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On 14 February 2023, Frontiers in Reproductive Health published a perspective paper on the evolution of HIV self-testing (HIVST), which was a collaborative thought piece produced by members of Aviro Health, Ezintsha, The Aurum Institute and Utrecht University. The perspective chronicles the history of HIVST and describes how digital interventions are being used to improve self-testing programmes.

For over 5 years, Aviro Health has been improving health outcomes by developing digital platforms that complement HIVST in sub-Saharan Africa, but self-testing has a much longer, complex history. The idea of HIVST was first proposed in 1986 as a way for individuals to quickly learn their HIV status, independent of a healthcare facility. HIVST removes barriers and increases access to testing for key populations, but it took a quarter of a century to get the first HIVST kit approved by the FDA. Since then, the floodgates have opened, and dozens of studies have revealed the benefits of HIVST programmes. This growing body of evidence led to the World Health Organization formally recommending HIVST in 2016, and now almost 100 countries have incorporated HIVST into their national testing strategy.

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Despite the popularity, HIVST presents three main challenges, and digital interventions for HIVST have been introduced to address them:

1. Inconsistent pre-and post-test counselling

2. The inability to report results for epidemiological data

3. The inability to link users to care (ARVs for newly identified people living with HIV and PrEP for people that test negative)

The first digital intervention for HIVST was introduced in 2014 and showed that digital interventions could be used to distribute HIVST kits, report results and link users to care. Since then, dozens of studies have been conducted, which have validated and expanded on these early findings. Many of these studies were pilot projects with small sample sizes and lacked the standardization of indicators required to aggregate data across platforms to prove impact at scale. Although this is a great start, if digital interventions for HIVST are to be championed for scale-up, they must continue to show measurable impact at larger scales, while still maintaining and standardizing data security and integrity. Aviro Health is committed to showing measurable impact at scale, and last year, the Aviro Pocket Clinic was used by over 15,000 people, including almost 14,000 users that accessed NDOH-approved counselling videos and reported results, which led to over 1,000 people living with HIV starting life-saving ARVs.

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