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DIGITAL HEALTH OP-ED

Groundbreaking HIV-prevention initiative harnesses AI to bring medicine to the people

Groundbreaking HIV-prevention initiative harnesses AI to bring medicine to the people

The ePrEP programme represents a significant leap forward in addressing critical challenges in PrEP accessibility, continuity and adherence among transgender women and men who have sex with men.

The healthcare landscape is constantly evolving, and within this dynamic environment, groundbreaking initiatives are reshaping the way men who have sex with men and transgender women access HIV self-testing and pre-exposure prophylaxis (PrEP). 

PrEP, a vital tool in HIV prevention, has offered hope to these communities facing a disproportionate burden of the disease. However, accessibility, follow-up and adherence challenges have historically hampered the effectiveness of PrEP programmes. 

POP INN clinics, established by African, global health impact organisation The Aurum Institute, offer free sexual health services to gay, bisexual, queer and transgender people, as well as men who have sex with men (key populations), in five districts across South Africa. POP INN clinics have partnered with Audere, a global digital health solutions nonprofit organisation, and South African managed care organisation CareWorks to address these challenges and provide stigma-free access to prevention medication through ePrEP.

A key enabler to the programme is an AI-powered ePrEP mobile application, which seamlessly integrates routine HIV self-screening and a national courier service to deliver PrEP directly to the client at their preferred location. With the primary objective of improving accessibility, uptake and adherence to PrEP medication, ePrEP aims to bridge the gap for rural clients and individuals encountering barriers to using clinics. 

This approach also seeks to reduce the financial and time burden on clients seeking PrEP and associated support services by reducing needed clinic trips. The programme was launched in July 2023 and has already enrolled more than 100 clients across the five Aurum POP INN clinics, making tangible progress in advancing PrEP access and HIV prevention.

eprep

Health engage with hostel residents during intensified testing and screening in Alexandra, Johannesburg, on 25 April 2020. The drive included testing for flu-like symptoms, comorbidities such as diabetes, asthma and hypertension, as well as for HIV and tuberculosis. (Photo: Dino Lloyd)

The ePrEP solution: A seamless path to health

Upon enrolment, clients are connected to telehealth counselling services and the ePrEP mobile app. The AI-powered app guides clients to test monthly for HIV using the Mylan HIV self-testing kit manufactured in South Africa. 

The following is a step-by-step overview of the process required:

  1. Enrol and download the ePrEP app: Clients can easily enrol and download the app, available for Android (6.0+) and iOS (13+), and create an account;
  2. Self-test for HIV: Clients complete a risk assessment and scan the unique HIV test kit barcode to link it to their record, ensuring accurate tracking and monitoring. The app then offers clear, digital instructions for clients to perform an HIV self-test, making the process straightforward and accessible;
  3. Capture and interpret results: Clients are guided to take a photograph of the completed tests, ensuring the results are accurately recorded. The app verifies that the correct test is being used and that the quality of the image is acceptable, and helps clients to interpret the results; and
  4. PrEP home delivery: Counsellors are sent HIV test images captured via the app alongside results interpreted by both the client and AI. This information is used to facilitate the delivery of PrEP to clients with negative test results at their preferred location, removing the need for in-person clinic visits. Clients who test positive are immediately contacted and connected to antiretroviral therapy initiation at their nearest or preferred healthcare facility.

The app, which was co-designed with input from clients and health workers who specialise in HIV, also offers versatile access to counselling services via various channels such as WhatsApp, PleaseCallMe or phone calls. It incorporates a dedicated support page featuring programme links and contact information for healthcare providers. 

Users can choose to receive self-screening reminders and notifications through WhatsApp or SMS. The aim is to maintain continual engagement and encourage adherence to screening protocols.    

(Image: orderprep.co.za)

Unlocking ePrEP success stories

The ePrEP initiative is already yielding impressive results, effectively bridging long-standing gaps in PrEP adoption and HIV prevention. Here are some of its noteworthy successes:

  1. Overcoming follow-up challenges: Traditional healthcare models often struggle to ensure regular follow-up visits due to clients’ busy schedules. The ePrEP initiative aims to revolutionise this aspect of healthcare service delivery by bringing care to clients when they need it most. Through the CareWorks delivery system, they can have PrEP medication delivered to their preferred location, simplifying the process and enhancing adherence;
  2. Empowering rural communities: Recognising the critical role of accessibility in rural communities, initiatives such as ePrEP aim to disseminate information effectively and empower individuals to engage with healthcare professionals. Educational campaigns are crucial for sharing knowledge, offering self-monitoring opportunities and encouraging professional involvement, ultimately bridging the information gap;
  3. The vital role of partnerships: ePrEP operates in close partnership with established organisations such as partners and universities funded by the US President’s Emergency Fund for Aids Relief (Pepfar), which share the vision of expanding access to students and young people. These partnerships ensure the initiative remains rooted in local knowledge, drawing insights from individuals familiar with the area and tailoring services to local needs;
  4. Empowering clients with HIV self-test kits: Clients on ePrEP have access to blood-based HIV self-test kits, offering the convenience of clinical-level services from their own homes. This approach not only improves accessibility but also prioritises the well-being and preferences of clients, empowering them to take control of their health;
  5. Aurum POP INN and Higher Health Partnership: In a notable collaboration, Aurum POP INN partnered with nonprofit company Higher Health in Mpumalanga’s Ehlanzeni district and affiliated healthcare clinics within various higher education institutions to raise awareness and sensitise the public about enhanced service delivery. Incentives such as brightly coloured hoodies and user-friendly flyers with easily digestible information have made the initiative more accessible to the target audience, resulting in the district reporting the highest number of enrolments, with 41 clients on ePrEP; and
  6. Using AI-powered technology for good: Consistent access to PrEP is simple for clients when they are guided through testing and sharing results with their care team. Powering an app with AI result confirmation can reduce the chance of misinterpretation, supporting both patients and counsellors.

The ePrEP programme represents a significant leap forward in addressing critical challenges in PrEP accessibility, continuity and adherence among transgender women and men who have sex with men. By making PrEP and HIV self-testing more accessible, user-friendly and client-centred, this innovative initiative is poised to facilitate PrEP literacy and improve PrEP access and uptake. 

This programme is an example of how AI can be used for good to enable future differentiated care delivery for not only HIV, but sexually transmitted infections, sexual and reproductive health, and other conditions. 

As ePrEP continues to expand and evolve, it enables a future in which HIV transmission can be significantly reduced through accessible, client-centred healthcare solutions. DM

Tarique Variava is a psychologist and research coordinator in The Aurum Institute’s key populations programme. Vuyolwethu Ncube is a research coordinator at the programme. Matshidiso Chabane is a clinical associate leading the South African key populations programme. Shawna Cooper is principal product manager at Audere and a published researcher. Dino Rech (CEO Audere, CEO/founder Audere Africa) is a global health leader, published researcher and physician who has dedicated his career to the advancement of global health through research and innovation. Boitumelo Ramashala is a public health specialist with extensive experience in HIV/TB management for key populations. Maria Sibanyoni is a public health specialist with extensive experience in HIV management, currently working as the senior technical adviser at The Aurum Institute. Jacqueline Pienaar is a psychologist and public health specialist, currently serving as the technical director at The Aurum Institute.

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