A digital health initiative launched in wartime Ukraine appears to have reached people at elevated risk of HIV and steered them toward testing and care services at a cost per potential case identified roughly 40 percent below modeled national estimates, according to an evaluation published in BMC Digital Health. The intervention, called TESTporuch, which means “TEST nearby,” combined a Telegram-based chatbot, a multi-landing website and targeted digital advertising campaigns, and operated from August 2022 through January 2025 while the country’s health system was under severe strain from the full-scale invasion.
The evaluation, led by researchers including Hlib Aleksandrenko of the State Enterprise Center of Public Health of the Ministry of Health of Ukraine, analyzed user interaction data, website analytics and project documentation against the World Bank’s framework for the economic evaluation of digital health interventions. Because war-related restrictions prevented the team from accessing clinical HIV registries, the study relied on an exploratory proxy measure: transitions of users from the testing-promotion chatbot to a separate chatbot called ARTporuch, which is designed specifically to connect people living with HIV to antiretroviral therapy and related services. The authors stress that this proxy does not represent laboratory-confirmed HIV diagnoses and should be interpreted with caution.
The reach of the intervention was substantial. Two sequential digital communication campaigns delivered more than 31.9 million impressions and generated 191,511 clicks across target audiences. The multi-landing website, launched in April 2023, recorded 195,496 users through January 2025, with population-specific interfaces for key populations accounting for 63.7 percent of total traffic. The chatbot itself, launched in August 2022, was accessed by 4,968 unique users, of whom 93.4 percent completed the initial screening phase. HIV infection risk was identified in 50.8 percent of users, and 8.7 percent self-identified as members of key populations.
The central effectiveness finding concerned conversion between the two chatbots. Among the 4,640 users who completed initial screening in TESTporuch, 3.15 percent, or 146 users, subsequently registered with ARTporuch. Conversion rates varied sharply by user category. Users with an identified HIV risk converted significantly more often than those without identified risk, at 3.84 percent versus 2.31 percent, corresponding to a relative risk of 1.66 with a 95 percent confidence interval of 1.18 to 2.33. Members of key populations converted at 7.91 percent compared with 2.66 percent among non-members, a relative risk of 2.97 with a confidence interval of 2.05 to 4.31. The highest conversion rates were observed among former prisoners at 14.29 percent, people who inject drugs at 10.81 percent, men who have sex with men at 9.62 percent, and partners of people living with HIV at 7.69 percent.
Communication campaigns appeared to amplify these outcomes. The first campaign, running from April to July 2023 and aimed at the general population, coincided with conversion rates that climbed to 4.7 percent in summer 2023, a 24 percent improvement over the preceding winter period. The second campaign, from March to June 2024, targeted key populations specifically, including female sex workers, men who have sex with men and people who inject drugs, and was associated with conversion rates of 3.3 to 4.4 percent in spring and summer 2024, a 132 percent increase relative to the winter 2023 to 2024 baseline. The campaigns also boosted key population engagement by 17 to 48 percent, and the second campaign increased HIV risk identification among users by 6 percent. Notably, the first, general-population campaign showed limited conversion effectiveness and was associated with an 8 percent decrease in risk identification, while the key-population-targeted second campaign performed substantially better.
Geographic patterns reflected the realities of the conflict. Chatbot usage concentrated in central and western regions, with Kyiv city showing the highest engagement, followed by Lviv, Kyiv Oblast and Dnipropetrovsk Oblast. Southern and eastern oblasts with the most temporarily occupied territories, including Donetsk, Luhansk and Kherson, showed substantially lower usage. Interestingly, conversion rates did not simply mirror usage: Donetsk Oblast achieved a 10.5 percent conversion rate and Mykolaiv Oblast 9.3 percent despite lower absolute numbers, while Cherkasy Oblast recorded the highest rate among major regions at 11.7 percent. Kyiv city, despite the largest absolute number of conversions, had a relatively low conversion rate of 2.2 percent.
The cost analysis broke expenditure into a creation stage, covering preparation, development and launch, and a maintenance stage covering operation and updates. Total implementation cost amounted to 94,962 US dollars, of which capital expenditures accounted for 11.2 percent and operational expenditures 88.8 percent. Communication campaigns were the largest expense category at 67,000 dollars, or 70.6 percent of total costs, followed by project management at 9.2 percent. Technical services dominated spending by resource type at 75.1 percent, with human resources at 24.3 percent and software subscriptions at just 0.6 percent. Dividing total cost by the 146 proxy-identified cases yielded 879.63 dollars per case, which the authors report is approximately 40 percent lower than modeled national estimates of the cost per HIV case identified for 2022 to 2024, with the caveat that the comparison rests on the proxy outcome.
The authors contextualized their proxy conversion rate against national HIV positivity statistics from Ukraine’s national epidemiological monitoring system. The overall proxy conversion rate of 3.15 percent exceeded the average national HIV positivity rate of 0.68 percent for 2022 to 2024, and the key population conversion rate of 7.91 percent exceeded the corresponding national estimate of 3.06 percent. However, the study is explicit that these measures are not directly comparable. National positivity rates are calculated from laboratory-confirmed results among all people tested, including routine and clinically indicated testing, whereas TESTporuch users form a self-selected, risk-motivated population, not all of whom completed HIV testing. National statistics for the same period may even include TESTporuch users themselves, which could partially double-count and underestimate the difference. The comparisons are therefore presented for context only and do not constitute direct evidence of superior diagnostic yield.
Several limitations shape how the findings should be read. The proxy measure likely underestimates effectiveness, since many users may have accessed HIV testing services without ever registering with ARTporuch, which is not mandatory for people diagnosed with HIV. By September 2025, ARTporuch had approximately 4,500 users in total, a small fraction of new HIV cases registered nationally, suggesting only a minority of newly diagnosed people use that platform. Approximately 20 percent of Ukraine’s territory, home to an estimated 3 to 3.5 million people, remains under temporary occupation, limiting chatbot accessibility and creating geographic disparities. The digital divide, worsened by electricity outages, internet limitations and varying digital literacy, likely introduced selection bias. The study also focused on implementation outcomes rather than clinical endpoints, so impacts on HIV transmission, viral suppression and mortality could not be assessed, and financial data for HIV testing interventions after 2021 were unavailable, requiring cost modeling based on pre-war estimates.
Ukraine’s HIV context underscores why such tools matter. The country had the second-highest rate of newly diagnosed HIV infections in the WHO European Region in 2021, at 37.1 cases per 100,000 population, and of approximately 245,000 people living with HIV as of early 2022, about one-third remain unaware of their status. The war has damaged more than 1,000 health facilities and displaced millions, disconnecting thousands of people living with HIV from regular care. The authors conclude that TESTporuch demonstrated promising outcomes and cost-effectiveness, particularly in engaging key populations, and suggest that digital health initiatives may serve as a complementary component, rather than a replacement, of healthcare delivery strategies in conflict-affected and resource-limited settings, provided campaigns are strategically planned and precisely targeted.
Subject of Research: Evaluation of a chatbot-based digital health intervention promoting HIV testing in war-affected Ukraine
Article Title: Digital health initiative for HIV testing promotion in war-affected Ukraine: effectiveness evaluation
Article References: Aleksandrenko, H., Chervak, O., Krasnikova, K., Shevchenko, M., & Yurochko, T. (2026). Digital health initiative for HIV testing promotion in war-affected Ukraine: effectiveness evaluation. BMC Digital Health, 4(1), Article 78. https://doi.org/10.1186/s44247-026-00311-7
Image Credits: AI Generated
DOI: 10.1186/s44247-026-00311-7
Keywords: digital health, HIV testing, Ukraine, chatbot, war-affected settings, cost-effectiveness, key populations, communication campaigns, ARTporuch, public health, humanitarian crisis, Telegram
News Source: Denise Maddox. (October 27, 2026). Chatbot-driven HIV testing campaign shows promise in wartime Ukraine. Scienmag.
