i-sense researchers at UCL and Imperial are working on a number of projects in collaboration with Africa Health Research Institute (AHRI) to develop and implement diagnostic tools and technologies for those hardest hit by HIV.
Collaborating with South Africa
Postdoctoral Research Associate in the McKendry group at UCL, Dr Valérian Turbé, says “Through the m-Africa collaboration, which received funding from the Medical Research Council Global Challenges Research Fund in 2016, we have been able to evaluate the feasibility of introducing mobile phone-connected tools to improve access to HIV testing, as well as linkage to care, in KwaZulu-Natal, South Africa.”
South Africa is the country most affected by HIV; almost seven million people are living with HIV and 300,000 new cases of HIV occur each year. The province of KwaZulu-Natal is particularly affected. Forty-five per cent of women attending antenatal clinics have HIV and only half of all people diagnosed with HIV receive care within the following year.
i-sense researchers have been working with different end-users in KwaZulu-Natal to understand how simple paper-based diagnostic tests [lateral flow tests] that use mobile phones for readout, can fit into and help reduce the load on the local healthcare system.
Understanding our end-users
Senior Clinical Lecturer for Infection and Population Health at UCL, Dr Maryam Shahmanesh, says “Initial studies, based on population surveys ran by AHRI, highlight social trends related to the HIV situation in the region.
“These include the high levels of unemployment, as well as mobility and stigma around HIV, particularly in hard to reach groups, such as men. These findings will help shape the design of the online care pathway.”
An ethics application has been put forward to run focus groups with the local population, and key informant interviews with health care workers that will help us gain further information to refine the design of our tools, and understand how they will fit into the HIV testing, prevention and treatment landscape.
“Questions about ownership and usage of smartphones have been added to the routine questionnaire used by AHRI fieldworkers,” says Dr Shahmanesh.
Adapting our technology for the user
The ultimate aim is for our apps to read out HIV test results within minutes and also to interpret already available HIV tests, automatically linking results to a doctor and helping people receive the rapid and regular care that they need.
Chief Information Officer at AHRI, Dr Kobus Herbst, says “Our interdisciplinary team has made progress in the design of mobile applications, with the initial focus on developing an image recognition module, using the mobile phone camera to automatically interpret the results of a lateral flow test.”
“The app will also use machine-learning to classify pictures taken of test results into three categories; positive, negative, and invalid.”
A library of images of the tests currently used by AHRI has recently been built (5000+ pictures of tests taken in the field) to train the model, and a system has been put in place for AHRI field workers to take pictures of the tests they will administer daily, thereby constantly increasing the size of the library and helping to refine the model. An accuracy of 96 per cent was achieved on an initial proof-of-concept model, which will now be optimised and retrained using the new library.
A workflow facilitating smooth synchronisation and backing up was adopted and will allow for the mobile device to sync to a dedicated server when in range of WiFi.
The p24 lateral flow assay developed within i-sense will soon be piloted at AHRI, using approximately 100 patient samples. This pilot study will initially focus on assessing the levels of non-specific binding affecting the readout of negative samples. The reason for this is that non-specific binding could vary (in nature and levels) between patient samples from the UK and South Africa.
m-Africa builds on the expertise and pioneering digital health approaches of the i-sense team. These technologies are being developed for HIV in the first instance, but they can be applied across a range of infections and medical conditions and quickly integrated into the community, empowering patients to manage their own health.
This project is led by Professor of Biomedical Nanotechnology at UCL and Director of i-sense EPSRC IRC, Professor Rachel McKendry, and Director of Africa Health Research Institute Professor Deenan Pillay.