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

m-Africa的长期愿景是建立用户友好的、与移动电话相连的艾滋病毒检测方法，将其与预防和医疗保健的在线途径连接起来。这些系统将由人们在自己的家庭和社区内使用，并且可以在受艾滋病毒影响最严重的南非社区迅速建立起来。这将使人们能够充分利用最近在艾滋病毒护理方面取得的突破，并最终使面临最大风险的人能够管理自己的健康。联合国的目标是到2030年结束艾滋病毒/艾滋病流行。然而，尽管在艾滋病毒治疗、预防和护理方面取得了巨大进展，但许多国家缺乏大规模推广这些措施的条件，许多人仍然害怕进行检测和寻求治疗。南非是受艾滋病毒影响最严重的国家；近700万人携带艾滋病毒，每年有30万人感染艾滋病毒。非洲卫生研究所（AHRI）所在地夸祖鲁-纳塔尔省受到的打击尤其严重。在产前诊所就诊的妇女中，有45%感染了艾滋病毒，在所有被诊断患有艾滋病毒的人中，只有一半在接下来的一年内接受了医疗护理。AHRI的研究表明，定期的家庭艾滋病毒检测和立即治疗可以减少艾滋病毒并延长生命，但是一旦他们被诊断出来，让年轻人进入诊所是非常具有挑战性的。这是因为一旦其他人知道他们感染了艾滋病毒，年轻人就会感到被评判和看不起。而且他们也不能为了赴约而耽误工作。“移动非洲”的目标是建立新一代与移动电话连接的艾滋病毒诊断测试，以及一个在线应用程序，使人们能够在家中或当地社区在线获得检测结果和医疗服务。这甚至可能包括获得预防或治疗艾滋病毒的药物。这将使人们在更隐私的情况下进行测试，避免他们觉得非常困难的诊所访问。南非人拥有的智能手机几乎比其他任何非洲国家的人都多。我们希望利用这一点，让更多的人接受检测，尤其是那些以前从未接受过检测的人。但是，为了使这些令人兴奋的新想法取得成功，我们必须开发出有感染艾滋病毒风险的人、卫生保健专业人员和政府认为有吸引力的解决方案。因此，我们的研究将从询问这些群体中的人对我们的想法的看法开始。我们将采用焦点小组、个人访谈和AHRI对10万人进行的定期家庭调查中的问题。与此同时，我们将开发并要求人们测试诊断测试原型，这将包括研究新的超敏感“纳米材料”测试如何最好地发挥作用。这些方法可以在感染的早期阶段检测到艾滋病毒，这是最可能传播和最重要的预防阶段。我们还将设计应用程序来解读现有的艾滋病毒检测结果，从而将结果与医生联系起来，进行在线护理。我们将从一开始就与主要利益攸关方接触，包括社区咨询委员会、夸祖鲁-纳塔尔省卫生部、行业、决策者和监管机构，以确保我们制定出能够迅速付诸实践的解决方案。这很重要，因为我们开发的技术可以应用于广泛的感染和医疗条件。这项计划非常符合南非流动保健战略。我们的团队汇集了来自南非和英国的优秀临床医生、科学家、工程师和公共卫生研究人员，主要目标是改善艾滋病毒的预防和护理，在全球艾滋病毒的中心提供主要的健康和经济效益。

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.