Brent Allan, ILF Civil Society member
Digital technologies offer great potential to completely change access to healthcare. However, the digital revolution is rolling out amid increasing disparities. While low- and middle-income countries face poverty and inequity of access to technology, high-income countries are where the most focus and investment in digital innovations take place.
This came under the spotlight at the IAS Industry Liaison Forum (ILF) and UNAIDS satellite session at IAS 2021, “Will the revolution be digital and leave no one behind? Lessons learned from COVID-19”. The session explored how digital technologies can be best developed and implemented to improve the HIV continuum of care, in particular in low- and middle-income countries. It looked at how emerging health technologies could transform equitable access to health services and drive progress towards the Sustainable Development Goals.
To open, we heard from community voices on the aspirations of the global community about how digital interventions could be used to advance prevention, treatment and care in HIV.
The session Co-Chairs, ILF Co-Chair Anton Pozniak and UNAIDS Director of Innovation Pradeep Kakkattil, sought to frame the conversation to highlight the challenges and opportunities of the new digital revolution.
Kakkattil posed perhaps the most singularly perplexing question: who benefits most from the digital revolution?
Kakkattil reminded us that as digital tools (many of which have already been adopted due to COVID-19) begin to roll out and scaled, we must remain focused on ensuring that access to healthcare services remains central and that the principles underlying the success of these digital technologies are sustained past the COVID-19 crisis.
Pozniak spoke about the recent work of the ILF and the 10 principles it identified as underpinning advances made in digital technological innovations during the COVID-19 pandemic.
Three live polls were conducted during the session. They pointed to was strong agreement that digital tools have helped continuity of access to HIV prevention and care services during the COVID-19 pandemic and strong support that we continue to use digital tools for HIV prevention and care even after the COVID-19 crisis.
Access and confidentiality remain the two most critical concerns about the use of digital tools for HIV prevention and care.
A panel discussion followed the polls, with five panellists covering a wide array of issues with the question: How do we ensure that no one is left behind in the digital revolution?
Apart from what was captured in the word cloud image, other issues demanded attention. Among them:
People are not drawn instinctively to apps. We need to work with the major software platforms if we are to make real change.
"People are not using apps. Many people are going to Google, Facebook, video gaming apps and reaching out to friends and peers for health information. What are they accessing there and how are we engaging with those platforms?" – @IHEID's Sara LM Davis
What we have achieved in the past year is something we would have expected to achieve in 10 years. We need continued collaboration.
"Within #HIV, we need to see the private sector more broadly than Pharma and diagnostics companies, so that other sectors like mobile tech and IT are involved too. We need partnerships and collaboration." – @ViiVHC's Helen McDowell
"For me, I fear the people that will be left behind will be the world's most vulnerable ... The rich will have access to several of these technologies, others won't." – @UNAIDS Pradeep Kakkattil
Investing resources in tools that the community feels no ownership of is wasteful and unwise.
"Innovations will have greatest impact if they are adapted to settings with demonstrable need and accessible to those who need them most." – @AntonPozniak
Behind the success of any useful tool remains the literacy on how to use it.
How do we ensure no one is left behind? "We can't forget people who are not used to smartphones. People need to be able to talk to their doctors, and vice versa, simply." –@portaltelemed Rafael Figueroa
We need to ensure that new technologies have buy-in from governments and are adopted locally.
How do we ensure no one is left behind? "Clients need to be involved and participate, not just in development but in implementation. And we need to adapt to the local contexts and languages." – @EGPAF's Nick Hellmann
Digital tools are meaningless without infrastructure support.
"We have to make sure that apps are adapted to local contexts and languages, with the ongoing technical support and maintenance for those tools so that they are sustainable through time." – @EGPAF’s Nick Hellmann
The imperative, DOES NO HARM, must be built into the design, application and utility of the tool.
"We need to ensure confidentiality of the data so that the information of the client is maintained. We also need to ensure the cost of connecting is not prohibitive. And that tools are cost-effective, we all want value for money." – @NEPHAKKENYA's @rahabmwaniki
What struck me most profoundly was the discussion about who controls the access to deliver new technologies and the knowledge to relay critical “how-to-use” information.
Today we call these personnel “admin”. In the healthcare sector, we often call them “nurses”.
In our digital revolution, we must consider a new role: the digital health worker. This is the person who advises the user how to use the tool, why it is being used, how it can improve their health and why it’s important.
Think about it: chances are that when you were first given a jar to pee into, told how blood would be drawn or told what test results mean, you had a healthcare worker at your side.
The digital revolution demands a new skill and a new type of worker who can walk you through the app to allay your fears, explain the basics and help you understand how to input, extract and interpret your data in a context of profound interconnectivity.