Background: Human immunodeficiency virus self-testing (HIVST) can reduce facility-based HIV testing barriers; however, no proven applications exist with widespread uptake for self-reporting or linkage to care. Mobile health (mHealth) applications (apps) have shown high usability and feasibility scores, so Ithaka was developed for South Africans to self-report HIVST results outside clinical settings.Objectives: This study investigated the use of Ithaka as a support tool for HIVST users, specifically the ability to self-report results.Method: This cross-sectional study was conducted from November 2018 to June 2019. At existing HIVST distribution sites, individuals were given HIVST kits and then invited to use Ithaka. Participants could test at home and report their results through the app anytime. Ithaka tracked when people logged-on, registered, received counselling and reported results. Post-study surveys on user experience were also conducted.Results: Of 751 participants, 531 (70.7%) logged onto the app, 412 (54.9%) registered, 295 (39.3%) received counselling and 168 (22.4%) self-reported results. Participants strongly agreed that Ithaka was useful and that it was easy to upload results. Forty-one participants completed a post-test survey, and 39/41 (95.1%) completed the app journey. Most participants (36/41;87.8%) had no challenges, although 2/41 (4.9%) cited perceived data costs, 2/41 (4.9%) difficulty uploading results and 1/41 (2.4%) language, as challenges.Conclusion: Despite the small sample size, this study has shown that HIVST participants under pragmatic conditions were willing and able to self-report results via the app, whilst also identifying areas of improvement for scaling up.

Background: HIV testing is the first step for linkage to HIV prevention or treatment services. Facility-based HIV testing is the most utilised method, but faces challenges such as limited work space and human resources. Digitally supported HIV self-testing (HIVST) provided in clinics shifts testing to the client, potentially empowering the client, and addresses such constraints.Objectives: The study primary objective was to determine the feasibility of integrating digitally supported HIVST into the clinic. Secondary objectives were to describe HIV testing volume, populations reached, and antiretroviral treatment (ART) initiation.Method: We conducted an analysis of prospectively collected data during implementation of digitally supported HIVST in two healthcare facilities based in South Africa from June 2019 to September 2019. We described implementation and client characteristics using HIVST and compared testing before and during implementation.Results: During the 4-month implementation period there were 35 248 client visits. A total of 6997 (19.9%) of these visits involved HIV testing. Of those testing, 2278 (32.5%) used HIVST. Of the 2267 analysed, 264 (11.6%) were positive: 182 (12%) women and 82 (11%) men. Of those, 230 (95.4%) were confirmed HIV positive and 150 (65%) initiated ART within 14 days. During a four-month pre-implementation period, 14.5% of the clients tested for HIV. Compared to the pre-implementation period, we observed a 25% increase in HIV testing.Conclusion: Digitally supported HIVST increased the number of clients completing HIV testing in the health facility, without a need to significantly increase staff or space. Facility-based digitally assisted HIVST has the potential to increase HIV testing in high HIV prevalence clinic populations.

HIV self-testing (HIVST) complements traditional HIV testing programmes by removing barriers and increasing access to testing for key populations, and digital interventions have been developed for HIVST to improve the testing and linkage to care experience for users. The first HIVST kit was proposed in 1986, but it took 10 years for the home sample collection (HSC) HIVST to become available and another 16 years for rapid diagnostic test HIVST to be approved by the Federal Drug Administration. Since then, studies have shown high usability and performance of HIVST, which led the World Health Organization formally recommending HIVST in 2016, and currently almost 100 countries have incorporated HIVST into their national testing strategy. Despite the popularity, HIVST present challenges around pre-and post-test counselling, as well as the ability to report results and link users to care, and digital interventions for HIVST have been introduced to address these challenges. The first digital intervention for HIVST was introduced in 2014 and showed that digital interventions could be used to distribute HIVST kits, report results and link users to care. Since then, dozens of studies have been conducted, which have validated and expanded on these early findings, but many were pilot studies with small sample sizes and lacked the standardization of indicators required to aggregate data across platforms to prove impact at scale. For digital interventions for HIVST to be championed for scale-up, they must continue to show measurable impact at larger scales, while still maintaining and standardizing data security and integrity.

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BACKGROUND Youth-friendly services increase the uptake of HIV testing among 12-24 year olds. Medecins Sans Frontieres, partnered with Aviro Health to develop a series of youth-friendly sexual health educational videos, as well as a digital HIV counselling support syllabus, the “HIV Journey”. Both were hosted on a data-free web-based platform, named Khetha. OBJECTIVE To determine if Khetha would encourage youth to link to testing, and if youth would use the platform when undertaking an HIV test, a pilot was conducted at 2 youth clinics in the peri-urban, low socioeconomic suburb of Khayelitsha in Cape Town, South Africa. METHODS Recruitment ran from October 2020 to March 2021, with 3 methods utilised: a peer-recruiter enrolled youth in the waiting room of the clinics, 2 outreach events were held in the community surrounding the clinics, and 2 Facebook advertising campaigns were run. Youth were supplied a pamphlet, or Facebook-messaged, a unique code which allowed access to Khetha. Youth could undertake the “HIV Journey” at any time or place, but if they went for an HIV test at either clinic they could choose to enter their results into Khetha, with the counsellor entering a unique code to verify the test was conducted. All data was collected by the platform. RESULTS 182 users accessed Khetha, with 142 choosing to register. Of which, 117 undertook the “HIV Journey” (101 recruited at clinic, 15 via Facebook, 2 via outreach). Of these, 82% (96/117) completed the pre-test information component, and 24% (28/117) completed post-test counselling. 22% (21/96), all recruited at the clinic, opted to enter their result, of which 7 were positive. 20 educational videos were available on Khetha, and were watched 374 times, with the top 3 being: Female Condom - Femaler (100), Going for the Test - Female (50), and PrEP - Female (42). CONCLUSIONS Khetha use was highest within facility, suggesting benefit in making youth-friendly digital platforms available at testing sites. The high video views reaffirm the need for youth-friendly educational materials.