Digital Health Initiative for HIV Testing Promotion in War-Affected Ukraine: Effectiveness Evaluation

Abstract Background: With approximately one-third of Ukrainians living with human immunodeficiency virus (HIV) unaware of their status, the ongoing military conflict has severely disrupted healthcare delivery, creating significant barriers for HIV testing and care engagement. Digital health initiatives have emerged in response to humanitarian crises, but their effectiveness still requires evaluation. This evaluates the effectiveness of a digital health intervention to promote HIV testing among war-affected Ukrainians. Methods: This study examined the outcomes and costs of TESTporuch ('TEST nearby'), a digital health intervention that integrates a messenger-based chatbot, a multi-landing website, and digital communication campaigns to evaluate its effectiveness. Data on user interactions with the chatbot, website visitors, and communication campaign metrics from August 2022 to January 2025 were analyzed along with project documentation. The conversion from TESTporuch to ARTporuch (a specialized chatbot that connects people living with HIV to antiretroviral therapy and related services) served as a proxy for HIV-positive cases, enabling the calculation of HIV positivity rate and cost-effectiveness for comparison with national estimates reflecting the overall effectiveness of HIV testing interventions nationwide. Results: The digital communication campaigns generated 32,982,883 impressions, while the multi-landing website engaged 179,072 visitors. Among 4,968 unique chatbot users, 93.4% completed the initial screening phase, HIV infection risk was identified in 50.8% of users, and 8.7% self-identified as key populations. Overall, the digital health intervention demonstrated a HIV positivity rate of 3.15%, exceeding the national average by 363%. The interventions surpassed the national average twice in engaging key populations, which also demonstrated conversion rates of 7.91%, surpassing the national average by 159%. The digital health intervention has a total cost of $879.63 per HIV case identified, 40% lower than the overall national estimates from HIV testing interventions. Digital communication campaigns increased conversion effectiveness up to 132% and boosted key population engagement compared to non-campaign periods. Conclusions: The TESTporuch digital health intervention demonstrated promising outcomes and cost-effectiveness in promoting HIV testing among war-affected Ukrainians, particularly engaging key populations at high risk. The findings suggest that similar digital health initiatives may constitute an effective component of healthcare delivery strategies in conflict-affected and resource-limited settings for vulnerable communities.