Background:
Affordable and reliable rapid test kits pave the way for widespread screening. However, it is crucial that the process be user-friendly, quick, confidential, cost-effective and include medical support when needed. It should also save healthcare workers (HCW) time. The Napneung project is working towards efficient HIV screening methods.
Methods:
The Napneung project offers free and anonymous self-screening for HIV, syphilis and hepatitis B and C at five locations in northern Thailand to anyone aged ≥15 years. The medical team in collaboration with IT specialists developed an advanced web app, available in several languages, to automate most processes: online appointments to avoid queues and waiting times, instructions for user-guided self-screening, and standardized information provided on sexually transmitted infections while awaiting results. The app allows a HCW to assist multiple users at once. Only two drops of blood from a finger prick are needed to screen for the four infections. If a test is positive, confirmatory tests are performed, then post-test counseling and personalized referral for evaluation and treatment are provided. High-risk HIV-negative users are encouraged to start PrEP and re-test regularly. For demand creation, the service is promoted online through social media and search engines, and offline through posters and vouchers. No incentives are offered.
Results:
16,753 screening sessions were provided to 12,175 users between Oct 19, 2015 and Jun 7, 2023. 49% of users were male at birth, 45% were aged 15-24 years, 17% reported being MSM or transgender women, and 63% had never tested for HIV. Median (interquartile) time from arrival to reading of test results was 36 (30-44) minutes. >99% reported being satisfied with the self-screening process. 222 (1.7%, excluding those already aware) were newly diagnosed with HIV (50% had never tested for HIV, and 62% were MSM or transgender women), 230 (1.9%) with syphilis, 193 (1.6%) with hepatitis B and 67 (0.5%) with hepatitis C. The relatively high median CD4 count at diagnosis (370 cells/mm3, versus 200 nationwide) and recency assay testing showed that the service is used shortly after HIV acquisition. 95% of users newly diagnosed with HIV subsequently confirmed that they initiated treatment.
Conclusions:
This effective, well-received and affordable system saves time for HCW and users. Associating multiplex tests with IT resources enables the integration of efforts to fight these four chronic infections without additional burden.