m-Africa: Building mobile phone-connected diagnostics and online care pathways to support HIV prevention and management in decentralised settings.

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m-Africa's long term vision is to build user-friendly, mobile phone-connected HIV tests which link to online pathways for prevention and medical care. These systems will be used by people within their own homes and communities and they can be set up quickly in South African communities hardest hit by HIV. This will enable people to take full advantage of recent breakthroughs in HIV care and ultimately empower those at greatest risk to manage their own health. The United Nations aims to end the HIV/AIDS epidemic by 2030. Yet despite huge advances in HIV treatment, prevention and care, many countries lack the set up to roll them out on a large scale and many people remain afraid of testing and seeking care.South Africa is the country most affected by HIV; almost seven million people are living with HIV and 300,000 people acquire HIV each year. The province of KwaZulu-Natal, home to The Africa Health Research Institute (AHRI), is particularly hard hit. Forty five percent of women attending antenatal clinics have HIV and only half of all people diagnosed with HIV go for medical care within the following year. AHRI research showed that regular home-based HIV testing and immediate treatment could reduce HIV and prolong lives, but getting young people into clinic once they had been diagnosed was hugely challenging. This was because young people felt judged and looked down on once others knew they had HIV. Also they simply couldn't afford to miss work in order to come for an appointment. The aim of m-Africa is to build a new generation of mobile phone-connected HIV diagnostic tests together with an online app that allows a person, from within their home or local community, to get their test results and medical care online. This could even include getting HIV drugs for prevention or treatment. This would allow people to test with more privacy, avoiding the clinic visits they find so difficult. South Africans have more smartphones than people in almost any other African country. We want to take advantage of this to enable more people to get tested, especially those who have never tested before. But in order for these exciting new ideas to succeed we have to develop solutions which people at risk of HIV, health care professionals and government find appealing. So our research will start by asking people from these groups for their opinions on our ideas. We will use focus groups, individual interviews and questions in a regular AHRI household survey of 100,000 people. In parallel we will develop and ask people to test out diagnostic test prototypes, which will include looking at how new ultra-sensitive "nanomaterial" tests could best work. These can detect HIV at the very early stages of infection, when transmission is most likely and prevention most important. We will also design apps to interpret already available HIV tests, which could link results to a doctor for online care. We will engage with key stakeholders from the outset, including the Community Advisory Board, Directorate of Health KwaZulu Natal, industry, policy makers and regulators, to ensure we develop solutions that will be quickly put into practice. This is important because the technologies we develop could be applied across a wide range of infections and medical conditions. This plan is very much in line with the South African mobile health strategy. Our team brings together outstanding clinicians, scientists, engineers and public health researchers from South Africa and the UK, with the primary goal of improving HIV prevention and care to deliver major health and economic benefits at the global epicentre of HIV.