Alone But Supported: A Qualitative Study of an HIV Self-testing App in an Observational Cohort Study in South Africa

Abstract

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.

Platform encounters: A study of digitised patient follow‐up in HIV care

“…Videoconferencing and telephone consultations involved a ‘respatialisation’ of the clinical encounter (Andreassen et al, 2018). In this way, our participants elaborated how they had to ‘negotiate space’ (comparable to findings of Janssen et al, 2020) to avoid risk of disclosure in synchronous tele‐interactions. A 41‐year‐old patient described how he experienced a call on his phone as more spatially sensitive than receiving and managing information within the app:…”

Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa

“…Exploration of choice of strategy and venue in the context of this study has been examined in great detail in related recently published qualitative research from this project. 38 39 …”

Evaluation of a mobile application to support HIV self-testing in Johannesburg, South Africa

“…These include telephone hotlines, short message service interventions, internet-based platforms and mobile applications (apps). 16,17,18,19,20 A Brazilian study conducted in 2019 showed that an internet-based intervention targeting men who have sex with men led to 21.4% of online participants self-reporting, whilst an interactive voice response telephone line in South Africa was found to link 9.8% of participants to care. 21 Whilst these platforms have shown varied success, the introduction of mHealth interventions for linkage to care and M&E are in line with the South African National Department of Health mHealth Strategy (2015), and should be explored further.…”

“…24 The app interface also provides developers with a malleable platform that can be tailored to individual users, allowing them to curate a collection of HIVST information, resources and guidance for testers, whilst also capturing the HIVST result data. 19,20 Recently, HIVSmart TM , a Canadian app, was developed to guide users through the testing process, link them to care, and store the HIVST result data. Preliminary evaluations in key Canadian populations, as well as healthcare workers in South Africa have shown the app to be feasible and acceptable; however, neither HIVSmart TM , nor any other app, has been developed or tested for the general population in LMICs.…”