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Lessons from Hepatitis C Self-Testing Research and Implementation
In 2022, the WHO estimated that 58 million people were living with chronic hepatitis C (HCV), yet only 26% were aware of their status, and even fewer had received treatment. Despite advancements in treatment, low awareness and limited access to testing services keep many individuals undiagnosed. Building on the HIV self-testing insights from the STAR Initiative, the WHO released guidance on HCV self-testing in 2021, highlighting key research priorities for implementation. This session will feature researchers and implementers from the STAR Hepatitis C Self-Testing Consortium, who will share findings on the feasibility, acceptability, accuracy, costs and cost-effectiveness of HCV self-testing across various settings. The discussion will also explore how these findings are influencing policy and guidance at the country level.
We invite you to watch the webinar recording.
International Conference on AIDS and STIs in Africa December 2023
International Health Economics Association Congress July 2023
International HIV Coinfection + Viral Hepatitis Elimination Conference July 2023
IAS July 2023
South African AIDS Conference June 2023
Interest Conference 2023
AIDS 2020 Satellite Session Towards Sustainable Models of HIVST
Watch Presentation
AIDS 2020 Satellite Session Towards Sustainable Models of HIVST
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Acceptability of a Peer-to-peer delivery of HIV Self-testing and Sexual Health Information to Support HIV Prevention among Young Women in rural KwaZulu-Natal, South Africa.
Preparing for scale-up: The changing cost and cost-effectiveness of HIV self-testing integration into community-based mobile outreach and index HIV testing models in Lesotho.
Reaching partners through secondary distribution of HIV self-testing in Malawi: A cost analysis of a pragmatic cluster-randomized trial.
Secondary distribution of HIVST kits in different clinical setting: a cohort study in Zambia
The varying cost of facility-based HIV self-test distribution across urban and rural districts in South Africa.
Preparing for scale-up: The changing cost and cost-effectiveness of HIV self-testing integration into community-based mobile outreach and index HIV testing models in Lesotho.
Reaching partners through secondary distribution of HIV self-testing in Malawi: A cost analysis of a pragmatic cluster-randomized trial.
The Impact and Cost of HIV Self-Tests Distribution In Workplaces In South Africa.
Read Abstract
The rationale for a 3-test HIV diagnostic algorithm: balancing accuracy and cost
Read Abstract
A cluster-randomised controlled trial to determine the effect of peer delivery HIV Self screening to support linkage to HIV prevention in rural KwaZulu-Natal, South Africa: interim analysis.
Read Abstract
Economic cost analyses of HIV self-test kits distribution in Malawi, Zambia and Zimbabwe: Community-based, Voluntary Medical Male Circumcision and Health facility-based models.
Read Abstract
HIV-related stigma and uptake of HIV self-testing in Malawi and Zambia.
Read Abstract
Reaching partners of antenatal and index HIV-positive patients in Malawi: a pragmatic cluster randomized trial evaluating uptake, yield, and accuracy of secondary distribution of HIV self-test kits.
Read Abstract
Estimating the costs of scaling up HIV self-testing: Incremental cost multipliers.
Read Abstract
Economies and Diseconomies of Scale of HIV Testing Services in Zambia: Results from Markov Microsimulations
Read Abstract
Cost analysis of two alternative HIVST distribution models in Malawi, Zambia and Zimbabwe: Voluntary Medical Male Circumcision and Health Facility based models.
How much does it cost to add HIV self-testing into male circumcision, outpatient, and HIV testing services in Malawi, Zambia, and Zimbabwe?
A systematic literature review of costs and cost-effectiveness analysis of HIV testing services in sub-Saharan Africa
Economies and diseconomies of scale of community HIV self-testing services in Zambia: A Markov microsimulation model
Community-led delivery of HIV self-testing targeting adolescents and men in rural Malawi: a cluster-randomised trial.
Read Abstract
Does the use of HIV self-testing kits lead to unintended effects? Evidence from female sex workers in Malawi
Read Abstract
Persuaded HIV Self-Testing During Community-Based Distribution Of Self-Test Kits: A Population-Based Survey And Nested Qualitative Study In Zimbabwe.
Read Abstract
Retesting for HIV on antiretroviral therapy (ART) against recommendations: investigating the sensitivity of supported HIVST using two HIV self-test kits in patients on long-term ART in Blantyre, Malawi.
Read Abstract
Too much of a good thing? Prevalence and determinants of frequent HIV testing in Zambia and Malawi
View Poster
Uptake and performance of blood-based self-test versus oral fluid-based self-test in Blantyre district, Malawi.
Read Abstract
Value of secondary distribution of HIV self-test kits to male partners of female sex workers.
View Poster
Who self-reports never-testing for HIV after community-based distribution of HIV self-testing kits in Malawi, Zambia and Zimbabwe?
Adolescents, and adult men report never-testing for HIV in the context of community-based distribution of HIV self-testing in Malawi, Zambia and Zimbabwe, 2017
Finding the Missing Children With HIV: Index-Linked Testing In Clinics & Communities.
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Finding the Missing Children With HIV: Index-Linked Testing In Clinics & Communities. (Poster)
The Impact and Cost of HIV Self-Tests Distribution In Workplaces In South Africa
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HIV self-testing – where do we stand?: A review of HIV self-testing policies in 45 countries.
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So HIVST costs more than HTS in early introduction what can we do about it for scale up?
View Presentation
Secondary Distribution of HIV Self-testing among Malawian Men: A Qualitative Study Exploring Perceptions, Experiences and its Influence on Masculinity in Blantyre, Malawi
View Poster
A Systematic Literature Review of Costs and Cost-effectiveness Analyses of HIV Testing Services in Sub-Saharan Africa.
View Poster
Moving from ink to bytes – Addressing the challenges in transitioning from paper to Electronic Data Collection (EDC) in sub-Saharan African HIV research centres.
Read Abstract
An increase in the number of countries permitting lay provider HIV testing and counseling between 2015 and 2018: An updated policy review of 48 countries
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Applying User Preferences to Optimise the Contribution of HIV Self Testing to Reaching the “First 90” Target of UNAIDS Fast TracknStrategy: Results from Discrete Choice Experiments in Zimbabwe
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Comparison of HIV self-testing (HIVST) distribution models in Zambia: potential for impact and sustainability.
Read Abstract
Cost-effectiveness Workshop – What is it and does it matter?: Understanding and applying cost-effectiveness for high impact HIV testing programmes in low- and middle-income countries. (Presentation)
Cost-of-testing-per-new-HIV-diagnosis as a metric for monitoring cost-effectiveness of testing programmes in low income settings in Southern Africa: health economic modelling analysis.
Read Abstract
Does community-based HIVST increase coverage of HIV testing and uptake of ART, and at what cost? Insights from randomised trials in Malawi, Zambia and Zimbabwe (Presentation)
Exploring the drivers of User Costs as a barrier to accessing HIV Testing from Rural Malawi.
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Exploring the drivers of User Costs as a barrier to accessing HIV Testing from Rural Malawi. (Poster)
Increasing knowledge of HIV status and demand for ART using community-based HIV self-testing in rural communities: a cluster randomised trial in Malawi.
View Poster
Preferences for HIV self-testing distribution and linkage to care models: results from discrete choice experiments in Zimbabwe
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Preferences for HIV self-testing distribution and linkage to care models: results from discrete choice experiments in Zimbabwe (Poster)
Systematic literature review of critical gaps in costs and cost-effectiveness analyses (CEA) of HIV testing services in sub-Saharan Africa.
Read Abstract
Systematic literature review of critical gaps in costs and cost-effectiveness analyses (CEA) of HIV testing services in sub-Saharan Africa. (Poster)
Cost of delivering HIVST in a social franchise clinics in Urban Malawi
Does community-based HIVST increase coverage of HIV testing and uptake of ART, and at what cost? Insights from randomised trials in Malawi, Zambia and Zimbabwe
Exploring the drivers of user costs as a barrier to accessing HIV Testing in rural Malawi
View Poster
Comparison of HIV self-testing (HIVST) distribution models in Zambia: What matters, scale or scope? (Presentation)
Reaching the first 90: Preferences for HIV self-testing service delivery among hard to reach populations in Zimbabwe (poster)
Cost analysis of differentiated HIV self-testing kits distribution strategies in Zambia.
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Linkage to care after HIV Self-testing in Zimbabwe: A Cluster Randomised Trial.
Read Abstract
Does Community-Based Distribution of HIV Self-Test Kits Increase Uptake of HIV Testing at Population Level? Results of a Cluster-randomised Trial in Zambia.
View Poster
Economic cost analysis of community-based distribution of HIV self-test kits in Malawi, Zambia & Zimbabwe (Presentation)
Economic cost analysis of community-based distribution of HIV self-test kits in Malawi, Zambia & Zimbabwe
View Poster
A clinical utility risk – benefit analysis for HIV self-testing (Abstract)
A clinical utility risk – benefit analysis for HIV self-testing
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A user costs analysis for HIV testing among rural communities in Malawi. (Abstract)
A user costs analysis for HIV testing among rural communities in Malawi.
View Poster
Closing the HIV testing gap: Facility-based integration of HIV self-testing, a way to improve testing coverage, yield and efficiency of client-initiated HIV testing services in Zimbabwe
View Poster
Determination of OraQuick® HIV self-test result stability with delayed visual re-reading: An external quality assurance analysis
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Does Community – Based Distribution of HIV Self – Test Kits Increase Uptake of HIV testing at Population Level? Results of a Cluster – Randomised Trial in Zambia
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Economic evaluation of non-financial incentives to increase couples HIV testing and counselling uptake in Zimbabwe
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HIV self-testing in Zambia: User ability to follow the manufacturer’s instructions for use.
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HIV self-testing in Zambia: User ability to follow the manufacturer’s instructions for use.
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HIV testing services (HTS) costs in public sector settings in Southern Africa: evidence from Malawi, Zambia and Zimbabwe (Abstract)
HIV testing services (HTS) costs in public sector settings in Southern Africa: evidence from Malawi, Zambia and Zimbabwe (Poster)
Informing targeted HIV self-testing service delivery in Malawi and Zambia – A multi-country discrete choice experiment
Read Abstract
Informing targeted HIV self-testing service delivery in Malawi and Zambia – A multi-country discrete choice experiment (Poster)
Is OraQuick® HIV – self – testing valid among intended users? Analysis from a clinical performance study in Lusaka, Zambia.
View Poster
Masculinity and uptake of HIV services: validity of the Conformity to Masculine Norms Inventory-22 in Malawi and Zambia
View Poster
Peer-led delivery model for HIV self-testing in female sex workers: Designing the model based on research and participatory strategies in urban Blantyre, Malawi (submitted)
Read Abstract
Preferences for Models of HIV Self-Test Kit Distribution: Results from a Qualitative Study and Choice Experiment in a Rural Zimbabwean Community
View Poster
Prevalence of testing and preference for self -testing in Malawi and Zambia: Baseline data from the STAR (HIV self-testing in Africa) project (Abstract)
Prevalence of testing and preference for self -testing in Malawi and Zambia: Baseline data from the STAR (HIV self-testing in Africa) project
View Poster
The role of Community Based Organizations (CBOs) in implementing HIVST interventions; a case of social harms monitoring in four southern districts in Malawi
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Values and preferences of PLHIV and key populations in HIV selftesting and partner notification in the Middle East and North Africa (Abstract)
Values and preferences of PLHIV and key populations in HIV selftesting and partner notification in the Middle East and North Africa
View Poster
Views on HIV self-test kit distribution strategies targeting female sex workers: Qualitative findings from Zimbabwe
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Views on HIV self-test kit distribution strategies targeting female sex workers: Qualitative findings from Zimbabwe (Poster)
Values and preferences of adolescent girls and young women in Kenya for three HIV prevention approaches: PrEP, HIV self-testing and HIV partner notification
View Poster
A review of values and preferences for blood-based versus oral fluid HIV self-tests
View Poster
Community-based distribution of HIV self-test kits: results from a pilot of door-to-door distribution of HIV self-test kits in one rural Zimbabwean community
Read Abstract
Discrete Choice Experiments in Malawi, Zambia and Zimbabwe to guide HIVST implementation, distribution and linkage options – Satellite session on HIV Self Testing. Oral presentation. (Presentation)
Door-to-door distribution of HIV self-test kits: a qualitative study among community-based test kit distributors in Zimbabwe
View Poster
Cost-Effectiveness of Different Delivery Approaches for HIV Self-Testing.
Read Abstract
Cost-Effectiveness of Different Delivery Approaches for HIV Self-Testing. (Poster)
Increasing knowledge of HIV status and demand for ART using community-based HIV self-testing: A cluster randomised trial in rural Malawi
Read Abstract
Increasing knowledge of HIV status and demand for ART using community-based HIV self-testing: A cluster randomised trial in rural Malawi (Presentation)
Informing HIV self-testing services in Malawi using discrete choice experiments.
Read Abstract
Informing HIV self-testing services in Malawi using discrete choice experiments. (Presentation)
Providing user support for HIV self-testing beyond instructions-for-use in Malawi. (Presentation)
Providing user support for HIV self-testing beyond instructions-for-use in Malawi.
View Poster
HIV self-testing services in Malawi using discrete choice experiments
How quickly does external quality assurance to prevent early infant misdiagnosis of HIV save costs in 4 African countries
Read Abstract
Progress towards the first 90: Innovative approaches, including self-testing (invited oral presentation)
View Presentation
The costs of community-based HIV self-test (HIV-ST) kit distribution: Results from three (3) district sites in Zimbabwe
Read Abstract
The costs of community-based HIV self-test (HIV-ST) kit distribution: Results from three (3) district sites in Zimbabwe (Presentation)
User Costs for HIV Testing in Rural Malawi
View Poster
Informing targeted HIV self-testing service delivery in Malawi and Zambia – A multi-country discrete choice experiment (oral presentation)
View Presentation
Informing targeted HIV self-testing service delivery in Malawi and Zambia – A multi-country discrete choice experiment (Poster)
“Not without us…”: views on the introduction of HIV self-testing among health care workers providing integrated HIV and sexual and reproductive health services.
Read Abstract
Acceptability of woman-delivered HIV self-testing to the male partner: a qualitative study of antenatal clinic-linked participants in Blantyre, Malawi.
Read Abstract
Acceptability, feasibility, and preference for HIV self-testing in Zimbabwe.
Read Abstract
Acceptability, feasibility, and preference for HIV self-testing in Zimbabwe. (Poster)
Can ‘late-read’ of self-test devices be used as a quality assurance measure? Results of a pilot HIV self-test project in Zimbabwe.
Read Abstract
Community-based distribution of HIV self-test kits: results from a pilot of door-to-door distribution of HIV self-test kits in one rural Zimbabwean community.
Read Abstract
Community-based distribution of HIV self-test kits: results from a pilot of door-to-door distribution of HIV self-test kits in one rural Zimbabwean community. (Poster)
Systematic Review on HIV Self-Testing (HIVST) Performance And Accuracy Of Results
Read Abstract
Systematic Review on HIV Self-Testing (HIVST) Performance And Accuracy Of Results (Poster)
The influence of masculinity on HIVST community intervention: a qualitative evaluation of empirical evidence from Blantyre, Malawi.
Read Abstract
The influence of masculinity on HIVST community intervention: a qualitative evaluation of empirical evidence from Blantyre, Malawi. (Poster)
Understanding coercion in the context of semi-supervised HIV self-testing in urban Blantyre, Malawi.
Read Abstract
A baseline assessment of the policy and regulatory environment for HIV self-testing in Malawi, Zimbabwe and Zambia
Read Abstract
A baseline assessment of the policy and regulatory environment for HIV self-testing in Malawi, Zimbabwe and Zambia (Poster)
Introducing HIV self-testing to rural communities in Malawi: cognitive interviewing may alert implementers to the need for additional support beyond that provided by manufacturer’s instructions-for-use (IFU).
Read Abstract
Improving gender equity in HIV testing and care through gender-responsive HIV self-testing.
Read Abstract
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Governments in LMICs that have opted for a pathway toward UHC involving health insurance are implementing various measures to increase health insurance coverage. However, these efforts do not automatically translate into high uptake of health insurance or, among those enrolled, into increased utilization of services, as several barriers may still prevent individuals from enrolling or from utilizing the available services provided under insurance schemes. How can governments navigate the complexities of health insurance to accelerate uptake in LMICs?
Technical Brief
PSI’s Health Systems Accelerator is built on 50+ years of experience collecting and elevating consumer and health system insights, scaling innovations and partnering with government and private sector actors to shape stronger, more integrated health systems that work for consumers. Learn more here.
In the absence of a trusted and dedicated Primary Healthcare (PHC) provider, individuals often spend valuable time and resources navigating through a multitude of health facilities, visiting various providers in search of the right place to address their health concerns. Challenges navigating the health system can result in delays in assessment, diagnosis, and treatment, potentially leading to poor quality of care and adverse health outcomes. One promising solution is the digital locator, which can enable healthcare consumers to promptly find high quality, affordable health products and services when they need them. What are current applications of digital locator tools? How can they be improved? What are the challenges faced in utilizing these tools?
Overview
Technical Brief
In the ever-evolving health landscape, a robust health management information system (HMIS) stands as a cornerstone of a strong health system. It not only guides decision-making and resource allocation but also shapes the well-being of individuals and communities. However, despite technological advancements that have revolutionized data collection, analytics, and visualization, health systems in low- and middle-income countries (LMICs) continue to grapple with a fundamental challenge: fragmented data and limited effective data use for decision-making. What are some promising solutions?
Technical Brief
Technical Brief
In this video, Wycliffe Waweru, Head of Digital Health & Monitoring at Population Services International outlines three barriers to the use of data for decision-making in health in low- and middle-income countries. For each barrier, Wycliffe proposes some concrete solutions that can help overcome it.
In this video, Dominic Montagu, Professor Emeritus at the University of California, San Francisco, and CEO of Metrics for Management outlines the three levels of data from private healthcare providers in low- and middle-income countries that need to be sequentially integrated into a country’s health information system to assure that governments can manage the overall health system more effectively.
Join us in this illuminating session as we explore the evolution of the STAR self-testing project, sharing insights, challenges, and successes that have emerged over the years. By examining the lessons learned and considering the implications for future healthcare strategies, we hope to foster a deeper understanding of the transformative potential of self-testing in improving healthcare accessibility and patient-centric services.
This enlightening session promises to provide updates from WHO guidelines and share insights on the journey toward viral hepatitis elimination. It will also showcase outcomes from the STAR hepatitis C self-testing research and discuss how these findings could potentially inform hepatitis B antigen self-testing and the use of multiplex test kits in the context of triple elimination. Join us in this crucial discussion as we work together to fast-track the global journey toward a hepatitis-free world by 2030.
In this two-part session, the Bill & Melinda Gates Foundation, PSI, and Population Solutions for Health will share lessons and best practices from rigorous research and hands-on implementation experience in Zimbabwe. The session will cover important topics like client-centered, community-led demand creation, differentiated service delivery, sustainable financing, and digital solutions. The sessions will also cover lessons in the program.
In this session, PSI and PSH will share lessons for optimizing access to comprehensive, culturally sensitive HIV and sexual and reproductive health services. Topics will include enhancing the accuracy and reliability of sex worker population data, improving HIV case finding among men who have sex with men (MSM) through reverse index case testing, and scaling differentiated service delivery models. The session will also cover integrating mental health and substance abuse in key populations (KP) programming and lessons in public sector strengthening.
Additionally, the session will showcase solutions that MSMs have co-designed, highlighting how this collaboration has improved the consumer care experience. It will demonstrate the critical role of KP communities in establishing strong and sustainable HIV responses, including amplifying KP voices, strengthening community-led demand, and establishing safe spaces at national and subnational levels for KP communities to shape and lead the HIV response.
This enlightening session promises to provide updates from WHO guidelines and share insights on the journey toward viral hepatitis elimination. It will also showcase outcomes from the STAR hepatitis C self-testing research and discuss how these findings could potentially inform hepatitis B antigen self-testing and the use of multiplex test kits in the context of triple elimination. Join us in this crucial discussion as we work together to fast-track the global journey toward a hepatitis-free world by 2030.
In this two-part session, the Bill & Melinda Gates Foundation, PSI, and PSH will share lessons and best practices from rigorous research and hands-on implementation experience in Zimbabwe. The session will cover important topics like client-centered, community-led demand creation, differentiated service delivery, sustainable financing, and digital solutions. The sessions will also cover lessons in program management. These insights are applicable beyond Zimbabwe and can be used to scale up HIV prevention efforts in the region.
Strong surveillance systems are essential to detect and respond to infectious disease outbreaks. Since 2019, PSI has worked alongside the Ministries of Health in Cambodia, Laos, Myanmar, and Vietnam to strengthen disease surveillance systems and response. Learn more here.
As COVID-19 spread globally, so did misinformation about countering the pandemic. In response, PSI partnered with Meta to inspire 160 million people to choose COVID-19 preventative behaviors and promote vaccine uptake. Watch the video to learn how.
Early warning of possible outbreaks, and swift containment actions, are key to preventing epidemics: disease surveillance, investigation and response need to be embedded within the communities. Public Health Emergency Operations Centers (PHEOCs) are designed to monitor public health events, define policies, standards and operating procedures, and build capacity for disease surveillance and response. Learn more here.
Private sector pharmacies and drug shops play an important role in improving access to essential health services and products for millions of people living in low- and middle-income countries (LMICs), where healthcare resources are often limited. However, the way in which these outlets are, or are not, integrated into health systems holds significant importance. Do they serve as facilitators of affordable, high-quality care? Or have they become sources of substandard health services and products?
For over 50 years, PSI’s social businesses have worked globally to generate demand, design health solutions with our consumers, and work with local partners to bring quality and affordable healthcare products and services to the market. Now consolidating under VIYA, PSI’s first sexual health and wellness brand and social business, our portfolio represents the evolution from traditionally donor–funded projects towards a stronger focus on sustainability for health impact over the long term. Across 26 countries, the VIYA model takes a locally rooted, globally connected approach. We have local staff, partners and providers with a deep understanding of the markets we work in. In 2022, we partnered with over 47,000 pharmacies and 10,000 providers to reach 11 million consumers with products and services, delivering 137 million products. VIYA delivers lasting health impact across the reproductive health continuum, from menstruation to menopause. Consumer insights drive our work from start to finish. Their voices, from product exploration to design, launch, and sales, ensure that products not only meet consumers’ needs but exceed their expectations. The consumer is our CEO.
In 2019, our human-centered design work in East Africa explored ways that our work could support and accompany young women as they navigate the various choices required for a healthy, enjoyable sexual and reproductive life. Harnessing insights from consumers, VIYA is revolutionizing women’s health by addressing the confusion, stigma, and unreliability surrounding sexual wellness. Across five markets – Guatemala, Kenya, South Africa, Uganda and Pakistan – VIYA utilizes technology to provide women with convenient, discreet, and enjoyable tools for making informed choices about their bodies. The platform offers a wealth of high-quality sexual wellness information, covering topics from periods to pleasure in an accessible and relatable manner. Additionally, VIYA fosters a supportive community where users can share experiences and receive guidance from counselors. In 2023, VIYA will begin offering a diverse range of sexual wellness products and connect users with trusted healthcare providers, ensuring comprehensive care tailored to individual needs.
By: Fana Abay, Marketing and Communications Director, PSI Ethiopia
In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.
In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.
Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.
By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.
By: Christopher Lourenço, Deputy Director, Malaria, PSI Global
Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.
For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.
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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With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.
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