App-based HIV self-testing program created in Montreal detects new infections and connects to care, new study says

An HIV self-test (HIVST) app created in Montreal was studied in South Africa with encouraging results, according to the study's first author and platform creator.

The digital guide acts as a holistic program. It helps participants detect new infections and also links them to medical care and other services.

“When I started out on this journey 11 years ago, there was nothing out there," said Dr. Nitika Pant Pai who is with the Research Institute of the McGill University Health Centre. "People thought I was foolish to believe that Africans could self-test for HIV by using a smartphone.” 

But against all odds, Pai says she stood by her vision. The study published Wednesday in BMJ Global Health online shows that compared to conventional HIV testing, not only did subjects carry out HIV self-tests efficiently when guided by Pai’s HIVSmart! app, they also broadened the reach of the program by referring the digital program to friends and partners.

Pai said nearly all of the people who received a positive diagnosis, then went on to seek clinical care, counselling, and treatment afterward, and learned about disease prevention “which never happens usually with our base programs."

“The second most exciting thing,” Pai said, “was women became change agents in our project. They were the ones who came forward to get self-tested, and that sets the stage for greater involvement of women in diagnostics initiatives.”

"They are the caretakers, they asked their male partners within their network to come forward and get tested," the physician-researcher said.

The research was published at an auspicious time, said Pai because the World Health Organization (WHO) has called for more scientific evidence about the use of digital strategies, links to care, and the integration of community health workers into the process of HIV self-testing.

Whereas recent studies have shown increases in self-test usage and infection detection, linking people to preventative care or treatment has been a challenge, according to an MUHC press release.

The findings in Pai’s research suggest technology-based self-testing programs such as this one “could accelerate progress towards UNAIDS targets for HIV elimination worldwide,” read the release.

HOW THE STUDY WORKED

Pai collaborated with colleagues at the University of Cape Town. They introduced HIVSmart! in township populations of Western Cape in South Africa.

A total of 3,095 adults were recruited from various clinics over 18 months.

The quasi-randomized trial gave participants a choice between the oral self-testing program, with all the digital supports the HIVSmart! App offers, and conventional HIV testing.

Almost all who used the app (99.7 per cent) “were linked to antiretroviral treatment initiation or preventative care pathways through the HIVSmart! Program,” according to the MUHC statement.

More new HIV infections were detected within the self-testing group than in the conventional testing group (6.8 per cent).

The research also found that participants who engage in higher-risk behavior, for example, having sex with multiple partners, were more represented in the self-testing group.

“Hopefully it [the study] will inform and set the stage for more initiatives in this space,” said Pai.

She said it will take new partnerships between well-intentioned investors and social impact entrepreneurs to roll out the HIVSmart! program, if it is ever to have an impact on the deadly scourge of HIV which continues to affect about 40 million people around the world.

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