysis We used a thematic analysis approach for data extraction and synthesis, and assessed confidence in the findings using GRADE CERQual approach. We developed a conceptual framework to illustrate how the findings relate. Main results We found 32 studies. All studies were conducted in low‐ and middle‐income countries. Twenty‐seven studies were conducted in high‐tuberculosis burden countries and 21 studies in high‐MDR‐TB burden countries. Only one study was from an Eastern European country. While the studies covered a diverse use of low‐complexity NAATs, in only a m...
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