JMIR Publications

ABSTRACT

Background:

The use of mobile communication technologies (mHealth) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralise access to healthcare and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to co-develop (with potential users) a new generation of mobile phone-connected HIV diagnostic tests and online clinical care pathways needed for optimal delivery of decentralised HIV testing, prevention and care in low- and middle-income countries.

Objective:

The purpose of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa.

Methods:

Fifty-four in-depth interviews and nine focus group discussions were conducted with potential users (including healthcare providers) in two different communities. Theoretically informed by the ‘candidacy framework’, themes were identified from the interview transcripts, manually coded and thematically analysed.

Results:

Participants reported barriers such as fear of HIV identity, stigma, long waiting hours, clinic space and healthcare workers attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services based on their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone-linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers due to its privacy (individual control of HIV testing over health provider-initiated testing), convenience (individual time and place of choice HIV testing versus clinic-based testing) and time-saving.

Conclusions:

Mobile phone connected HIV testing and online clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for an individual to test their ‘candidacy’ for HIV services, the barriers which can make the service unattractive at clinic level will also need to be addressed if potential demand is to turn into actual demand.