In Almaty, Kazakhstan, if a person wanted to get tested for HIV, they used to have to go through the process of blood testing, which was often time-consuming, inconvenient, and for some, indiscreet. Thanks to a collaboration between ICAP at Columbia University, the Almaty AIDS Center, and local community NGOs, people living in Almaty can now receive an HIV test free of charge, anonymously, and with a simple click of a button.
With support from the Elton John AIDS Foundation, ICAP in Kazakhstan, the Almaty AIDS Center, and local NGOs launched an online self-test service – the website hivtest.kz – in early 2022 so that clients can access a convenient, anonymous HIV self-testing system. Clients simply go to the website and choose where they would like to pick up the HIV test kit based on a series of location options. The package they receive contains one OraQuick HIV Self-test and various informational materials about HIV and infection prevention methods in Kazakh and Russian. Clients are not required but are encouraged to submit their test results through the website, as in the event of a positive test, the online service coordinators provide the client with assistance and support in next steps for treatment and care. All information related to the client’s identity remains confidential and anonymous.
In 2021, 3,500 adults and children were newly infected by HIV in Kazakhstan, and 80 percent of people living with HIV knew their status. While immense progress has been made in recent years to provide lifesaving HIV prevention and treatment services to the people of Kazakhstan, there is a continued need to close gaps in access to those services as well as to reduce stigmatization surrounding HIV acquisition.
“Levels of stigma towards people who use drugs, men who have sex with men, transgender persons, and sex workers are still present in Almaty, including among health care workers,” said Anna Deryabina, MD, DrPH, MScIH, ICAP regional director in Central Asia. “Fearing stigma, people from key populations, especially those who are younger, are often hesitant to utilize traditional facility-based HIV testing. NGO-based assisted HIV testing options aimed at key populations are also not always acceptable as they often imply self-reporting certain behaviors. Rapid HIV tests can be procured from some private pharmacies in Almaty, but they are expensive and unaffordable for many. These factors lead to delayed diagnosis and treatment initiations. The more testing options we provide, the more chances there are that people with elevated risk of HIV acquisition will undergo regular HIV testing.”
Crucial to developing the web application was setting up the supply chain for ordering and delivering HIV self-tests to pick-up sites. ICAP, in collaboration with the local private pharmacy network Sadykhan, the Almaty Model of HIV Epidemic Control, and public organizations such as Community Friends and Revansh, organized a small launch campaign to promote the online service, which included posting about it on social networks and in various nightclubs popular among key populations.
Ekaterina Skurat, head of the Sadykhan pharmacy sales department, said the value of the online service centers on its ability to give people living in Almaty more than one option in accessing HIV health services.
“When ordering a test from the online system,” Skurat said, “a person can choose a delivery method that is convenient for them – either through community-based organizations such as Community Friends or Revansh, self-service kiosks, or pick it up at one of our pharmacies that works around the clock.”
The online service has only been live since the start of 2022 but is already successfully garnering attention from key population groups. Close to 500 people have ordered HIV tests through the platform thus far, with five people testing positive.
“Since the launch of the platform, the number of orders has increased significantly,” said Aliya Bazarbekova, a coordinator of the online platform from the Almaty AIDS Center. “We now receive from 6-10 applications daily! Considering that we did not conduct any large promotion campaigns yet, I think this is an excellent milestone. Our customers appreciate the efficiency and convenience of the service and are grateful for the opportunity to order tests without leaving their house.”
This online service complements another web-based platform that ICAP in Kazakhstan has initiated for people who have tested positive for HIV to send anonymous messages to partners. Through the website www.sms.icapapps.kz, a person who knows their HIV+ status can send an anonymous short message to their past and current partners to notify them about possible exposure to HIV. Individuals are then provided a link to the anonymous HIV self-test website so they can easily access testing services.
To continue to improve access and actively respond to the evolving ways in which people receive information and services, ICAP in Central Asia is introducing a variety of innovative online systems for HIV treatment and care. As a next step, ICAP is working to develop a TelegramBot – an online interface – with individual and group chat functions for people living with HIV. The TelegramBot will aim at improving HIV treatment adherence by providing alternative ways for people to communicate with providers, receive counseling, and participate in peer-support groups. The program will open the door for more HIV services to go digital, making them more accessible and acceptable to many people living with HIV.
ICAP will launch similar online HIV testing services in Bishkek, Kyrgyzstan, and Dushanbe, Tajikistan in August 2022 with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
A major global health organization that has been improving public health in countries around the world for nearly two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 30 countries and is working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies.