Eswatini has one of the highest burdens of HIV in the world. Doctors Without Borders (MSF) teams introduced HIV self-testing in 2016. This was done with the aim of empowering patients, as they can conduct HIV testing at their own place and at their convenience. The self-testing kit is a tool which enables the patient to screen for HIV and then go to a health facility to confirm their HIV status. This is empowering to the patient as they are in full control of their testing experience.
On inception of the HIV self-testing initiative, both urban and rural populations were targeted with education, along with the HIV self-testing kits. Patients were given a choice of conducting a test without assistance or with on-site counselling assistance.
This was done with the integration of educational awareness sessions which aimed to encourage better health-seeking behaviour, by explaining the effectiveness of the self-testing kits. For those who opted to test at home without assistance, follow-up appointments were made to ascertain the results and provide referrals for treatment and care as needed.
Patients who had tested HIV-negative were referred to more preventative measures such as, access to condoms, and HIV pre-exposure prophylaxis (PreP), whereas patients who screened HIV-positive were referred to the nearest hospital for the confirmatory HIV test and antiretroviral therapy (ART) initiation.
The feedback received from the community revealed that some patients preferred self-referrals, meaning they would refer themselves to their preferred health facility when they require further treatment and care. However, this compromised the quality of the post-test counselling to the patients and the time taken before the patient was able to access the relevant services.
Digitalising a self-test tool
Realising the need to reduce contact with health workers during HIV testing, but still provide an exceptional HIV self-testing patient experience, in October 2022 MSF adapted the “Pocket Clinic”, a digitally supported approach to HIV testing. This innovative tool positions around the needs of patients as it offers both pre- and post-testing counselling digitally, using a tablet. The patients are guided throughout the HIV self-testing journey while they watch self-explanatory videos orienting them on
- what HIV is
- why testing for HIV matters
- what is next when one tests HIV-negative or positive
As part of its first phase, The Pocket Clinic is currently offered on-site and can be equally effective online and offline.
“Before Pocket Clinic, we were not really able to assist patients after taking a HIV self-test kit, the Pocket Clinic allows us to effectively refer and offer the necessary support after testing. Also, a patient would have to wait for us to finish assisting other patients, however with Pocket Clinic, I am able to assist more that one patient at a time. All I have to do is register then monitor a patient, otherwise they are able to do everything independently,” says Ivy Nxumalo, MSF counsellor in Shiselweni, Eswatini
With proximity to patients being one of the values MSF upholds, the Pocket Clinic is available in both urban and rural settings. To provide an ideal support for patients in rural communities, the Pocket Clinic is mobile, can be accessed by patients in various hotspots on different days. Should the need arise, communities are still free to reach out to MSF teams requesting services during community campaigns.
The Pocket Clinic currently benefits around nine patients a day and about 135 patients have used it in the first month.
“What I like most about the Pocket Clinic is that I get to do things with privacy without the feeling of rushing through. Also, should I misunderstand any information, I feel free to rewind the video, whereas when I am at a hospital, I am always mindful of not wasting the nurse’s time, whilst asking clarity with certain information. Yes, a lot has been said about HIV testing, but the Pocket Clinic concept brings ahead the benefits of getting more correct information as I am more of a visual learner, therefore I prefer visual orientation over listening to a health worker. I am happy about the service,” says Khosi, a patient who has accessed the Pocket Clinic.
The Pocket Clinic adds to some of the few already employed digital initiatives in MSF’s Eswatini projects, ensuring ease and improved patient service provision.