Médecins Sans Frontières has launched the “Pocket Clinic” project in Swaziland which allows patients who carry out the self-test to be guided and monitored remotely.
The long duel against HIV is also fought with the help of technology. In Eswatini (as Swaziland was renamed in 2018) in the Shiselweni region, since 2007 the international non-governmental organization Doctors Without Borders (MSF) guarantees healthcare for hiv and tuberculosis
reaching communities in the most remote areas, where people do not have access to public transport and must travel at least two hours to access basic health care. Since 2016, MSF has implemented a Hiv self-test system but the real technological innovation arrived last October with the Pocket Clinic: through a tablet it is possible to follow the patient in the pre and post HIV test phase, explaining through some video tutorials what the disease is, why it is important to get tested and what to do based on the result. The whole ensuring greater privacy than stigma against this disease and easier to carry out the test at home.
Information campaigns
Swaziland has one of the highest HIV rates in the world. Médecins Sans Frontières (MSF) teams introduced the HIV self-test in 2016 to empower patients to carry it out home and at their convenience. The self-test kit is a tool that allows the patient to screen and then go to a healthcare facilityari
a to possibly confirm HIV positivity. Before starting, an information campaign was conducted among both urban and rural populations. Patients were given the option of testing without assistance or in the presence of an expert on site. They were also conducted educational outreach sessions aimed at encouraging more health-conscious behaviors, explaining the effectiveness of self-test kits.
For those who have chosen to test at home without assistance, follow-up appointments were made to ascertain the results and provide referrals for treatment and care as needed. For patient results Hiv-negative more preventive measures such as access to condoms and HIV pre-exposure prophylaxis (PreP) were indicated, while those positive they were referred to the nearest hospital for initiation of confirmatory HIV testing and antiretroviral therapy (ART).
Digitization of a self-test tool
Realizing that it was necessary reduce contact with healthcare professionals during the test, in October 2022 MSF adapted the «Pocket Clinic», a digitally supported approach to HIV testing. This innovative tool is better suited to the needs of patients, because offers both pre- and post-test counseling using a tablet. Patients are guided through the self-test process as they watch self-explanatory videos which guide them on: what is HIV; why testing is important; what happens once negative or positive results. In this first phase, Pocket Clinic is currently being offered onsite and can be equally effective online and offline.
“Before Pocket Clinic, we weren’t really able to care for patients after they self-tested, the Pocket Clinic allows us to make an effective consultation and offer the necessary support after the test. Also, a patient would have to wait for us to finish assisting others whereas with Pocket Clinic I am able to assist more than one patient at a time. All I have to do is register and monitor a patient, otherwise they are able to do everything independently,” he says Ivy NxumaloMsf consultant in Shiselweni.
The first results
So long as proximity to patients is one of the values supported by MSF, the Pocket Clinic is available in both urban and rural settings. To provide ideal support to patients in rural communities, the Pocket Clinic is available for mobiles and patients can access it from various hotspots and on different days. In case of need, communities are still free to contact MSF teams requesting services during community campaigns. How many patients have used it? “To date, 187 users have had access, of these 166 (88.8%) have completed the process that led to the identification of 4 (2.4%) HIV positive cases, 2 out of 4 (50%) received the confirmatory HIV test and both were started (100%) on antiretroviral therapy» he explains Bernhard Kerschbergermedical lead of the project in Swaziland.
What do patients think
MSF has also started a patient follow-up activity to verify the effectiveness of the intervention. The results? “Inside Pocket Clinic,” he replies Kerschberger — there is a platform where those who are using it are asked to express their liking and the responses vary from very good to satisfactory, due to informational content such as videos. However, some have pointed out that it takes a lot of time to use it”. Khosi, one of the patients who had access to the Pocket Clinic, is enthusiastic: «What I like most about the Pocket Clinic is that t
use my privacy and I don’t feel like I have to rush everything. Furthermore, should I misunderstand any information, feel free to restart the video, while in the hospital I am always careful not to waste the nurse’s time when I ask for clarity on certain information. Yes, a lot has already been said about Hiv testing, but the Pocket Clinic concept offers the edge you get more correct information because I am someone who learns more by watching and therefore I prefer a “visual” approach to listening to a healthcare professional».
The difficulties encountered
The project goes ahead, without hiding the difficulties: which ones? «Reading the test results is a challenge at the moment, because duplications are often easily created. This forced to carry out many data cleansing operations to ensure the accuracy of those generated. However, MSF had a meeting with the team at the company that built Pocket Clinic and asked them to simplify the system for healthcare professionalsso as to facilitate reading without duplication,” concludes Kerschberger
November 30, 2022 (change November 30, 2022 | 19:23)
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