Evaluation of a mobile application to support HIV self-testing in Johannesburg, South Africa

Abstract

Background: Human immunodeficiency virus self-testing (HIVST) reduces barriers associated with facility-based testing; however, no formal mechanism exists for users to self-report results or link to care. The Aspect^TM HIVST mobile application (app) was developed for use in South Africa.

Objectives: This study evaluated the acceptability and feasibility of the Aspect^TM HIVST app for individuals from the inner city of Johannesburg.

Method: This cross-sectional pilot, with a convenience sample of 300 adults, was conducted in July 2018. Participants were provided an OraQuick HIVST kit and a smartphone preloaded with the app, then asked to follow the in-app instructions for use (IFU) to complete the HIVST and upload results. Trained healthcare workers (HCWs) observed and recorded any deviations from the IFU, and conducted a post-test survey to assess acceptability. Feasibility was evaluated by the number of participants who agreed to participate, completed the self-test, and uploaded all information onto the app correctly.

Results: Most participants (98.7%) found the app easy to use. To reduce difficulties related to the IFU (26; 8.7%), participants suggested multimedia supplements (4; 1.3%), additional languages (4; 1.3%) and simplified instructions (5; 1.7%). All individuals approached, agreed to participate, 267 (89.0%) correctly completed all steps and 210 (78.7%) successfully captured all information on the app. Most errors (26; 8.7%) were testing errors and 1 (0.3%) was from the app sequence. Twelve (4.5%) errors were with test strip imaging and 72 (27.0%) discordances were with demographic information.

Conclusion: Despite some challenges with IFU interpretation and data capture via the app, this pilot showed that the Aspect^TM HIVST app is an acceptable way to upload mobile HIVST results and demographic information to a central database.