July 31, 2018
Written by Dr. Jane Thomason and Lauren Weir, Abt Associates
Frontier technologies including blockchain, big data, artificial intelligence, biometrics, and machine learning present powerful potential ways to address difficult development and health challenges. At this year’s 2018 AIDS conference, a satellite session sponsored by Abt Associates and our partners discussed how such technologies have shown promise and could accelerate the prevention of HIV transmission.
In particular, these solutions can help provide HIV-related services to hard-to-reach populations such as long-distance truck drivers and female sex workers. Both groups are key reasons for the persistence of HIV transmission. Estimates from 2014 and 2016 in South Africa, for example, indicate the truck drivers have an HIV prevalence of 56 percent while the figure for female sex workers is 90.6 percent., The population is challenging to reach because it is difficult to create demand, and traditional services are not targeted toward these groups.
The new technology solutions could help lower those disturbing rates in a variety of ways. They can help improve continuity of care, data access, targeting for programming and design, reliability of supply chains, and funds movement. Blockchains combined with biometrics can protect portable identities and privacy and improve the interoperability of health records. One means of ensuring continuity of care would be provision of a unique digital identity linked to an electronic personal health record in clinics and care points along trucking routes. That would enable truckers to have confidential access to care in multiple locations and even multiple countries.
Blockchains also can benefit supply chains for antiretroviral therapies. Blockchains rely on sophisticated algorithms to create unbreakable codes and consensus rules for a distributed ledger—a file much like a database–that reflects transactions or transfers of assets (blocks) in chronological order (the chain). Blockchains can ensure continuous supplies of needed medicines in various ways:
Donors can cut costs and improve targeting with blockchain digital smart contracts.  Smart contracts are computer programs that act as pre-programmed agreements that self-execute and self-enforce. The contracts eliminate the time, costs, and leakage associated with middlemen. They can track the location of aid in the supply chain and ultimate delivery. A smart contract can automatically pay a healthcare provider after the provider notes in an electronic medical record that it has delivered the service, and the patient confirms receipt of the service. The patient would use a blockchain-enabled identity for the confirmation. The blockchain also can provide a record of care achieved through the funding.
Thoughtfully tailored to local contexts, these technologies can help address a wide array of current challenges. Thought leaders also need to consider the role of technology in tackling longer term issues. They include building local digital capacity, education of governments and donors about the benefits of technology, and building partnerships and conversations with ecosystems that have not been part of the discussion in the past. Thought leaders also must develop a taxonomy, standards, and governance for ways to protect the vulnerable. Abt Associates looks forward to continuing this conversation with our donors, partners, governments, and our colleagues on the ground who work every day to reduce HIV transmission.
 Delany-Moretlwe S, Bello B, Kinross P, et al. HIV prevalence and risk in long-distance truck drivers in South Africa: a national cross-sectional survey. Int J STD AIDS. 2014;25:428–438.
 Grasso M, Manyuchi AE, Osmand T, et al. High HIV prevalence and low health service access and utilization among mobile populations along the N3 highway in South Africa [abstract] In: 21st International AIDS Conference; 2016. July 11–22; Durban, South Africa: AIDS 2016; Abstract Nr A-792-0243-06260.