Will an innovative connected AideSmart! app-based multiplex, point-of-care screening strategy for HIV and related coinfections affect timely quality antenatal screening of rural Indian women? Results from a cross-sectional study in India

Abstract

ObjectivesIn rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women’s preference for home delivery and health illiteracy affect health service delivery. To address these issues, we developed AideSmart!, an innovative, app-based, cloud-connected, rapid screening strategy that offers multiplex screening for STBBIs and anaemia at the point of care. It offers connectivity, integration, expedited communications and linkages to clinical care throughout pregnancy.MethodsIn a cross-sectional study, we evaluated the AideSmart! strategy for feasibility, acceptability, preference and impact. We trained 15 healthcare professionals (HCPs) to offer the AideSmart! strategy to 510 pregnant women presenting for care to outreach rural service units of Christian Medical College, Vellore, India.ResultsWith the AideSmart! screening strategy, we recorded an acceptability of 100% (510/510), feasibility (completion rate) of 91.6% (466/510) and preference of 73%. We detected 239 infections/conditions (239/510, 46.8%) at the point-of-care, of which 168 (168/239; 70%) were lab confirmed, staged and treated rapidly. Of the 168 confirmed infections/conditions, 127 were anaemia, 11 Trichomonas and 30 hepatitis B virus (HBV) (25 resolved naturally, 5 active infections). Four infants (4/5; 80%) were prophylaxed for HBV and were declared disease-free at 9 months. Recruited participants were young; mean age was 24 years (range: 17–40) and 74% (376/510) were in their second trimester. Furthermore, 95% of the participants were retained throughout their pregnancy.ConclusionThe AideSmart! strategy was deemed feasible to operationalise by HCPs. It was accepted and preferred by participants, resulting in timely screening and treatment of HIV/STIs and anaemia, preventing mother-to-child transmission. The strategy could be reverse-innovated to any context to maximise its health impact.

Economic evaluation of implementing a decentralised Hepatitis B virus diagnostic intervention under National Viral Hepatitis Control Programme in Tamil Nadu, South India

“…Our study population represents adult population who are at increased risk of HBV (key population) in the state of Tamil Nadu, South India. The key population considered in the study includes individuals with sexual risk behaviours [9], individuals with STDs [10], people living with HIV [11,12], blood donors [13,14,15], antenatal women [16,17] and men who have sex with men (MSM) [18].…”

Multiplexed technologies for sexually transmitted infections: global evidence on patient-centered and clinical health outcomes

“…Testee preference for multiplexed testing varied from a low of 60.2% to a high of 97.2% among study participants. 18 19 21 Overall, participants reported high satisfaction with being tested by multiplexed technologies (92.0%-99.5%) 19 21 and high acceptance of multiplexed technologies (100.0%). 18 21 With regard to recommendation, up to 99.1% of study participants would recommend multiplexed technologies to others.…”

“…The impact of multiplexed technologies was defined in one of several ways including their ability to detect new infections, increase uptake and to improve turnaround times to test results and linkages to care. Impact was reported by 11 (25.6%) where 3 (6.8%) studies reported on the increased detection of new/previously undiagnosed infections as a result of multiplexed testing, 1 (2.3%) study reported the increase in multiplexed testing from baseline, 21 6 (13.9%) studies reported the turnaround time to test results, [22][23][24][25][26][27] and 3 (6.9%) reported on linkages to/retention in care 18 21 28 (table 1).…”

“…19 In another study, 30 new infections of hepatitis B virus (HBV) and 11 new infections of Trichomonas vaginalis (TV) were detected with immunochromatographic assays. 21 Finally, one study determined that 3.2% more infections of TV were detected by a molecular assay than culture and 71.4% more infections were detected compared with wet mount 29 (table 1).…”

“…Increased uptake of multiplexed testing from baseline was reported for four STIs: HIV (58.0% at baseline to 100.0% at follow-up, an overall 42.0% increase), HBV (21.0% at baseline and 100.0% at follow-up, an overall 78.6% increase), hepatitis C virus (HCV) (0.6% at baseline and 100.0% at follow-up, an overall 99.4% increase) and TV (0.4% at baseline and 100.0% at follow-up, an overall 99.6% increase). 21 The turnaround time for immunochromatographic devices ranged from 15 min to 20 min, whereas for molecular assays it ranged from 14 min to 300 min. [22][23][24][25][26][27] Most participants who underwent multiplexed testing were linked to care (70.0%-100.0%) 18 21 28 (table 1).…”