Johannesburg, South Africa – 12 July 2018: The adoption of the UNAIDS targets to end AIDS by 2020 has placed an impetus on public health stakeholders to focus on identifying 90% of people living with HIV, place 90% of those on sustained Antiretroviral Therapy (ART) and ensure that 90% of those on ART achieve and maintain viral suppression. To achieve these goals, innovative approaches are warranted.
Given increased focus in South Africa on identifying those people living with HIV who remain undiagnosed, and on improving uptake of ART, Shout-it-Now has designed a new community-based HIV Screening and immediate ART initiation service that dovetails with the goals and services of the public health system in Gauteng. A six-month pilot of this new “Test and Treat” programme of semi-automated mobile HIV Testing and immediate ART initiation clinic will be launched today.
The highly scalable new mobile Test & Treat clinic will see Shout-It-Now offering free, fast and friendly HIV testing, counselling and treatment from a pair of customised vehicles, giving the programme increased flexibility to target high risk patients and offer those with HIV immediate and seamless access to treatment. The mobile clinic consists of two trucks working in tandem: one dedicated to HIV testing and a second to ART initiation.
Shout-It-Now will make use of public health data and mapping tools to identify neighbourhoods and populations in greatest need of the mobile clinic’s services. The community testing locations will primarily be social & residential areas that are currently underserved by public health clinics in the area, with the Test and Treat service designed to see up to 250 clients per day with an HIV incidence of 10 – 15%.
The set-up time for the Test and Treat mobile clinic is 15 minutes. A powerful generator, lighting and awnings ensures the capability for round the clock operation in communities that need the service most.
Onboard, the Testing van features 7 touchscreen kiosks with the latest audio-visual interface and needs only 3 health care advisors (HCAs) to perform all the functions including the physical tests and reading. The instructional AV aids are concise, engaging, and available in Zulu, English & Sepedi, while sophisticated biometric equipment ensures highly accurate and efficient identification and tracking of clients.
The testing process varies according to each client’s needs and can take as little as 5-10 minutes, results being shared via SMS. Those who test positive on their initial HIV test proceed to the ART van. Here a qualified doctor or NIMART nurse and HCA provide confirmatory testing, assess whether the client is eligible for immediate ART initiation and if so, issue a one-month supply of ARVs.
“HIV and AIDS remain the biggest social issue facing South Africa. As a stakeholder, we take our role in ensuring the national 90-90-90 targets are met seriously. We have found that first and foremost, our clients want convenience – fast, free and friendly service at a time and location that suits them.,” says Bruce Forgrieve, Chairman, Shout-It-Now.
“For this reason, we have extended our focus to what is now needed – convenient testing and treatment solutions, incorporating ART initiation into our model thus addressing the second component of the common 90-90-90 goal.”
According to UNAIDS 2017 Data, South Africa has made significant strides toward its 90-90-90 goals, with 86% of people living with HIV diagnosed, 65% of them on antiretroviral therapy (ART) and 81% of those on ART virally suppressed.
The rationale for “taking the service to the people” is motivated by a couple of factors. Primarily, the World Health Organisation (WHO) recommends ART should be given as soon as possible after diagnosis to everyone with HIV. Secondly, it is easier for the youth and other at-risk populations to be screened, counselled, and initiated into treatment whilst in their communities, as the ease of this process removes significant barriers to care.
Shout-it-Now’s Test and Treat approach also benefits the overburdened public health system by offloading the work of case finding and ART initiation on healthy people living with HIV, so the clinics can focus their resources on caring for complex HIV and other medical cases. Once Shout-it-Now initiates patients onto ART, they will be transferred at one month to the clinic for ongoing clinical care and dispensing of ARVs.
Shout-It-Now will also pilot a Clubhouse concept adjacent to a partner government clinic to improve clinic linkage and retention rates. The Clubhouse will be the first port of call for Shout-It-Now clients who, after their first month of ART, need integration into the government clinic system. HCAs at the Clubhouse will escort clients to the partner clinic and walk them through the transfer and registration process. As a further service to the adjacent public health clinic, walk-ins to the Clubhouse can also get tested and the facility is equipped to provide pre-ART initiation to clients.
“We continue to invest heavily in technology and tools needed to drive innovation in linking clients to the best care available at zero cost to the community. As a reliable and trustworthy partner of the government, we remain committed to our founding ethos of providing free, fast and friendly service to the community,” says Forgrieve in conclusion.
Shout-It-Now plans to scale-up the mobile clinic approach in Phase 2 to include an adherence programme, providing medication to clients monthly, further relieving the overburdened government clinic system. Shout-it-Now’s vision is to see the entire nation of South Africa serviced by its mobile Test & Treat clinics and extending its services to include primary healthcare screening for other chronic conditions.
Established in 2007, the non-governmental organisation (NGO) Shout-it-Now has a successful track record in offering mobile community-based HIV testing services. To date the NGO has performed more than 1.1 million HIV tests in four provinces including more than 800 000 tests in Gauteng. Of those tested by Shout-it-Now, on average about 80% of eligible clients were linked to care in the public health system.