Self-testing HIV kits and machine-dispensed medication reduces stigma in SA
Self-testing kits and vending machines distributing prescription drugs are two ways that HIV treatment is being automated to reduce stigma in SA, home of the world’s biggest HIV epidemic.
With 7.1-million people living with HIV in the country, removing human intervention is helping experts target hard-to-reach groups, such as young men who are often reluctant to queue in public clinics.
Students and labourers have flocked to a new HIV self-testing stand outside a supermarket in Hillbrow.
The project was started in Malawi, Zambia and Zimbabwe in 2015 and expanded last year to include SA, which has an 18.9% HIV rate among adults.
A small team of young and stylishly-dressed "peer educators" convince men aged between 18 and 30 to take the tests, which — in a breakthrough for SA — are self-administered.
"It’s targeted at young men and if we have a group of young men around, we pull more people in," said Lynne Wilkinson, from the University of the Witwatersrand’s Reproductive Health and HIV Institute, which oversees the project.
From May, the scheme will be extended to several of Joburg’s taxi ranks. After passers-by complete a simple form, they are handed a pack to take into one of a row of unassuming, portable pop-up tents to ensure privacy. They follow a short guide showing how to swab their gums with a small wand before placing it into a holder.
The project is an initiative of Unitaid, the Geneva-based organisation that says three out of every 10 people with HIV worldwide do not know they have the virus
"Instructions are in six languages and most of the time people do it right," said Mokgadi Mabuela, who distributes and demonstrates the tests. "They respond quite well when you explain it’s a self-test — although the men will often ask if you want to date!"
After 20 minutes, the test results are delivered by lines that indicate negative or positive. Those that show positive are offered immediate confirmation tests which, if conclusive, are followed-up with treatment referrals. Those not wanting to wait for their results can take the packs home.
"Last week I came past with my brother who tested and I was passing by today. It was easy and I did it to inform myself," said one young man, who declined to be named. The kits, which are free to the users, contain advice on what to do if a home test is positive.
The project is an initiative of Unitaid, the Geneva-based organisation that says three out of every 10 people with HIV worldwide do not know they have the virus. It has brought hundreds of thousands of the tests into SA and surrounding countries so far, and plans to distribute 4.8-million self-screening kits in total.
One of those who tested positive after self-screening was musician Oscar Tyumre from Alberton. "With their counseling, they advised me to go to their clinic to take their medication right away," he told AFP. "I was delicate at the time — but I started right away."
He added that knowing his status was actually a relief. "My advice is — don’t despair. It’s not the end of the world, you can go straight into treatment and still live to 100."
In Alexandra, not-for-profit Right ePharmacy last week launched an ATM-style dispenser that removes the need for face-to-face interaction with a pharmacist to collect HIV treatment. Patients can activate the vending machines — the first in Africa — using a membership card and PIN, which calls up repeat prescriptions pre-loaded by doctors.
South African law requires a pharmacist sign-off on the transaction so after a Skype-like video call, the medication is dispensed. It takes less than five minutes.
"It’s much easier and quicker," said Alexandra resident Philda Dladla, who uses the machines to collect HIV treatment twice a month. "Before, we used to wait for the whole day at a clinic. It’s easy and anyone can do it — as long as you don’t forget your PIN!"
The system’s privacy booths also mean patients can avoid publicly revealing their condition — unlike in busy local clinics. "The only way anyone would know your health status is if you left with the medication showing," said operations manager Thato Mathabathe next to one of the pharmacy’s four, $170,000, German-made robotic dispensers.
Roughly 200 patients use the system every day and users have collected 16,000 items, including HIV/AIDS drugs, as well as diabetes, epilepsy, asthma and hypertension medication since September. There are plans to expand to three other sites in the Johannesburg region.