This section will guide you in making the right preparations to ensure that your HIVST program will be a success.
At the most general level, HIVST distribution is either direct (primary) or indirect (secondary).
Primary distribution: This approach employs trained providers (eg, healthcare workers, pharmacists, community-based distribution agents [CBDs]). Importantly, studies have shown that even professional health care providers need additional training in order to ensure that they provide adequate support to users and appropriately facilitate linkage to other services.
Secondary distribution: This refers to distribution among partners of people who present to testing services and test positive (including sexual and drug-injecting partners) and via social networks.
Done appropriately, this approach can increase testing uptake and potentially help facilitate linkages to care. However, for this approach to be effective, it is important that the initial HIVST kit distribution include:
Studies have shown that even professional health care providers need additional training in order to ensure that they provide adequate support to users and appropriately facilitate linkage to other services.
HIVST products and related services can be distributed in a variety of ways, some of which might be better suited for certain contexts and priority populations than others. When HIVST kits are distributed directly to the user by retailers or manufacturers, via the Internet for example, it is imperative that sufficient instructions, information and support, as well as contact details (for example telephone hotlines or websites) – are provided with the kit.
The STAR initiative developed and piloted a range of methods for HIVST distribution that use a combination of primary and secondary distribution approaches. Please click on the expandable sections below to view information specific to each model.
This model relies on Community-Based Distribution Agents (CBDs) to promote HIVST and offer free kits to users via home delivery or in social venues such as marketplaces, busy streets, bars and beer halls. Users can also collect kits from the CBDs home, if preferred. In addition to providing kits, CBDs can support users throughout the process, as necessary.
While CBDs do not need to be medical professionals, they should have completed secondary school education and reside in the community they will serve. In the STAR initiative, we found participatory approaches to be effective, with community members nominating candidates following community sensitization meetings. Nominated CBDs completed a two-day training provided by PSI that included basic facts about HIV transmission and treatment, antibody-based diagnosis, discordancy and the principles of consent and confidentiality, as well as familiarization with the kits and how to demonstrate use to recipients, and data capture tools.
All trainees had to undergo competency testing at the end of the training course when training skills were assessed. Once they have completed training and successful competency testing, CBDs should be able to provide clients with: brief health information about HIV; information on the test; instructions for use (IFU) in local language, optimized for the priority population; and an in-person or video-clip demonstration of how to use the kit, to supplement manufacturer’s instructions.
Clients can choose to perform the test alone or with the help and guidance of the CBD. This is particularly helpful for illiterate and semi-literate participants, who might need the CBD to read the IFU and help them to complete any other paperwork that might be involved in the distribution process (eg, a user survey, in which case the CBD would explain the questions then let the user complete the checkboxes in private).
CBDs can also provide support and guidance post-test, such as answering questions and providing self-referral cards with locally adapted options to facilitate linkage to confirmatory testing, HIV care and prevention services.
Establishing a toll-free hotline to answer questions about the testing process, results and referral options is also good practice for a CBD-driven model.
In the STAR experience, HIVST kits were offered to clients of HTS clinics and mobile outreach facilities near “hot spots” such as bus and truck stops, mining areas, urban shopping malls, and other informal workplaces. The clients were told they could use the HIVST kit on-site, or at home. Those who accepted the HIVST kits received a brief demonstration (either by video or by a trained provider) and information about post-test support services and referral forms (confirmative testing, HIV treatment including ART, information about prevention services) prior to HIVST. Those who declined received conventional HTS, as usual.
In all cases, care was taken to ensure users received support and services. Counselor assistance with HIVST was made available in private cubicles or tents for those who opted to test on-site. Confirmative testing was made available for those reporting a reactive (potentially positive) self-test result.
As part of the STAR initiative, we distributed kits at worksites for the mining and farming industry. Peer promoters and outreach workers provided pre-test information and in-person demonstrations of the self-testing process. Clients could self-test on-site or at home and could take a test kit home for their partner to use with support for secondary distribution.
Confirmatory testing was available on site, provided by the PSI HTS outreach team or by workplace HTS services, or through self-referral forms providing information on local private and public-sector health services. Confirmed PLHIV were referred for ART at public or private sector providers. A toll-free hotline number was provided to all clients.
HIVST can be offered to patients accessing public sector outpatient departments or other clinical services. As part of the STAR initiative, health care providers, either nurses or counsellors working at out-patient departments, provided information and, if desired, demonstrations to clients before their consultation.
Clients could self-test in a separate room following a brief demonstration, with the option of sharing their results during their consultation. Information on confirmatory testing, ART and HIV prevention services was provided to all patients.
For those with reactive (potentially positive) self-tests, counselling, confirmatory testing and ART were available on-site through the routine facility services. HIVST-negative clients received HIV prevention messages by the nurse and health care provider in the out-patient department and male clients were referred for VMMC.
As part of the STAR initiative, HIVST was also implemented into ongoing Voluntary Medical Male Circumcision (VMMC) programs. VMMC mobilizers were trained (using the same course created for CBDs) to offer HIVST to all men who were interested in circumcision but cited fear of HIV testing onsite. Mobilizers provided pre-test information and demonstration of kit use before offering a kit to each potential VMMC client. In Zambia, VMMC mobilizers also distributed HIVST kits to women.
Selection of which HIVST products to use must first take account of the regulatory situation in the country (see Regulations, Section 1), whether there are already regulations governing the use of medical devices or, if not, which substitute regulatory body’s decisions will be used instead.
Your situational analysis and additional operational research should also have generated data on the preferences of your target populations for various different types of test kits and culture-specific issues, which will influence product choices.
Regardless of the final decision, all HIVST products should have been assessed and approved by a recognized national authority and/or an international body such as WHO, the Global Fund or a founding member of the Global Harmonization Task Force on Medical Devices. This will ensure the procurement of quality HIVST products without expensive and lengthy in-country validation studies.
Depending on the local context, you might also need to consider which strains of HIV the self-test is capable of detecting (for example HIV-1, HIV-2, or combined HIV-1/HIV-2). Choose products with acceptable specifications, including adequate sensitivity (proportion of people with the disease correctly identified as reactive by the test) and specificity (proportion of people without the disease correctly identified as non-reactive) of above 95%.
All HIVST products should have been assessed and approved by a recognized national authority and/or an international body such as WHO, the Global Fund or a founding member of the Global Harmonization Task Force on Medical Devices.
HIVST products should be highly sensitive and specific, so that the results are accurate, be simple to use; include all necessary consumables; provide results that are easy to read/interpret within a short period of time and contain clear pictorial instructions and support tools (including information on what to do and where to go after self-testing.
You should avoid products that have poor stability (ie, that cannot sustain suboptimal storage), are not robust (eg, cannot sustain common user errors) or that cannot be disposed of in the general waste disposal system. It is particularly important that the end-reading point is stable, meaning that the results can be accurately read for a significant time after the test is first done and results are visible. You should prioritize products that offer support tools such as instructional videos, hotlines, websites and referral information to help clients.
Furthermore, it is important to identify not only first choice products but also alternative products and suppliers to avoid service interruptions due to product or supply issues. There could also be cases where you might want to introduce multiple products to accommodate a variety of user preferences and increase choice as a strategy for promoting uptake among different users and priority populations (e.g., some users may prefer oral self-tests and others may prefer blood-based self-tests). You might also want to offer multiple options early on as a way of testing the market and planning for future procurement.
|
Sensitivity |
Above 95% |
|
Specificity |
Above 95% |
|
Use |
●Easy to use ●No auxiliary equipment required for performance of test or interpretation of results ●Should require technical training to perform the test, but have easy to follow instructions for use (IFU) ●Should have a stable end-reading point |
|
Rapidity |
Tests should be ready for interpretation within 20 to 40 minutes |
|
Storage |
The storage temperature should be between 2 to 30 degrees Celsius |
|
Shelf Life |
Above 12 months |
|
Packaging |
The entire kit should come in a single package |
|
Cost |
It should be affordable enough to allow scaling or access for all members of the priority population(s) |
Users who receive a reactive result must be immediately referred to confirmatory testing using conventional, professionally administered methods.
Community outreach and follow-up: Follow-up by trained peers or community workers can be a useful strategy for facilitating linkage to further testing, prevention and treatment. This can include offering community-based confirmatory testing, prevention and treatment while HIVST kits are distributed or on an ad hoc basis. Community workers and peer navigators may also accompany those with a reactive self-test result to receive further testing and care in a facility.
Telephone calls, text messages or social media counselling messages and reminders: Follow-up counselling, messages and reminders can be used to encourage self-testers to link to further testing, prevention and treatment.
Compensation or financial incentives: Small incentives offered to self-testers – such as the reimbursement of transport costs and/or financial compensation – may be useful, particularly for men. However, issues of feasibility, equity and sustainability need to be considered.
Empathy mapping is a quick exercise that can help you start to see the world and HIVST from an intended user’s perspective. Start by selecting a specific priority population (eg, MSM or postpartum women in high HIV burden settings). Then, sit down with other members of your team who have worked with that priority population before, and – based on what you know – fill out a chart like the one below, describing what the target user sees, hears, thinks and feels, and says and does in relation to HIVST.
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For example:
| MSM | Postpartum Women |
Sees | Partners and acquaintances testing positive for HIV. | Friends having relationship problems during pregnancy. |
Hears | Homophobic messages from the culture around him, including friends and family. | Warnings from her doctors about elevated HIV risks. |
Thinks & Feels | Feels concerned about his HIV status. | Feels pressured to have sex with her partner. |
Says & Does | Avoids testing for fear of stigma. | Has unprotected sex with her partner during pregnancy. |
By viewing our intended users’ worlds in these terms, we can get a clearer sense of the challenges they face related to HIV testing and the messages they might need to receive before adopting HIVST. Empathy mapping is supposed to be a quick exercise, which you can complete in one sitting. If, when attempting to develop an empathy map, you find that you don’t know your intended users well enough to imagine yourself in their situation, then you might need to do some research or recruit team members with more experience working with the group in question.
Journey Mapping is an exercise where we analyze an individual’s experience of using a health product/service or adopting a healthy behavior by dividing it into several distinct stages:
Awareness: How did they first learn of the product, service or behavior?
Decision: What events or influences made them decide to use the product/service or adopt the healthy behavior?
Uptake: When did they finally act on their intention and start using the product/service or practicing the behavior?
Continued Use: What was their subsequent experience using the product/service or maintaining the behavior, day to day?
Advocacy: To what extent did they influence others to use the product/service or adopt the behavior?
By viewing the intended user’s experience as a journey from initially learning about HIVST to eventually making use of it and, ideally, advocating HIVST to others, we gain a clearer sense of how their views might change over time and how we could potentially influence them at each stage, for example by informing local providers such as pharmacists about the benefits of HIVST or engaging with intended users on social media.
To give examples of journey maps for linkages to counseling, treatment and prevention:
| Step | Counseling | Adolescent Female, Prevention |
| Awareness | ●Given information on counseling by a CBD during assisted HIVST test | ●Sees messages on condom use on billboards ●Receives information on safer sex from pharmacist when acquiring HIVST kit |
| Decision | ●Amidst bout of depression after testing positive, re-reads materials provided by CBD and decides to seek out counseling | ●Has a scare with a recent partner testing positive for HIV ●After non-reactive HIVST result, decides to practice safer sex |
| Uptake | ●Goes to a local center for counseling | ●Purchases female condoms from pharmacy where she aquired HIVST kit |
| Continued Use | ●Visits counsellor occasionally during first six months following diagnosis | ●Uses female condoms for a while, but eventually finds a partner willing to use male condoms |
| Advocacy | ●Tells a friend who recently tested positive for HIV to seek counseling | ●Advocates for safer sex whenever friends, family ask for advice |
The examples given above represent ideal user journeys – in other words, the path we would like intended users to take towards using HIVST and related services. However, the reality might be a great deal more complicated. There might be unanticipated barriers, and our understanding of intended users’ decision-making process and motivations might be inaccurate, outdated or incomplete.
You will want to validate your ideal journey against the experiences of real users and, if necessary, create an “actual” journey map that reflects the current reality. This can help you identify gaps and develop strategies to bring users’ actual journeys more in line with your ideal.
Journey mapping requires more detailed knowledge of users and their day-to-day experience than simple empathy maps. At least some research will be required, including:
It is often helpful to create detailed profiles of fictional people representing “typical” members of your priority population. Doing this can make a priority population more relatable, which makes it easier to develop effective demand creation communications tailored to their specific needs and preferences.
These profiles or “archetypes” should be based on data collected during empathy mapping, journey mapping and situational analysis. Once an archetype for a particular priority population has been thoroughly researched and validated, it will likely remain relevant for a long time and should not need to be recreated for a few years.
A simple archetype document should tell a story about a hypothetical member of the priority population as a real person. While the archetype might represent a group with a range of characteristics, the archetype itself should represent a specific person with enough personal detail to help you imagine how this particular person might behave in real-life situations.
In addition to creating archetypes for intended users, it is sometimes helpful to create archetypes for other actors in the HIVST market (manufacturers, regulators, pharmacists, CBDs, etc.). In these cases, you will want to understand the key drivers of a business or the broader policy objectives and alternatives facing donors and policy-makers.
While we have provided a template link at the top of this section, not all archetypes need not look the same, or contain the exact same information. The output should be concise (about 1 or 2 pages long) and easy to understand, with key insights and considerations clearly highlighted.
Most archetypes will contain the following core components:
Once you have a solid understanding of your intended users and the larger market around HIV testing, you can start designing your demand creation campaign. The major steps in designing a campaign are:
While most of our discussion so far has been about intended users, there are many potential audiences for demand creation messaging, including:
You will need to make a decision about how much time, effort and resources to allocate to each of these groups. Ideally, the insight you gained through your consumer and market research will help you evaluate their relative importance in terms of convincing more intended users to take advantage of HIVST and related services.
Before designing your own demand creation campaign, take a moment to review literature from past programs that addressed similar audiences in a similar market context, and ask if any aspects of their demand creation campaigns could be reused or adapted for your own program. You should feel free to “steal with pride” and copy successful programs if there is reason to believe they will translate to your current market context.
In the following sections, we will review various methods for adapting existing models to your context or – if you can’t find a proven model that translates to your context – developing a demand creation campaign from scratch.
When promoting HIVST and related services, it can help to approach the task with the same mindset as a commercial marketer. At the highest level, demand creation strategies can be divided into two categories:
“Push” strategies that encourage distributors and other influencers to actively promote products and services to the target consumer.
“Pull” strategies that seek to generate demand among consumers.
Your campaigns for HIVST and related services will likely employ a combination of both.
Traditionally, commercial marketers think in terms of the “Ps”: Proposition, Product, Place, Price, and Promotion. An explanation of each of these “Ps” is provided below.
The 5 “Ps” of Effective Marketing Campaigns | |
Proposition | ·How can we frame the value of HIVST (and HIV testing in general) in terms our audience will appreciate? Should we focus on convenience? Privacy? The ability to reach underserved populations? Something else? ·How can we best frame the value of counseling, treatment and prevention? |
Product | ·How can you inspire confidence in the quality and reliability of HIVST kits? ·What counseling, treatment and prevention options are available and are they appropriate for your target audience? |
Place | ·Where will HIVST kits be available? Where will we display our messages? For example, can you place brochures or signs in local pharmacies? Can you coordinate promotional events when mobile services with HIVST kits are in town? ·Where can intended users access counseling, treatment and prevention services? Should they be provided with literature when they receive their HIVST kits? How else can you raise awareness? |
Price | ·This guide assumes that HIVST products will be made available free of charge. ·Are there costs associated with counseling, treatment and prevention options? Are the costs reasonable for your intended users? |
Promotion | ·What channels are you using to create demand for HIVST and related services (e.g., social media, billboards, events, brochures, etc.) and will the messages resonate with your intended audiences and move them to take advantage of HIVST and related counseling/treatment/prevention services? |
Click on the titles to learn more about each of the five elements.
Demand creation is ultimately about making a promise to the consumer regarding the value of a particular product or service – in this case, HIVST and related services. Commercial marketers refer this as the product or service’s “value proposition” or “positioning”.
An effective value proposition has the following elements:
Typically, a positioning statement is constructed as follows: [Target] uses [product] in [context] because [points of difference]
For HIVST, your value proposition might be “[HIV self-testing] offers [married people] a way to check their HIV status [in private], so they can [protect their loved ones].”
Alternately, depending on your audience, you might choose to emphasize the privacy aspect, for instance “[HIV self-testing] offers [incarcerated people] a convenient way to learn their status [without having to leave their facility] so they can [receive necessary services and treatment while in prison].”
Again, the above examples are only suggestions. Your proposition should be informed by the insight you gained from researching your intended users, then validated and refined through subsequent prototyping and testing. You should also be mindful of any local regulations on what, exactly, manufacturers and distributors can say about a health product’s benefits.
While the options for HIVST products are relatively limited, we want to make sure to select the most appropriate option for our intended audiences, and that everything we do to promote it presents an image of quality and reliability.
As for counseling, treatment and prevention, we want to present an appropriate range of options for our target audience. For example, some MSM might prefer to receive counseling anonymously via social media rather than attending public support groups.
There are three components to a successful brand:
“Place” or Placement Strategy focuses on making products, services, and communications available in places where they will attract consumers’ attention and be convenient for consumers to access.
There are two main dimensions to Placement Strategy:
Making products and services available. Simply distributing HIVST kits and making counseling, treatment and prevention services available to your intended users can be a challenge, depending on your country’s infrastructure and other practical considerations. That’s why it’s critical to select the most appropriate distribution model(s), practice effective supply chain management and create effective linkages to support services.
Making products and communications visible. Consumers in nearly all markets are exposed to an increasing amount of marketing messaging. Your challenge is to place your products and communications in areas where they will catch the consumer’s attention among everything else competing for their attention, both in terms of HIV testing/treatment/prevention, and in general.
To determine appropriate placement, we should ask: Where does the target consumer typically go in a day? Can we make products available or display communications in their workplace or in the neighborhoods where they live? What types of events do they attend, and could we sponsor them?
Specifically, where do consumers go for products or services related or similar to HIV testing? Do they visit a clinic or pharmacy when they are feeling sick? Do they visit brothels? Can we make HIVST kits and/or communications available in those places, and can we educate the staff to “push” HIVST kits towards intended users?
While this guide assumes that HIVST kits are being made available to intended users free of charge, we still want to ensure that adequate incentives are in place for stakeholders involved in the distribution and/or promotion of HIVST to do their jobs.
Price might also be an issue when it comes to counseling, treatment and prevention options. We want to make sure that we are in a position to provide effective yet reasonably priced options for all our target audiences. For instance, PrEP might be less affordable than condoms for adolescents, and incarcerated people might have very few options for support and treatment.
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In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.
During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].
Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.
Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.
In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.
Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.
By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia
In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level.
During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates.
T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities.
To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.
“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”
— Michael Negash, Deputy Chief Party of T/WASH
By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis
Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.
Here’s how we got there.
Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.
However, through the groundbreaking research from the Unitaid-funded HIV Self-Testing Africa (STAR) initiative led by PSI, we demonstrated that HIVST is not only safe and acceptable but also cost-effective for reaching populations at high risk with limited access to conventional HIV testing. This research played a pivotal role in informing the normative guidelines of the World Health Organization (WHO) and shaping policies at the country level. As a result, more than 108 countries globally now have reported HIVST policies, with an increasing number of countries implementing and scaling up HIVST to complement and partially replace conventional testing services. This became especially significant as nations tried to sustain HIV services amidst the disruptions caused by the COVID-19 pandemic.
By leveraging our expertise, PSI is conducting research to identify specific areas and populations where the adoption of Hepatitis C and COVID-19 self-testing could significantly enhance testing uptake and coverage. This research serves as the foundation for developing targeted strategies and interventions to expand access to self-testing, ensure that individuals have convenient and timely options for testing for these diseases, and are linked to care, treatment and prevention services through differentiated test and treat approaches.
By: Shawn Malone, Project Director, HIV/AIDS Gates Project in South Africa, PSI Global
In South Africa, where the HIV response has lagged in reaching men, PSI’s Coach Mpilo model has transformed the role of an HIV counselor or case manager into that of a coach and mentor who provides empathetic guidance and support based on his own experience of living with HIV. Coaches are men who are not just stable on treatment but also living proudly and openly with HIV. Situated within the community and collaborating closely with clinic staff, they identify and connect with men struggling with barriers to treatment and support them in overcoming those barriers, whether that means navigating the clinic or disclosing their HIV status to their loved ones.
PSI and Matchboxology first piloted the model in 2020 with implementing partners BroadReach Healthcare and Right to Care as well as the Department of Health in three districts of South Africa. Since then, the model has been rolled out by eight implementing partners in South Africa, employing more than 300 coaches and reaching tens of thousands of men living with HIV. To date, the model has linked 98 percent of clients to care and retained 94 percent of them, in sharp contrast to the estimated 70 percent of men with HIV in South Africa who are currently on treatment.
Given the success of the program, South Africa’s Department of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have each embraced the Coach Mpilo model in their health strategy and are embedding it in their strategies and programs.
“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”
– Anu Khosla, Member, Maverick Collective by PSI
By: Hoa Nguyen, Country Director, PSI Vietnam
In late 2022, with funding from the Patrick J. McGovern Foundation, PSI and Babylon partnered to pilot AIOI in Vietnam. By combining Babylon’s AI symptom checker with PSI’s health provider locator tool, this digital health solution analyzes symptoms, recommends the appropriate level of care, and points them to health providers in their local area. The main goal is to support people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system, while reducing the burden on the healthcare workforce. The free 24/7 service saves people time and subsequent loss of income from taking time off work and from having to pay unnecessary out-of-pocket expenses. Under our global partnership with Meta, PSI launched a digital campaign to put this innovative product in the hands of people in Vietnam. By the end of June 2023 (in the nine months since product launch), 210 thousand people accessed the AIOI platform; 2.4 thousand people created personal accounts on the AIOI website, 4.8 thousand triages to Symptom Checker and linked 2.2 thousand people to health facilities.
Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.
— Martin Dale, Director, Digital Health and Monitoring, PSI
By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar
Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.
Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.
In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.
By: Anya Fedorova, Country Representative, PSI Angola
The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.
Here’s what it looks like in practice.
In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.
Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.
By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.
Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.
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We prioritize the voices of people and communities in designing programs, deliver direct-to-consumer products and information, and accelerate social and behavioral change for health impact.
Across 40+ countries, we scale digital solutions that make it easier for people to take ownership of their own health, and health systems to use resources efficiently and increase health impact.
We support health systems in shaping the policy and regulatory environment for self-care interventions and ensuring self-care is included as an essential part of healthcare services.
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