By Karin Hatzold, Associate Director for HIV/TB, and Kasey Henderson, Advocacy Coordinator, PSI
Globally, health officials are struggling to navigate a new world in which clinics and hospitals need to cater for the influx of COVID-19 patients, while at the same maintaining vital health services without putting patients at risk of infection. Minimizing patient contact with health facilities reduces both the risk to recipients of care and the burden on these facilities. In the rush to respond to the pandemic, vital HIV prevention and treatment services have come under threat. Meeting the needs of people who live with or are at risk of HIV has never been more important, and it must be balanced with protecting health workers and people living with HIV as well as limiting the spread of COVID-19.
The ongoing pandemic has radically reshaped how HIV testing services are provided. HIV self-testing may be an acceptable alternative to maintain services while adhering to physical distancing guidance. PSI is well positioned to respond rapidly to this change. Here are three ways we have adapted HIV programming in South Africa and Kenya to respond to the immediate needs of our health consumers.
Leveraging the Digital Economy
Before the pandemic, HIV self-test kits were distributed free of charge at urban hotspots and in crowded places such as taxi ranks and at workplaces with large workforces. As the novel coronavirus began to spread and governments limited the size of gatherings, PSI has turned to virtual online ordering and home delivery of HIVST kits to continue to meet the needs of an increasing number of beneficiaries as access to conventional HIV testing services became restricted.
In Kenya, PSI’s implementing partner PS Kenya has been making HIVST kits available through private sector pharmacies for over three years with the support of the Children’s Investment Fund Foundation and the Elton John AIDS Foundation. In light of COVID-19, they have drastically reduced the price to increase affordability — and it’s working. At the beginning of April, PS Kenya began subsidizing HIVST kits to Mydawa Pharmacy, an online drug retailer . Because the kits are provided at no cost, Mydawa can sell them for only 150 Kenyan Shillings (roughly US$1.40), which covers shipping and handling costs.
Before the spread of COVID-19, Mydawa Pharmacy sold about four tests a day. Since the reduction in cost, they have doubled their sales to upwards of eight test kits a day. In the first 12 days of this program, 189 test kits were sold.
In South Africa, a similar online platform for HIVST distribution has existed for almost a year through the HIV Self-Testing Africa (STAR) project, funded by Unitaid. With limited HIV testing services and restricted community based HIVST distribution channels due to confinement measures, this online service allows STAR to continue providing consumers with an accurate and truly private method of HIV testing while they shelter in their homes. Information on how to conduct the test is provided through easily accessible virtual platforms instead of direct contact with health care providers at the clinics, limiting the risk of COVID-19 exposure.
While the pressure to stay home increases in South Africa and Kenya, the demand for online services will only continue to rise. PSI and STAR are committed to ensuring that HIV services are accessible and affordable, even during a pandemic.
Physical Distancing, Social Connecting
As HIV self-tests are distributed using online ordering platforms with home–based delivery, PSI is committed to using other online tools to spread information about HIV further than ever before.
With every self-test kit, clients are given the opportunity to access additional medical information through WhatsApp for Business. A chatbot shares information on self-testing and diagnostics, walking the client through every step as they test themselves, read their results and decide on their next steps. The chatbot then links users to confirmative testing and treatment, if needed, and offers advice on when to test again if their result is negative. They are also asked if they would like to receive a follow-up after they are done testing. Throughout the process, the client is asked if they will consent to sharing their results, reminding them that the data they provide will remain anonymous.
Given its success, PSI and its partners also saw the opportunity to also use this online platform to spread information about COVID-19. The WhatsApp platform is now being used to send out tips on how to minimize exposure and offers guidance on how to avoid infection such as frequent handwashing/hand disinfection, physical distancing and wearing of masks, and where further support can be received in case of symptoms of illness. All this information is sent to consumers without using their mobile data. For those that opt into this platform, it can also be employed for contract tracing.
Ensuring Safety for Frontline Health Workers and Clients
While PSI is opening access to HIV self-tests through its online platforms, there are still people who may not be able to have a test kit delivered to their home.
Through the STAR project, PSI has partnered with pharmacies across South Africa to give away HIV self-tests at no cost to consumers. While most public spaces have been closed to maintain physical distancing, pharmacies are one of the few places deemed essential and that remain open for business. Consumers often prefer to get their medications and other health supplies at pharmacies so they can avoid clinics and hospitals, where the potential to come into contact with COVID-19 is much greater. And with limited interaction needed between the pharmacist and client, HIV self-tests can be distributed widely without increasing the spread of the virus.
To reach consumers who do not or cannot go to pharmacies, PSI and its partners in South Africa have trained community health workers (CHWs) to provide information about both COVID-19 and HIV prevention and the importance of status knowledge as well as offer HIVST kits for free. CHWs are already distributing personal protective equipment like hand sanitizer at taxi stands, workplaces and throughout communities, and can easily add HIV self-test kits to the list of products they give out.
PSI has been working with the South African National Department of Health to ensure that CHWs have the proper personal protective equipment to keep themselves safe as they distribute health products and carry out other life-saving activities in their communities. Because self-tests allow clients to test themselves at a safe distance from the health worker, it lowers the risk of infection for CHWs who are already out in the field and reduces the strain on health facilities.
With existing platforms set up to distribute HIV self-test kits, there is now an opportunity to offer the option of COVID-19 self-sampling, providing guidance and instructions over WhatsApp in the same way that it is done for HIVST. The platform can also be used for other self-care interventions, including self-diagnostic and self-evaluation, moving forward.
The coronavirus pandemic has radically reshaped how HIV testing services can be delivered. PSI and our partners are well positioned to respond rapidly to this change with self-care interventions, such as self-testing and self-diagnostics, and with the use of existing mediums that allow us to respond to the immediate needs of our clients. COVID-19 kicked the shift to self-care into overdrive, showing just how valuable it can be for health consumers. As we continue to provide guidance to health workers and their clients alike, the arena of self-care will continue to grow and support overstretched health systems.