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Edited by
Joao Breda
World Health Organization Office on Quality of Care and Patient Safety (Greece),
World Health Organization (Greece), Greece
Reviewed by
SHAHZAD ALI KHAN
Health Services Academy, Pakistan
Válter R Fonseca
World Health Organization (Denmark), Denmark
Table of contents

 * Abstract
 * 1. Introduction
 * 2. Technology and HIV services
 * 3. Methodology and approach
 * 4. Findings and key observations
 * 5. Discussion and conclusion
 * Author contributions
 * Funding
 * Acknowledgments
 * Conflict of interest
 * Footnotes
 * Publisher's note
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REVIEW ARTICLE

Front. Health Serv., 30 October 2023
Sec. Implementation Science
Volume 3 - 2023 | https://doi.org/10.3389/frhs.2023.1198008
This article is part of the Research Topic Innovations in Quality of Care View
all 7 articles


SCALING UP DELIVERY OF HIV SERVICES IN AFRICA THROUGH HARNESSING TRENDS ACROSS
GLOBAL EMERGING INNOVATIONS

Moredreck Chibi1*William Wasswa2Chipo Nancy Ngongoni1Frank Lule2
 * 1Science and Innovation, Assistant Regional Director, World Health
   Organization Africa Region, Brazzaville, Congo
 * 2HIV, Tuberculosis and Hepatitis, Universal Health Coverage/Communicable and
   Non Communicable Disease Cluster, World Health Organization Africa Region,
   Brazzaville, Congo

Globally, innovations for HIV response present exciting opportunities to enhance
the impact and cost-effectiveness of any HIV program. However, countries
especially in the African region are not on equal footing to effectively harness
some of the existing innovations to accelerate impact on HIV services delivery.
This paper aims to add to the discourse on innovative solutions to support
countries to make informed decisions related to technologies that can be adapted
in different contexts to strengthen HIV programs. A scoping review which
involved a search of innovations that can be used in response to the HIV
epidemic was carried out between June 2021 and December 2022. The results showed
that a high level of technological advancement occurred in the area of digital
technologies and devices. Out of the 202 innovations, 90% were digital
technologies, of which 34% were data collection and analytics, 45% were mobile
based applications, and 12% were social media interventions. Only 10% fell into
the category of devices, of which 67% were rapid diagnostic tools (RDTs) and 19%
were drone-based technologies among other innovative tools. The study noted that
most of the innovations that scaled relied on a strong ICT infrastructure
backbone. The scoping review presents an opportunity to assess trends, offer
evidence, and outline gaps to drive the adoption and adaptation of such
technologies in Africa.




1. INTRODUCTION

The burden of HIV continues to be a protracted developmental challenge for the
African continent, with East and Southern Africa being the regions worst
affected (1). The COVID-19 pandemic has been reported to have worsened the
situation by instigating disruptions to HIV services (2). According to the
report by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the pandemic
was something to be wary of, as a 6-month complete disruption in HIV treatment
could have caused more than 500,000 additional deaths in sub-Saharan Africa
between 2020 and 2021 (3). This would return the region to 2008 AIDS mortality
levels (4). It is important to find innovative ways for interventions that
circumvent the effect of disruptions like pandemics to improve or facilitate
linkage to antiretroviral therapy (ART) care and retention of the practices and
processes that are in place in low- and middle-income settings (5). Moreover,
despite the increasing global coverage of HIV testing, treatment services, and
enabling technologies, key populations such as drug users and sex workers are
still underserved (6).

Given that there is a huge asymmetry to the information regarding access to
technological innovations for HIV services among African countries, a proactive
approach is desired to collate innovations deployed in other parts of the world
and share with countries in the African region. This helps to facilitate
informed decisions about the possibility of adopting and adapting such
innovations in the region. This is a multistage process that aligns with
scanning the technological landscape then assessing the various resources needed
for successful and sustainable integrations and implementations. This paper
addresses the first stage of understanding the various options available by
collating innovations that support efficient HIV service delivery across the
continuum of prevention, diagnostics, treatment and management, access to HIV
services, behavioral change, and strategic information. The key question guiding
the review is What technologies are currently being used in the delivery of HIV
services and what are the key factors for creating an enabling environment for
the adoption of these technologies in the African context? The article proposes
that assessing such technologies helps facilitators and HIV program coordinators
be proactive in resource mobilization and creating enabling environments for
successful integration of these innovations. Moreover, this helps in adjusting
to the new normal of blended services along all aspects of service provision in
the healthcare sector.

To ensure alignment, this paper will be based on the following definitions.
Innovation is noted as new (re)combinations of ideas as outlined by Schumpeter
(7). This innovation can encompass product, process, or systemic innovations
introduced into the health systems in an incremental, radical, or disruptive
manner (8, 9). In particular, innovation in healthcare has been defined as a
novel idea or set of behaviors, routines, and/or ways of working that involve a
change in practice within a healthcare setting (10). As Peter Drucker
highlighted, this innovation can be intrinsic or extrinsic to the system or
organization (11). Technology is defined as a practical application of
scientific knowledge and discoveries for the purpose of creating tools, systems,
and methods that simplify health system workflows1. This can be systemic in how
messages are conveyed or in the form of a tangible device.

The remainder of this article is structured as follows: Section 2 presents the
summarized outline of other research related to technological usage in the
delivery of HIV services. Section 3 describes the methods utilized in this study
and the results are presented in Section 4. Section 5 presents the policy and
technological implications of the various findings from the study.


2. TECHNOLOGY AND HIV SERVICES

Technology usage in HIV services is one key aspect that has gained momentum over
the past 10 years with the intent of scaling HIV prevention efforts (12). The
World Health Organization (WHO) developed guidelines on leveraging technologies,
innovation, and digital solutions for HIV prevention, diagnosis, treatment, and
care for key populations (13). This is especially around consideration of the
underlying socio-cultural, economic, political, legal, and various other
contextual factors. Muessig et al. (14) looked at how technologies could be
applied at various stages of HIV care across primary and secondary prevention
activities in the period of 2013–2014. The tools that the authors covered
included social networking sites, provision of real-time assessment and
feedback, gamification, and virtual reality. These are all key aspects which can
be utilized especially in this era of COVID-19. They identified that gaps remain
around linkage to care, retention in care, and initiation of antiretroviral
therapy, and this was pre-COVID. Notably, they only focused on completed and
planned interventions conducted within the United States (14).

Another study by Navarra et al. (15) looked at the US trends for
technology-enabled adherence interventions among HIV-infected youth between the
ages 13 and 29 years. The aim of this study was to look at the feasibility of
computer-based interventions and the efficacy of SMS texting for adherence
support among HIV-infected adolescents and young adults. Cao et al. (16) did a
scoping review of 23 studies between March 2018 and August 2019 where the
studies looked at how digital technologies can be utilized to enhance prevention
messaging, develop testing services, increase pre-exposure prophylaxis (PrEP)
uptake, refine big data algorithms for surveillance, optimize clinical
intervention, and assist mental health services. They highlighted the need to
consider strategic implementations that leverage digital platforms for
network-based interventions and evaluate their roles on a community level. More
importantly, they gave a solid categorization of the types of digital HIV
interventions shown in Figure 1. The aspects in that paper around issues such as
prevention, mental health, and big data can help outline the monitoring and
evaluation aspects that direct the norms of individual digital intervention
platforms for HIV services.


FIGURE 1

Figure 1. Type of digital STI/HIV interventions. Source: Cao et al. (16).




On the other hand, Horvath et al. (17) highlighted how technology-assisted HIV
testing interventions are strategically important to reach national and global
targets for HIV status awareness. They put forward those questions that are
still being asked around ascertaining which interventions work for various
target populations, how technology like social media platforms can be leveraged
to promote HIV testing services, and best practices for scaling up mobile heath
(mHealth) and other technology-based interventions (17). Interestingly, another
study by Veronese et al. (18) showed that over 50% of HIV testing uptake
occurred due to exposure to digital communication interventions. The review
compared the impact of generic and less interactive online messaging to various
tailor-made interventions using online social networking and online engagement
tools such as videos and digital messages (18). Notably, tracking and
synthesizing technology tools such as mHealth innovations in HIV is a bit
difficult due to the broad range of tools and initiatives and speed of
innovation (19). This comes from a rapidly changing pipeline of technology-based
care and prevention methods and to assess whether the interventions are
appropriately diversified (20).

There are important technology and regulatory gaps in low- and middle-income
countries with a need for further development of post market surveillance
systems for HIV-related services (21). An additional call has been made for
researchers to invest in more efficient and expedited intervention development
so that current and future needs are addressed (20). The works described above
all looked at the important facets of impact of technology on HIV services;
however, there still seems to be a void in understanding and visibility of what
types of technologies are being utilized for HIV services. This paper aims to
raise awareness of the trends and hence be part of foundational discussions on
the various technologies that are available for HIV services that can benefit
other contextual settings especially in Africa.


3. METHODOLOGY AND APPROACH


3.1. DATA SOURCES, SEARCH STRATEGY, AND STUDY SELECTION

This study adopted a systematized search strategy to identify innovations across
five scientific databases (PubMed, Google Scholar, Scopus, IEEE, and Science
Direct) using different keywords pertaining to different HIV response areas,
i.e., HIV prevention, diagnosis, treatment and management, strategic
information, access to services, and behavioral change were combined with the
words “innovations or technology” in the search query. Duplicates, drugs,
vaccines, and social programs were excluded. A total of 180 papers were
identified; however, after screening, only 38 papers were included.

Additionally, innovations were found across gray sources such as the Google Play
Store, iOS App Store, and websites. The search for mobile apps was conducted
using the same set of keywords pertaining to the HIV response area. The
applications had to have a description and have 1,000 + downloads to be included
in the analysis and a total of 418 apps were identified and 25 were included in
the analysis. Apps not in English were excluded. From websites, the web content
mining encompassed technologies published on different cooperate organizational
websites, social media channels like Twitter, and legitimate news websites,
which resulted in the identification of 139 innovations. Innovations that did
not have functional and tested prototypes and were not related to HIV were
excluded.

Overall, a total of 202 HIV innovations (38 from scientific databases, 25 from
the Google Play and iOS App stores, and 139 from web-content mining) were
considered for detailed analysis. The process is shown in Figure 2.


FIGURE 2

Figure 2. The HIV services innovations search strategy.





3.2. DATA ANALYSIS

The identified innovations were profiled using the name of the innovation,
company or organization, country of origin, description of the innovation, the
category assigned to the innovation, and the URL link to indicate the source.
The innovations were categorized according to intervention areas, which included
prevention, treatment, services access, diagnostics, behavioral change, and
strategic information, and classified as a digital technology (i.e., digital
platform-based interventions, mobile web/mobile apps, or Web 2.0/social media)
or as a device [i.e., drones, rapid diagnostic tools (RDTs), adherence
monitoring devices, etc.], as shown in Figure 3.


FIGURE 3

Figure 3. The HIV services technological innovations categories.





4. FINDINGS AND KEY OBSERVATIONS

The study revealed that a myriad of innovations has been developed across the
world to contribute to equitable access to HIV services, with the majority of
them emerging from countries like the United States of America, Switzerland, and
China. Out of the 202 HIV services innovations, 90% were digital technologies
whilst 10% were devices. Under the digital technologies, the split was 34% being
web-based innovations, 45% mobile based applications, and 11% Web 2.0/social
media interventions. On the other hand, in the devices category, 67% were RDTs,
19% drone-based technologies, and 14% were other tools developed specifically
for HIV services. The following sections will highlight some of the key selected
digital initiatives and devices that have been rolled out in various settings to
accelerate scaling up access and utilization of HIV services and products. These
innovations include therapeutic products like microbicides (22), post-exposure
prophylaxis (23), and pre-exposure prophylaxis (24).


4.1. DIGITAL PLATFORM-BASED INTERVENTIONS USED IN HIV SERVICES

The analysis showed that web-based technologies around the creation of digital
platforms are increasingly being used in HIV service delivery across the
continuum of prevention, diagnostics, treatment, access to HIV services,
behavioral change, and strategic information. For example, the Open Medical
Record System (OpenMRS)2 has been widely used as an electronic medical record
storage and retrieval system for managing millions of HIV/AIDS and tuberculosis
(TB) patients in the developing world. OpenMRS has been used and evaluated in
different countries like Rwanda, Haiti, Lesotho, Mozambique, Pakistan,
Philippines, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe (25). Allen et
al. (26) reported the experience in implementing the OpenMRS medical record
system to support HIV treatment in Rwanda. They found out that OpenMRS addresses
the problem of configuring electronic management records (EMR) systems to suit
new sites, languages, and diseases (26). Other medical record systems have been
developed inspired by the OpenMRS architecture. Tweya et al. (27) in Malawi
developed a point-of-care electronic medical record system for TB/HIV
co-infected patients and evaluated it in a public clinic in Malawi that serves
HIV- and TB-infected patients. Their experience suggests that an electronic
medical records system can improve patient management, enhance integration of
TB/HIV services, and improve provider decision-making (27). Haskew et al. (28)
implemented a cloud-based electronic medical record to reduce gaps in the HIV
treatment continuum in rural Kenya. Implementation of the EMR system
significantly improved data quality and provision of clinical care, helping to
ensure patients who are eligible for HIV treatment receive it early (28).

The Therapeutic Education System (TES)3 developed in the USA is an interactive,
web-based program theoretically grounded in the evidence-based community
reinforcement approach to behavior therapy (29). The TES is composed of
interactive, multimedia modules, including those focused on cognitive behavioral
skills training. The efficiency of therapeutic education systems has been
evaluated by several authors (30). A comparative study of the TES and standard
treatment by Chaple et al. (31) showed that the TES and standard treatment were
equally effective in reducing criminality, relapse to drug use, and HIV risk
behavior. TES solutions are offered by several service providers including Total
Education Solutions4 and the Center for Technology and Behavioral Health5.

The HIV DHIS2 packages and tools developed by the Global Health Infrastructures
Group at the University of Oslo in partnership with the World Health
Organization (WHO) support HIV case surveillance tracking and aggregation. BAO
Systems teamed with FHI 360 and others to develop a standardized tracker
metadata package called the DHIS2 HIV Case Surveillance Package6. It facilitates
automated reporting of 70+ President's Emergency Plan for AIDS Relief (PEPFAR)
monitoring, evaluation, and reporting and custom indicators, while allowing
flexibility to customize the model to meet local reporting requirements. DHIS2
has been used by organizations such as MEASURE Evaluation7 to develop
comprehensive guidance for developing an electronic solution to track patients
across the prevention of mother-to-child transmission (PMTCT) of the HIV
continuum of care, with several positive results reported by different authors
(32). DHIS2 has also been used to generate HIV-indicator data for
decision-making in Kenya (33). However, prior to the adoption of DHIS2 by some
countries, there existed other systems, for example, in Kenya, the Kenya
HIV/AIDS Program Monitoring System (KePMs). KePMs is a computerized database for
the management and analysis of the PEPFAR, treatment, and prevention indicators
required by the United States of America Government program managers. The
evaluation of this system showed a consistency rate of 79.5% with the DHIS2
system (34).

In Mozambique8, the Drug Resources Enhancement against AIDS and Malnutrition
(DREAM)9 software was born out of the need to computerize the management of the
clinical files of the project patients. The DREAM software is now being scaled
up in Angola, Cameroon, Democratic Republic of Congo, Guinea, Kenya, Malawi,
Nigeria, Eswatini, and Tanzania. The DREAM software has also been considered an
option as a tool to be used in the implementation for the prevention of
mother-to-child transmission in Cameroon (35).

Web-based systems have also been used in supporting access to services. In
Thailand, Adam's Love, a novel online-to-offline (O2O) model, was implemented
for disseminating HIV education and counselling (36). The tool's
online-to-offline model helps in identifying, reaching, and linking vulnerable
populations to HIV clinical services. The Adam's Love (O2O) model has been
reported to be highly effective in linking at-risk individuals from the
LGBTQ + community to PrEP and HIV testing services. This tool has high potential
to be replicated and scaled up in other settings with erratic power supplies and
high internet penetration rates among key populations (36).

Web-based tools also make it possible to integrate data from different sources.
In Haiti, a national HIV reporting electronic platform known as Suivi Actif
Longitudinal du VIH en Haiti (SALVH)10 is being used to integrate data from
multiple sources into a single national dataset. The platform makes it possible
for authorized users to analyze and visualize custom reports and dashboards from
the national SALVH database. The tool has been found to be very effective in
providing real-time aggregated national data for strategic planning (37). In
Botswana, the Botswana Harvard AIDS Institute Partnership developed the Botswana
Combination Prevention Project (BCPP) data linkage tool11 to support
individual-level patient tracking. In New York, Healthix,12 the largest public
health information exchange (HIE) in the USA sends alerts and offers
Consolidated Clinical Document Architecture (C-CDAs) to providers in real time
when an HIV or AIDS patients needs medical attention. The Human Resource for
Health (HRH) inventory tool provides countries with a wealth of information
about donor investments in HRH (38). By profiling donor investments, development
partners and host governments can more easily track and analyze investments in
HRH staffing, down to the site level, which can be utilized for more robust
sector-wide performance monitoring and HIV services program planning.


4.2. MOBILE-BASED INTERVENTIONS USED IN HIV SERVICES

The analysis revealed numerous mobile based solutions that help people living
with HIV to adhere to medication schedules, improve access to services for
patients, and assist administrators to have access to strategic information. The
Klick app developed by ViiV Healthcare in Europe uses digital tools to triage
HIV patients according to clinical needs (39). The app allows patients to manage
appointments, complete health assessments, review results, and communicate with
their healthcare team. The WHO HTS Info App13 provides on-the-go access to WHO's
current HIV testing services guidelines and information, whilst the WHO HIV Tx
App14 offers consolidated guidelines and documents for HIV treatment and care.
The national prevention information network (NPIN) PrEP provider data and
locator widget15 was developed to enable people in the USA to search for PrEP
providers according to their zip code, state, or full address, and filter out
services that do not offer PrEP to the uninsured. The HIV iChart app16 provides
up-to-date information on potential reactions between antiretroviral drugs and
other prescription drugs, as well as over the counter, recreational, and
alternative medications. SmartLink was a mobile phone app developed in South
Africa which could provide HIV patients with laboratory test results and be used
for providing care and information after diagnosis (40), whilst PositiveLinks is
an app that was designed to deliver just-in-time messaging with the aim to
improve linkage and retention among people living with HIV (41).

The use of digital games is rapidly becoming an important tool for improving
health behaviors and supporting the delivery of care and education especially
among HIV patients (42). As a result, gamification has been found to be an
effective way to reach certain groups with information about HIV prevention,
testing, and treatment services, particularly young people (43). Tumaini,
developed by the Centre for Global Health Research in Kenya, is a smartphone
game-based intervention that prevents HIV among young Africans (44). It is
designed to increase the usage of condoms by increasing knowledge about sexual
health and HIV. Evaluation of Tumaini in Kenya showed that the intervention arm
showed significant gains in sexual health-related knowledge and self-efficacy,
behavioral intention for risk-avoidance strategies, and sexual risk
communication compared with the control arm (44). The National AIDS Control
Organization (NACO) AIDS17 app is used to raise awareness through its
gamification features.

P3 (Prepared, Protected, Empowered)18 developed in the USA is a smartphone app
for HIV-uninfected young men who have sex with men and young transgender women
who have sex with men that utilizes social networking and game-based mechanics
to improve PrEP adherence. In Eswatini, SwaziYolo19 is an interactive game for
HIV-negative young adults living in Eswatini. In this app, players can practice
relationship and health choices while looking for love. UNESCO developed Fast
Car: Travelling Safely around the World (45), which is a racing game that helps
you to learn about HIV and AIDS prevention. The game aims to provide young
people with accurate and reliable information about HIV prevention, intending to
educate and entertain as well as promoting healthy behavior.

A myriad of HIV-related applications has also been developed to support HIV
diagnosis and access HIV services. HIVSmart20 was developed by a team of
scientists and physicians at the Research Institute of the McGill University
Health Centre to assess users’ HIV exposure risk, interpret their self-test
results, then link those who test positive to treatment. The HIV self-testing
(HIVST) mobile application (app) was developed for use in South Africa to reduce
barriers associated with facility-based testing (46). The Doctor On Demand app21
allows users to access different health specialists to get health advice, basic
medical exams, diagnoses, prescriptions, and other medical care quickly, whilst
the GoodRx22 helps users locate pharmacies, compare prices, and find ones with
the lowest cost. Apps like Life4me+23, Daily Charge24, and the HIV Atlas app25
push notifications and reminders to users about appointments and medications as
well as track lab results. An interesting design is a the aDOT platform which is
integrated with a mobile app (LYNX) designed to support HIV testing and PrEP
uptake designed by Liu et al. (47).

Additionally, apps have been developed to provide social support to those living
with HIV through communities. myHIVteam26 is a social network for anyone living
with HIV whilst Positive Peers27 is a private support app for young people
living with HIV. There are also several dating apps like Positive Singles,
Positive Match, and Hzone that are connecting people with STDs, including HIV.
It is key to note that consideration of resource-constrained areas is also what
pushes mobile-based services. The use of unstructured supplementary service data
(USSD) and short message services (SMS) to send reminders or information is one
key feature across mobile apps.


4.3. SOCIAL MEDIA-BASED INTERVENTIONS USED IN HIV SERVICES

Social media platforms play a key role in the mental wellbeing and support of
HIV services delivery. Some organizations are using social media to target and
interact with people living with, most affected by, or at risk of HIV who may
feel isolated or less visible. Organizations like Avert28 create campaigns to
increase the awareness and understanding of HIV and sexual health around the
world. These campaigns include the #StandUpToHIV empowers people to get over
their fears of what happens during a test and what other people will think, and
#KnowTheScore which aims to get young men in Southern Africa tested for HIV. HIV
social media kits29, which are a collection of key messages, graphics, and
sample content shared on social media that strengthen communications for
national HIV awareness days, have been developed by several organizations such
as the Centers for Disease Control and Prevention (CDC) and HIV.gov30 to support
consistent communication across organizations. These collection of social media
toolkits can be used to promote HIV prevention, testing, treatment, and
anti-stigma messaging to social media audiences by other organizations.

Chatbots have also been widely used in HIV services with ongoing research in
improving the interactivity of the chatbots to make conversations more natural.
Ardiana et al. (48) built a mobile-based chatbot application using artificial
intelligence markup language (AIML) to aid the foundation in giving people
reliable HIV/AIDS related information. AIML was used because it can make bots
closer to human capabilities with the aim of emulating human conversation as
good as a counseling session. Other notable chatbots include the Marvin chatbot,
developed by McGill University which uses AI to engage HIV patients in their
antiretroviral therapy (49); the Eli chatbot developed by the United Nations
Educational Scientific and Cultural Organization (UNESCO) Institute for
Information Technologies in Education (IITE) and which can answer questions
about growing up, love, relationships, and sexual health, including HIV
prevention and treatment (50); SHIHbot is a Facebook chatbot for sexual health
information on HIV/AIDS (51); and Sophie Bot31, developed in Kenya, also offers
information on reproductive health. Additionally, these chatbots are being
integrated into communications apps such as WhatsApp, Telegram, and Signal,
helping to disseminate information and connect citizens with trained healthcare
providers and counsellors at times and in places that suit them32.


4.4. HIGHLIGHTS OF DEVICES USED IN HIV SERVICES

The devices presented in this paper have been categorized into adherence
monitoring devices, drones, and digital test kits. There are three types of HIV
diagnostic tests: nucleic acid tests (NAT), antigen tests, and antibody tests
(52). Blood tests are the most common way to diagnose HIV. However, over the
years, other non-invasive body fluid-based tests have been developed. These
include the oral fluids-based tests like those that use saliva and urine as
samples (53).

Several innovative rapid test kits (RDTs) have been designed that enable
home-based HIV testing. These include the SURE CHECK® HIV 1/2 ASSAY33, a
self-test for the detection of antibodies to Human Immunodeficiency Virus Types
1 and 2 (HIV 1/2) in fingerstick whole blood. The SURE CHECK HIV Self-Test is
intended for use by untrained users to aid in the diagnosis of HIV infection.
Other self-test kits include the Mylan HIV Self-Test34 and INSTI® HIV
Self-Test35. Over the years, non-invasive test kits have been developed that do
not require blood and these include DPP HIV 1/2 Assay36, EXACTO©37 TEST, and
OraQuick HIV Self-Test38 that use an oral swab for testing. There are also
innovations that identify and determine the percentages and absolute counts of
mature human T-lymphocytes (CD3+) and helper/inducer (CD3 + CD4+) T-lymphocyte
subsets in erythrocyte-lysed blood such as the PIMA CD4 Test (54). These are
used to monitor and evaluate the body's response to ART.

Due to the increasing processing power of mobile devices, new technologies
harnessing the potential of mobile phone sensors, cameras, processing power, and
data sharing capabilities have been developed to improve HIV diagnosis.
Mobile-based apps have been developed that can read test results from an image
taken by end users on a mobile device. These apps can automatically analyze the
images and are also able to report results to public health systems for better
data collection; for example, a pioneering technology developed by University
College of London (UCL) and Africa Health Research Institute (AHRI) researchers
could transform the ability to accurately interpret HIV test results,
particularly in low- and middle-income countries (55). This is based on AI image
analysis for the diagnosis of HIV from test images. Several reports and reviews
have highlighted the potential of AI in HIV services especially for instant
diagnosis; however, few apps have been clinically tested and deployed for
clinical use (56).

Electronic adherence monitors (EAM) are another category of devices that have
been greatly adopted in HIV services. These monitors include the medication
event monitoring system (MEMS) adherence monitor39 that processes patient data
using predefined and validated algorithms to present a comprehensive picture of
patient adherence based on the dosing history from the MEMS packages. It
collects adherence data from digitally enabled hardware, through sensors and
stores it in a database. The Wisepill RT2000 Medication Dispenser40 is an
internet-enabled medication dispenser allowing remote, real-time medication
management. The rich feature set makes it a favorite for adherence research and
clinical trials. Other adherence devices include the Wisebag (57), AdhereTech41,
MedMinder 42, and Tell-Me-Box43.

Drone technology has also been used in HIV services especially for circumvent
supply chain disparities in the delivery of HIV drugs. Drones have been used in
Uganda to carry HIV medicines44 to isolated community groups and health
facilities. These have also been used in also other countries like Malawi to
improve the testing labs’ footprints from the central laboratory to the health
facilities.45


5. DISCUSSION AND CONCLUSION

In the study analysis, more than 75% of the innovations were developed and
deployed in Western and Asian countries including the United States of America,
Switzerland, and China, with very few from Africa. Innovation output is still
relatively low across the African continent as depicted in the 2022 edition of
the Global Innovation Index (58).

Dionne (59) highlighted how interventions in HIV/AIDS often encompass global
actors and argued that misaligned priorities usually can create multiple
opportunities for failure. Hence, this study sought to decrease the failure rate
by unlocking the potential for mapped innovations where African governments
should reflect on how such innovations can be integrated to improve healthcare
service delivery while taking ownership. The paper offers visibility of
technologies that address various aspects of HIV response, making it a starting
point which organizations such as the World Health Organization (WHO) and other
implementing partners may use as a source of innovations to foster
public–private partnerships and initiate strategic dialogue in developing
countries to pave a way forward to localization of these technologies. It is
important to note that co-creation is of paramount importance as exemplified in
Southwestern Uganda, where the information and mass media campaigns aimed at
improving adherence to ART among adolescents was designed to cater for the needs
of the adolescents through consultations (60).

As countries are exploiting the opportunities for adopting and adapting these
innovations in their respective contexts, they should take into consideration
aspects to do with: (a) Privacy and security, where a lot of content that is
stored on platforms where users enter their information needs to be protected
and also offer the users some form of data protection; (b) inclusive innovation,
where key stakeholders are involved in tool selection or development. This helps
standardization of the HIV services to increase trust, acceptance, and uptake of
the tools for HIV service delivery; (c) technical capacity and skills, where
training is needed to pass on the knowledge and skills required to design and
maintain the technological infrastructure; and (d) policy and infrastructure,
where even though the African region is doing a lot of work aligned with several
strategies, policies and frameworks that are looking at how best to integrate
telemedicine, AI, big data, and drones in health systems strengthening, there
are still more opportunities for leapfrogging improvements in the delivery of
HIV programs.

Considering some limitations of this paper, there is a lack of longitudinal
analysis of some of the innovations to track and trace how best they can be
integrated into strengthening health systems in African countries. Researchers
and implementers should undertake longitudinal studies that further investigate
the cost-effectiveness of the technologies that have been integrated into health
systems. It is important to undertake a cost–benefit analysis to see if the
innovations actually improve the cost effectiveness of HIV programs and how they
are implemented. Integrating healthcare interventions and innovations is
initially a costly and time-consuming process, hence it is important to
ascertain if the benefit that is purported translates to impact.

Overall, there is a big technological shift with the use of big data, artificial
intelligence, and other emerging technologies to support improvements in the
delivery of HIV programs. It is therefore critically important for countries in
Africa to initiate internal dialogues on how best to exploit these emerging
technologies to accelerate health impact. Furthermore, the findings of this
analysis of the HIV services innovations can help in providing implementation
strategies to African countries on how to adopt some of the technological
innovations.


AUTHOR CONTRIBUTIONS

MC and WW conceived and wrote the first draft of the paper; CN and MC revised
the paper and added insights on the interpretation of data and on how to
rearrange some sections; FL revised the paper critically and contributed further
insights. All authors contributed to the article and approved the submitted
version.


FUNDING

The author(s) declare that no financial support was received for the research,
authorship, and/or publication of this article.


ACKNOWLEDGMENTS

We would like to acknowledge the anonymous reviewers who helped strengthen this
paper.


CONFLICT OF INTEREST

The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential
conflict of interest.




FOOTNOTES

1https://resorcio.com/categories/technology-1628491222410

2https://openmrs.org/

3http://sudtech.org/about/

4https://www.tesidea.com/

5https://www.c4tbh.org/program-review/therapeutic-education-system-tes-2/

6https://dhis2.org/metadata-package-downloads#hiv-tracker

7https://www.measureevaluation.org/resources/pmtct-tracker.html

8https://www.hrhresourcecenter.org/node/561.html

9https://www.dreamprog.org/whatisdream/

10https://salvh.mesi.ht/pages/Default.aspx

11https://github.com/botswana-harvard

12https://healthix.org/

13https://play.google.com/store/apps/details?id=com.whohtsinfo&hl=en&gl=US

14https://play.google.com/store/apps/details?id=uk.co.adappt.whoarv&hl=en&gl=US

15https://npin.cdc.gov/preplocator

16https://play.google.com/store/apps/details?id=com.liverpooluni.icharthiv&hl=en&gl=US

17https://play.google.com/store/apps/details?id=com.naco.nhp&hl=en&gl=US

18https://batlab.web.unc.edu/p3/

19https://www.formula-d.com/projects/hiv-prevention-game/

20https://hivsmart.org/

21https://www.doctorondemand.com/

22https://www.goodrx.com/

23https://life4me.plus/en/about-us/

24https://play.google.com/store/apps/details?id=com.gilead.dailycharge&hl=en&gl=US

25https://m.apkpure.com/hiv-atlas/com.halosys.hivatlas.main

26https://play.google.com/store/apps/details?id=com.myhealthteams.myhivteam&hl=en&gl=US

27https://positivepeers.org/

28https://www.avert.org/who-we-are

29https://www.cdc.gov/stophivtogether/partnerships/social-media-toolkit.html

30https://www.hiv.gov/

31https://www.facebook.com/misssophiebot/

32https://breakthroughactionandresearch.org/regional-interactive-fp-rh-information-center/

33https://www.who.int/diagnostics_laboratory/evaluations/pq-list/191129_pqdx_0054_006_01_sure_check_hiv_self_test.pdf?ua=1

34https://www.mylanez2uz.com/

35https://www.insti.com/hiv-self-test/

36https://www.who.int/diagnostics_laboratory/evaluations/pq-list/hiv-rdts/160606PQPR_0053-006-00_DPPHIV_v2.pdf

37https://www.aidsmap.com/about-hiv/how-accurate-self-testing-hiv

38https://www.rockethealth.shop/product/oraquick-hiv-self-test/

39https://www.aardexgroup.com/solutions/mems-adherence-software/b

40https://www.wisepill.com/

41https://www.adheretech.com/

42https://www.medminder.com/

43https://clinicaltrials.gov/ct2/show/NCT03086655

44https://theacademy.co.ug/medical-drones-project/

45https://www.unicef.org/malawi/reports/drones-factsheet


PUBLISHER'S NOTE

All claims expressed in this article are solely those of the authors and do not
necessarily represent those of their affiliated organizations, or those of the
publisher, the editors and the reviewers. Any product that may be evaluated in
this article, or claim that may be made by its manufacturer, is not guaranteed
or endorsed by the publisher.


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Keywords: HIV services, devices, digital technologies, innovation, health
systems strengthening

Citation: Chibi M, Wasswa W, Ngongoni CN and Lule F (2023) Scaling up delivery
of HIV services in Africa through harnessing trends across global emerging
innovations. Front. Health Serv. 3:1198008. doi: 10.3389/frhs.2023.1198008

Received: 31 March 2023; Accepted: 22 September 2023;
Published: 31 October 2023.

Edited by:

Joao Breda, WHO Regional Office for Europe, Denmark

Reviewed by:

Shahzad Ali Khan, Health Services Academy, Pakistan
Válter R. Fonseca, World Health Organization, Denmark

© 2023 Chibi, Wasswa, Ngongoni and Lule. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other forums is permitted, provided the
original author(s) and the copyright owner(s) are credited and that the original
publication in this journal is cited, in accordance with accepted academic
practice. No use, distribution or reproduction is permitted which does not
comply with these terms.

*Correspondence: Moredreck Chibi chibim@who.int



Disclaimer: All claims expressed in this article are solely those of the authors
and do not necessarily represent those of their affiliated organizations, or
those of the publisher, the editors and the reviewers. Any product that may be
evaluated in this article or claim that may be made by its manufacturer is not
guaranteed or endorsed by the publisher.




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