BILI

Bili is a USSD-based solution that solves the linkage-to-care problem for self-test kit users in resource-limited settings.

Self-testing kits are a useful innovation in healthcare that has greatly improved the way we test and treat diseases, especially those that are easily communicable or associated with stigma. They refer to small and user-friendly diagnostic kits that allow an individual to test for a particular disease in the comfort of their home. Early evidence has shown that the deployment of rapid COVID-19 self-testing kits in the ongoing pandemic is improving access to testing, reducing the burden on healthcare systems and helping mitigate viral transmission by facilitating frequent testing, rapid results, and immediate isolation.

As a part of a holistic healthcare strategy, however, self-testing has to be supported by a system whereby users can be quickly and efficiently linked to the broader healthcare infrastructure. Uptake and linkage to care are important metrics that health institutions use to make important decisions about their healthcare interventions. This presents a major problem in Africa where access to healthcare is very limited and the current hi-tech linkage systems (often app or website-based) such as those used in the COVID-19 example above, are not feasible due to low internet and smartphone coverage. 

The integration of Self-testing in HIV eradication programmes in Africa has the potential to greatly impact the millions of lives that are affected by the disease, especially adolescents and young people (aged 15 - 24) who are at the most risk of contracting HIV/AIDS. Efforts by multinational research consortiums and ministries of health have, however, been met with the same difficulties with linkage to care. At the moment, they are forced to use capital and human-intensive strategies such as desk contact workers and physical vouchers to obtain vital uptake and linkage data. This presents a problem of scalability and cost-effectiveness and limits the ability of the government to make data-driven decisions which are critical to slowing down and ultimately eradicating the HIV pandemic in Africa.

We use USSD and data management tools to make self-testing a more feasible healthcare solution for people in low and middle countries

Bili facilitates linkage to care between self-testing kit users and the healthcare system through a low-tech system that is specifically designed for resource-limited settings. It combines USSD, database management and web application software into a novel system with low-tech entry at one end and powerful data management options at the other. In our system, each kit has a unique code which users dial on their GSM-enabled phone and input vital demographic information such as age, sex and location before getting the result interpretation and their choice of contact. On the backend, their contact and demographic information in addition to their result are stored and displayed on a user-friendly dashboard that is only made available to authorised entities, for easy follow-up. This dashboard presents an unprecedented opportunity for health institutions to track, collate and visualise self-testing data in real-time.

Bili has been applied to HIV Self-testing (HIVST) and is undergoing evaluation in a nationwide randomised controlled trial (RCT) in Nigeria as the underlying technology for the I-TEST (Innovative Tools to Expand HIV Self-Testing among young people in Nigeria) project led by experts from the University of North Carolina Chapelhill, New York University and the Nigerian Institute of Medical Research. Research facilitators on the ground indicate anecdotally that so far, Bili has improved the uptake of HIV self-testing kits with over 1,000 users; and project supervisors say that the Bili dashboard has made tracking and linkage much more feasible.

With a GSM penetration rate of 82% as opposed to the poorly distributed 43.1% internet penetration in Africa as of 2021 (GSMA, STATISTA), Bili presents a practicable solution to unlock self-testing as a valuable tool in healthcare institutions' repertoire.

Bili targets adolescents and young people (aged 15 - 24) living in Sub-Saharan Africa who are at the most risk of contracting HIV/AIDS. Only recently have global efforts been directed to the individuals in this age group who are disproportionately affected by this debilitating disease. HIV self-testing has emerged as a valuable strategy to meet the needs of this hard-to-reach population and the privacy (among other factors) that HIV self-test kits offer has been shown to improve uptake and consequently testing among this key age group. Bili fills an important gap by providing a feasible means through which they can be quickly and efficiently linked to life-saving care.

Our team is composed of dynamic young persons with over 15 years of combined experience cutting across Medical practice, technology and business development. Our team lead, Kelechi is a medical doctor and Rhodes Scholar-Elect who has experienced first-hand the risks of late diagnosis and treatment. He works with the National Institute of Health as a member of the Adolescent Bioethics Working Group under PATC3H-IN (Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected adolescents in resource-constrained settings - Implementation Science Network). This network is focused on encouraging adolescent and young person (AYP) participation in HIV research by improving informed consent processes. He is also a Youth Advisory Board Member of the I-Test (Innovative Tools to Expand HIV Self-Testing among young people in Nigeria) project at the Nigerian Institute of Medical Research through where he has over 4 years of experience designing and implementing health solutions targeted at young people in Nigeria.

Mesoma, our strategy lead, is a medical doctor and award winning essayist who, on a daily basis, faces the implications of poor medical record collection and management in Nigeria's Healthcare system. She has over 3 years' practical experience in implementing and evaluating healthcare interventions in hard-to-reach areas in Nigeria.

Ponmile, our business development lead, has over 5 years of work experience as a business developer in healthcare and has led the development of innovative products including telemedicine, Electronic Health Records and facilitated several partnerships for equitable healthcare.

Eniola, our technical lead, has over 7 years of software development experience as a full-stack developer. He is passionate about solving African and global challenges using technology.

Our team possesses the necessary skills and is uniquely positioned at the nexus of the government, research and private sectors. Bili represents a solution that was birthed from our own target population and we are poised to scale our working solution to impact the lives of millions of young people.

 We have done and are currently doing detailed research with our users. During the development of the solution, we collected qualitative data from our local target audience and used this insight to inform the final pilot design. This product pilot is undergoing testing in a nationwide randomised controlled trial and user feedback is actively being collected. We currently have over 1,000 users. We have also begun research on our key clients - the implementing organisations and government agencies that are HIV Self-Testing stakeholders in Nigeria, and are in the process of deploying HIV self-testing solutions

Our solution applies an approach that is specifically tailored to our target audience and fills a clear and important gap. It does this by linking simple technology which ensures access to hard-to-reach areas with more complex systems that enable a broad range of useful options. We expect to unlock the potential of self-testing kits in resource-limited settings by making them both more financially viable and comprehensive.

For the first time, health institutions in resource-limited settings will see, in real-time, the use of self-test kits and be able to make timely data-driven solutions. We also provide a secure means of data collection and act as a ‘data control panel’ for kits that will be deployed from multiple private distributors thereby solving a problem of information security before it even arises.

Bili has, so far, been used by over 1000 young people, and we plan to get to 5,000 within the next year following the completion of the randomised controlled trial this year and the deployment of self-testing kits by several organisations. We plan to achieve this by improving the features of the solution using feedback from the trial and reaching out to stakeholders in the self-testing sector who are in the process of deployment such as dkt and jhpeigo (Johns Hopkins Program for International Education in Gynecology and Obstetrics.)

Bili is a new application of existing technology with high-tech and low-tech components. The USSD is linked to our database (firebase) through a ussd service provider (Africa’s Talking) that allows for interactivity on the user end and storage and retrieval of information on the back end. This data is then displayed on a user-friendly dashboard that will only be available to people and institutions with authorised access.

Currently serving over 1000 people

Total number of people to be served next year: 5,000

The major barriers our solution currently face are financial and market-based. More financial resources will enable us to improve our solution and prepare it for larger-scale use. We also face the issue of access to key large-scale stakeholders within the self-testing sector who are interested in deploying in resource-limited settings.

We currently partner with the I-Test (Innovative Tools to Expand HIV Self-Testing among young people in Nigeria) project at the Nigerian Institute of Medical Research to facilitate linkage to care of adolescents and young people aged 15-24 in Nigeria.

SaaS (Software as a Service) business model targeted at test kit distributors as well as government service contracts.

We currently work with implementing organisations and share donor funds to improve the impact of their solution. As the market becomes self-sustaining and for-profit companies buy in, we intend to deploy a SaaS business model with implementing organisations as our key clients in collaboration with the Ministries of Health. We’ll also work with service contracts from the government to provide collated health data on the use of the self-testing kits in their respective constituencies.

Through dynamic stakeholder engagements, we will keep our clients engaged and offer competitive value to retain and grow our market share.