Technology-assisted interventions in the delivery of HIV prevention, care, and treatment services in sub-Saharan Africa: Scoping review

BACKGROUND: Sub-Saharan Africa (SSA) accounts for up to 67% of the global HIV burden yet grapples with health system challenges like distant health facilities, low doctor-to-patient ratio, and poor or non-functioning post-hospital follow-up mechanisms. The rising phone ownership and internet penetration in SSA (46% and 67%, respectively) offer an opportunity to leverage technology to address these gaps and drive toward achieving the UNAIDS (Joint United Nations Programme on HIV and AIDS) 95-95-95 targets. OBJECTIVE: We undertook a scoping review to understand how digital technologies have been integrated into HIV prevention, care, and treatment services delivery in SSA. METHODS: A scoping review involving 4 databases (PubMed, CINAHL, Cochrane, and Google Scholar) was carried out, encompassing studies related to technology use in the delivery of HIV prevention, care, and treatment published from January 1, 2019, to December 30, 2023. Search terms like “telemedicine,” “telehealth,” “mobile health,” “eHealth,” “mHealth,” “telecommunication,” “mobile application,” and “digital health,” among others, were used. Of the 310 papers identified, 11 were excluded due to duplicity, 299 were from outside SSA and the intervention was not well described, and 149 were due to the year of publication and study type being a literature review or study protocols, leaving 17 papers that were considered for the review. RESULTS: From the 17 studies summarized, the technologies identified included social media (n=1), interactive voice response (n=1), hotlines (n=1), mobile apps (n=7), health information systems (n=2), chatbots (n=1), and SMS text messages (n=5). Adolescents (11-14 years) and youths (20-35 years) formed the majority of users. The use cases included reminders on facility events, teleconsultations, patient registration, and health information dissemination, among others. Different parameters of individual digital tools were tracked, including feasibility, usability, adoption, and impact on the desired outcome. CONCLUSIONS: The integration of digital technologies in health care can address the known challenges in the delivery of HIV prevention, care, and treatment services, facilitate customization of care to individual needs, and thus increase or diversify options available to patients.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Social support
  • Health services
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
  • General HIV- population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
  • Treatment
• Prevention
  • Sexual risk behaviour
  • Biomedical interventions
  • Education/media campaigns
• Testing
  • Testing
• Health Systems
  • Delivery arrangements