BACKGROUND: HIV testing is the first step for linkage to HIV prevention or treatment services. Facility-based HIV testing is the most utilised method, but faces challenges such as limited work space and human resources. Digitally supported HIV self-testing (HIVST) provided in clinics shifts testing to the client, potentially empowering the client, and addresses such constraints OBJECTIVES: The study primary objective was to determine the feasibility of integrating digitally supported HIVST into the clinic. Secondary objectives were to describe HIV testing volume, populations reached, and antiretroviral treatment (ART) initiation METHOD: We conducted an analysis of prospectively collected data during implementation of digitally supported HIVST in two healthcare facilities based in South Africa from June 2019 to September 2019. We described implementation and client characteristics using HIVST and compared testing before and during implementation RESULTS: During the 4-month implementation period there were 35 248 client visits. A total of 6997 (19.9%) of these visits involved HIV testing. Of those testing, 2278 (32.5%) used HIVST. Of the 2267 analysed, 264 (11.6%) were positive: 182 (12%) women and 82 (11%) men. Of those, 230 (95.4%) were confirmed HIV positive and 150 (65%) initiated ART within 14 days. During a four-month pre-implementation period, 14.5% of the clients tested for HIV. Compared to the pre-implementation period, we observed a 25% increase in HIV testing CONCLUSION: Digitally supported HIVST increased the number of clients completing HIV testing in the health facility, without a need to significantly increase staff or space. Facility-based digitally assisted HIVST has the potential to increase HIV testing in high HIV prevalence clinic populations

BACKGROUND: Human immunodeficiency virus self-testing (HIVST) can reduce facility-based HIV testing barriers; however, no proven applications exist with widespread uptake for self-reporting or linkage to care. Mobile health (mHealth) applications (apps) have shown high usability and feasibility scores, so Ithaka was developed for South Africans to self-report HIVST results outside clinical settings. OBJECTIVES: This study investigated the use of Ithaka as a support tool for HIVST users, specifically the ability to self-report results. METHOD: This cross-sectional study was conducted from November 2018 to June 2019. At existing HIVST distribution sites, individuals were given HIVST kits and then invited to use Ithaka. Participants could test at home and report their results through the app anytime. Ithaka tracked when people logged-on, registered, received counselling and reported results. Post-study surveys on user experience were also conducted. RESULTS: Of 751 participants, 531 (70.7%) logged onto the app, 412 (54.9%) registered, 295 (39.3%) received counselling and 168 (22.4%) self-reported results. Participants strongly agreed that Ithaka was useful and that it was easy to upload results. Forty-one participants completed a post-test survey, and 39/41 (95.1%) completed the app journey. Most participants (36/41;87.8%) had no challenges, although 2/41 (4.9%) cited perceived data costs, 2/41 (4.9%) difficulty uploading results and 1/41 (2.4%) language, as challenges CONCLUSION: Despite the small sample size, this study has shown that HIVST participants under pragmatic conditions were willing and able to self-report results via the app, whilst also identifying areas of improvement for scaling up.

RESUMO Este artigo analisa a relação entre diferentes formas de accountability no contexto do Subsistema de Atenção à Saúde Indígena do Sistema Único de Saúde (SASI-SUS), por meio de um estudo de caso do Distrito Sanitário Especial Indígena (DSEI) do rio Negro, localizado no estado do Amazonas. A partir de um episódio de mobilização indígena iniciado após um surto de malária no DSEI, o estudo aponta alguns dilemas fundamentais decorrentes da incorporação de lógicas conflitantes de accountability ao desenho do SASI-SUS.

ABSTRACT This article discusses the interplay of different forms of accountability in the context of the Indigenous Health Subsystem of Brazil’s Unified Health System (SASI-SUS), via a case study of the Rio Negro Special Indigenous Health District (DSEI-ARN) in the State of Amazonas. Focusing on a case of indigenous mobilisation triggered by a malaria outbreak it highlights some of the underlying dilemmas that derive from the embedding of conflicting accountability logics within the architecture of the SASI-SUS.

RESUMO Mudanças econômicas e geopolíticas recentes obrigaram os países membros da OECD-DAC a reconhecer mais claramente as atividades de cooperação dos BRICS e de outros poderes emergentes que alegam seguir uma lógica diferente daquela dos modelos de transferência coercitiva de políticas públicas associados à cooperação Norte-Sul para o desenvolvimento. Também tem havido um rápido crescimento do “aprendizado recíproco” fora do arcabouço formal da cooperação para o desenvolvimento. Este artigo explora as implicações deste processo para a difusão internacional de políticas públicas na era do desenvolvimento “universal” imaginado pela Agenda 2030 da ONU.

ABSTRACT The economic and geopolitical shifts of recent years have forced the oecd-dac member countries to offer greater recognition to the development cooperation activities of the BRICS and other rising powers, who claim to follow a different logic from the coercive policy transfer models associ ated with North-South development cooperation. At the same time, there has been rapid growth in international “mutual learning” outside the formal framework of development cooperation. This paper explores the implications of this for international policy diffusion in the age of “universal” development envisaged by the UN’s Agenda 2030.

This article provides an overview of governance arrangements and changes in the Brazilian public health system since 1988, when the "Citizen's Constitution" declared health to be a universal right. Since then, population coverage has grown substantially and health indicators have improved. Despite these achievements, inequities in access remain an important barrier to universal coverage, in particular for marginalized groups such as indigenous peoples. This article discusses the innovation cycle that produced the gains and recent efforts to guarantee more equitable access to health services for the indigenous population in a continent-sized country historically plagued by great inequalities.