Leveraging technology in the fight against AIDS, non-profit organisation Shout-It-Now, has launched the world’s most advanced HIV testing technology in South Africa.

Currently piloting in the Ekurhuleni area, the Test and Treat mobile vehicles are a community-based HIV screening and immediate ART initiation service. With this innovative and highly scalable technology, Shout-It-Now aims to change the landscape of HIV testing in South Africa with a revolutionary approach that offers a real understanding of the AIDS epidemic in the country.

There are roughly 270 000 new HIV infections in South Africa every year. Despite the huge gains made in fighting HIV, SA remains a country with the highest HIV prevalence in the world. “The Test and Treat technology provides a better, cheaper, faster solution to HIV testing that takes as little as five to 10 minutes. The system captures perfect data that can be analysed in a way that’s never been done before,” says Bruce Forgrieve, Shout-It-Now’s Founder and Chairman.

With Test and Treat, the organisation plans on reaching inaccessible areas and communities such as hostels, factory sites, and rural townships, where the prevalence of HIV is often highest and antiretroviral therapy (ART) initiation lacking. Long queues at clinics, lack of time, fear of being asked embarrassing questions and the shame often attached to being HIV positive are some of the reasons people don’t get tested. Test and Treat aims to process up to 150 people a day in these previously inaccessible areas, with a quick, streamlined process.

Since 2007, Shout-It-Now has been working hard to relieve pressure on the public health system by providing community-based initial HIV screening and links to care. To date, Shout-it-Now has successfully performed over 1,1-million HIV tests in SA. The NGO aims to assist the National Department of Health (and other public health stakeholders) in reaching their 90.90.90 target – that is, that 90% of people living with HIV know their status, 90% of these patients receive antiretroviral (ARV) therapy and 90% of these ARV patients achieve viral suppression.

Test and Treat makes use of two mobile trucks that only require 5 staff, one of which is a licenced GP. The Test truck is equipped with seven self-help kiosks and the Treat vehicle offers confirmatory testing and ART initiation. The trucks can be ready to go within minutes and relocated quickly if necessary. Due to a smaller footprint, the new facility can get to those harder-to-reach communities and can be moved to multiple locations in one day.
Using interactive touchscreens and audio-visual aids, the programme can be navigated in English, Zulu and Sepedi, all the while maintaining the fast, free and friendly service that clients have come to expect from Shout-It-Now.

In fact, recent feedback from the pilot project of Test and Treat has revealed that so far over 86% of respondents who had tested previously in mobile tents felt the new service in customised vehicles was better. They loved the self-service, technology and felt it was a faster, easier and more advanced concept. There were also mentions of “no embarrassing questions” and “more informative videos”.

The new service employs public health data and mapping to ensure access to under-served populations, while analysing data in a way that enables Shout-It-Now to capture new information, observe patterns and customise the system accordingly. “Our use of technology means that we are able to efficiently collect data that we analyse to facilitate continuous improvement of our offering. We can find patterns and start asking different questions to better understand the AIDS problem in this country. The technology tracks multiple demographics, repeat clients, HIV incidence and links to care enabling us to ask questions according to a client’s unique circumstance. In other words, this is not a generic system” says Forgrieve.

Fifty five percent of South Africans living with HIV are on ARVs. Government’s second objective is to get that figure up to 90% (the second part of the 90.90.90 target). Initial ART treatment, and maintenance, remains a huge challenge in SA.

In terms of ART initiation, barriers have been the distance from point of diagnosis to a clinic, and the wait times and service at public health clinics. With Test and Treat, people who test HIV+ are immediately led to a second, customised “Treatment Truck” where a doctor and health care advisor provide confirmatory testing. Clients are then initiated onto ART by Shout-It-Now, receiving a one-month supply of ARVs, and a referral letter directing them to their local clinic to receive ongoing follow-up care and repeat medication. Shout-It-Now is currently planning a presence at referral clinics – a Shout-It-Now “Clinic Clubhouse” – to assist and fast-track these clients into the public health care system for ongoing care.

A big part of the Test and Treat programme is to dispel many of the myths around HIV and reinforce the message that living with HIV is no longer a death sentence. Shout-It-Now believes strongly in providing ongoing support and care for those too ashamed to confide in loved ones about their HIV status.

“Because we know that an HIV+ diagnosis can be traumatic, the Shout-it-Now Clinic Clubhouse aims to ease the integration into the clinic system by providing fast and friendly service within a warm and welcoming environment,” says Dr Kathryn Pahl, MD of Shout-It-Now.

Phase two of this service will see Shout-It-Now exploring an adherence programme, providing medication to clients on a monthly basis as a way of enhancing service to clients and complementing the clinic system. This will hopefully see Shout-It-Now assisting the Department of Health in meeting the third and most challenging part of the 90.90.90 target – that 90% of HIV patients on ARVs achieve viral suppression.
While this new service currently operates in the Ekurhuleni area, with enough support, Shout-It-Now aims to roll out more of these mobile clinics nationally, penetrating less accessible areas and locations where the prevalence of HIV may be higher.