Contributed Commentary by Neil Polwart
April 3, 2018 | HIV remains one of the greatest health challenges facing our generation and Africa carries a huge proportion of this burden. Sub-Saharan Africa, the hardest hit region, is home to nearly 70% of the global population of HIV sufferers, with one in every 25 people living with the disease.
Significant steps have been taken towards tackling HIV, which at one point, seemed to be an insurmountable challenge, and now the UNAIDS organisation is targeting zero deaths from HIV or new infections in Africa by 2030—an ambitious aim that would have seemed completely unachievable two decades ago.
Technology has played a key role in this transformation and the mobile phone has been an important factor in this journey. From breakthrough schemes like South Africa’s Project Masiluleke, which used mobile phones to send millions of text messages to people to increase awareness of HIV/AIDS, testing and treatment; to care workers and clinicians using smartphones to diagnose HIV out in the field.
Despite amazing progress being made, the most recent WHO data shows more than 36 million people around the world are still living with HIV, and half of those are unaware they are infected—increasing the risk of transmission and people contracting AIDS. A recent study by the US Centre for Disease Control’s Morbidity and Mortality Weekly showed that less than half of young women with HIV, in seven southern and east African countries, are aware they are infected.
The incidence of HIV infection among 15 to 24-year-old women in Lesotho, Malawi, Swaziland, Uganda, Tanzania, Zambia and Zimbabwe is currently around 3.6%—some 1.5 million young and adolescent women—with an infection rate almost double that of their male counterparts. Only 46.3% of those infected were aware that they had the disease, and only 45% of those with the infection were receiving treatment.
Tragically, children remain particularly at risk. Children are more vulnerable to the potentially fatal consequences of HIV than any other age group, but despite this, detection and treatment levels remain low.
Figures released by the African Union showed there are up to 1.4 million children living with HIV in Africa south of the Sahara—over half of all children living with HIV globally. Of the total number of children living with HIV, around half are not receiving treatment and of these untreated children, 50% die before they are two years old.
Next generation diagnostic technologies have a major role to play in addressing these imbalances and creating new solutions to unlock the specific challenges which affect at-risk groups—reducing the chances of infection and making HIV testing more accessible.
Attending clinics for HIV tests can be challenging for people living in areas with poor infrastructure—particularly potential vulnerable sufferers. There are societal challenges too: according to a new report by the United Nations Programme on HIV/AIDS (UNAIDS), men in developing countries reported not seeking out HIV tests and treatment because they felt unwelcome at clinics.
To address these barriers, UNAIDS has called for more self-testing options to become available for people to use from the privacy of their own home. This presents another opportunity for the mobile phone to play a part in tackling the stigma associated with HIV rather than a simple communication tool. By exploiting the intuitive user-experience on mobile devices, untrained users can be guided through the entire testing process with confidence in the resulting outcome.
The ability to transform a mobile phone into a diagnostic test reader can help local populations to overcome geographical barriers when accessing regular healthcare. Testing can also be performed remotely with the results, of lab-quality, delivered to a field technician or patient directly from the point of care.
Mobile enabled point of care testing (POCT) holds the potential to fundamentally revolutionise the way we monitor, test and treat infectious disease epidemics, particularly in areas with limited public health infrastructure. Mobile phone connectivity also enables results to be shared securely with healthcare professionals online. Sharing data via a mobile ecosystem helps to monitor the spread of infectious disease and identifies ‘hot spots’ where viruses are rife and in need of more targeted medical resource. This technology also has the potential to help patients monitor their own condition on a regular basis.
As we move forward in the battle to tackle AIDS, technology will also be key towards empowering people to manage their own conditions and treatment plans, following an early and accurate diagnosis. The fight against AIDS is far from over, however new approaches that capitalise on next generation diagnostic technologies and the solutions they can offer, will be critical in overcoming barriers posed by location, age, or gender—ensuring at risk groups are not left behind.
Neil Polwart has a PhD in Chemistry and over a decade of experience in mHealth development within the diagnostic industry, delivering connected health and enabling true point of care technology. He’s the founder of Novarum and BBI Group Head of Mobile. He can be reached at npolwart@novarumdx.com.