1275. Will an App-Optimized HIV Self-testing Strategy Work for South Africans? Results From a Large Cohort Study

Abstract

BackgroundHIV self-testing (HIVST) offers a potential for expanded test access; challenges remain in operationalizing rapid personalized linkages and referrals to care. We investigated if an app-optimized personalized HIVST strategy improved referrals, detected new infections and expedited linkages to care and treatment.MethodsIn an ongoing cohort study (n = 2,000) based in South Africa, from November 2016 to January 2018, to participants presenting to self-test at community township based clinics, we offered a choice of the following strategies: (a) unsupervised HIVST; (b) supervised HIVST. We also observed participants opting for conventional HIV testing (ConvHT) in geographically separated clinics. We observed outcomes (i.e., linkage initiation, referrals, disease detection) and compared it between the two (HIVST vs. ConvHT) for the same duration.ResultsOf 2,000 participants, 1,000 participants were on HIVST, 599 (59.9%) chose unsupervised HIVST, 401 (40.1%) on supervised HIVST; compared with 1,000 participants on ConvHT. Participants in HIVST vs. ConvHT were comparable young (mean age 27.7 [SD = 9.0] vs. 29.5 [SD = 8.4]); female (64.0% vs. 74.7%); poor monthly income <3,000 RAND ($253 USD) (79.9% vs. 76.4%). With HIV ST (vs. ConvHT), many more referrals (17.4% [15.1–19.9] vs. 2.6% [1.7–3.8]; RR 6.69 [95% CI: 4.47–10.01]), and many new infections (86 (8.6% (6.9–10.5)) vs. 57 (5.7% (4.3–7.3)); Odds Ratio 1.55 [95% CI 1.1–2.2]) were noted. Break up: 45 infections in supervised HIVST 45 (52.3%); 41 infections in unsupervised HIVST (47.6%)]. Preference for HIVST was at 91.6%. With an app-optimized HIVST strategy, linkages to care were operationalized within a day in all participants (99.7% (HIVST) vs. 99.2% (ConvHT); RR 1.005 [95% CI: 0.99–1.01]); 99.8% supervised HIVST, 99.7% unsupervised HIVST.ConclusionOur app-optimized HIVST strategy successfully increased test referrals, detected new infections, and operationalized linkages within a day. This innovative, patient preferred strategy holds promise for a global scale up in digitally literate populations worldwide.Disclosures All authors: No reported disclosures.

‘You're only there on the phone’? A qualitative exploration of community, affect and agential capacity in HIV self‐testing using a smartphone app

“…Study participants recruited for this qualitative study came from two quantitatively based studies: one in Cape Town, South Africa (Pai et al, 2018 ), and one in Montréal, Canada (Pant Pai et al, 2018 ). The quantitative studies aimed to evaluate an app‐based HIV self‐testing strategy (HIVSmart!)…”

Moments of Uncertainty: Exploring How an App-Based Oral HIV Self-Testing Strategy Fits in Communities ‘Living Under’ HIV Risk

“…app. The aim of the cohort study was to evaluate whether the app-based oral HIVST strategy improved referrals, detected new infections, and/or expedited linkages to care and treatment compared to conventional HIV testing through a healthcare provider (Pai et al 2018).…”

“…strategy. While the team on the quantitative arm of the study gathered numerical data on aspects such as the number of new infections detected, preferences regarding HIV self-testing strategies, and linkages to care (Pai et al 2018), RJ was responsible for gathering qualitative data on participants' experiences using the app and self-test and on study staff's experiences implementing the HIVSmart! strategy.…”