A new human-centred packaging system for ARV medication in Africa

A new system for the packaging of AIDS-related virus medication in Sub-Saharan Africa thinks more holistically about the user's needs.

The winner in the AfricaPack category of the RSA Student Design Awards is Positive Future: a packaging design, awareness campaign and mobile network support system for patients taking HIV medicines in Africa. The system targets both the usability of the medication and the stigmas that surround the illness it treats.

The Africapack design category, sponsored by GSK, called for students to submit designed that improve the way medicines are protected, dispensed, distributed and taken in Sub-Saharan Africa. The winner of the awards this year was Positive Future – a packaging design, awareness campaign and mobile network support system for patients taking HIV medicines, designed by industrial design students Megan Sands and Sarah Twaddle from the National College of Art and Design in Dublin. 

The challenges for pharmaceuticals in Africa are quite different from those in the west; illiteracy is high in certain countries and areas, which may call for image heavy instructions; hot and humid climates put added demands on the packaging; dosage for children of different ages and sizes has to be clear without the need for knowing accurate height and weight; and the experience of the patients in overcrowded clinics is often impersonal and lengthy. 

The Positive Futures system has user-friendly packaging, providing all the necessary information but removing any indication that the medication is for AIDS-related viruses (ARV). This shows sensitivity to the stigma that AIDS still has in African nations. The packaging also presents a personal story of an HIV positive “ambassador” to reassure the patient they are not alone. The system also only requires patients to take one pill per day, which reduces the likelihood of incorrect dosage. 

We talk to designers Sands and Twaddle about their winning design. 

Can you explain how the Positive Future system works? 

Positive Future is an innovative packaging design, awareness campaign and mobile network support system for Triumeq anti-retroviral medication in Sub Saharan Africa.

Positive Future uses Triumeq, a combination pill containing three active drugs. One tablet is taken once a day. Reducing the number of pills patients have to take lowers the risk of pills being forgotten or taken incorrectly.

Positive Future modifies the experience of taking ARV medication by reworking the packaging design into a new, more human-friendly solution. 

Our design contains the necessary medical information, but also allows the patient to remove the exterior information sleeve so it is no longer recognisable as an ARV drug. Our research proved that the stigma is cultural, and unlike in Ireland, is deeply rooted in character and societal standing. Therefore, we have created a way for patients to medicate discreetly and reliably.

The packaging contains a loaded dispenser and three refill sachets of seven pills, which should be replaced accordingly. The dispenser is a small device, which can be carried discreetly with the patient while ensuring the medication is protected.

We have included the story of a HIV+ ambassador to let patients know they are not alone. This story is to remind patients that they will live a normal life with treatment of their disease. The packaging informs the patient of the mobile support network which connects the patient to their doctor and provides them with a helpline if they notice symptoms of a hypersensitive reaction.

Positive Future is supported by an awareness campaign called Stop the Stigma. Posters and billboards will be displayed in towns and cities to educate society and encourage people to be more accepting of those who are HIV+. 

What is the aim of Positive Future?

The aim of the project is to create a much more human-friendly approach to HIV medication packaging by targeting the negative stigma associated with HIV and the mental health issues that surround the disease, which are seldom talked about. The Mobile network system closes the gap between patients living in rural areas and doctors. It provides easy access to information and help for both the patient and the doctor in a range of different languages. This network also collects data which can help regulate unpredictable supply and demand.

Where do you imagine it being used?

We decided to focus on the country of Botswana for the duration of the project. However, the concept has the potential to be generally applied throughout Africa and the rest of the world. We focused our design on Triumeq medication as it is one of only four antriretroviral medications currently available in single tablet form. Triumeq is a combination of three existing HIV medications into a single, once-daily pill. It consists of the integrase inhibitor dolutegravir (sold separately as Tivicay) and the NRTIs abacavir (Ziagen) and lamivudine (Epivir, 3TC). Coincidently in the beginning of June 2016 ViiV Healtthcare announced a public tender agreement with the Ministry of Healthcare in Botswana to make Tivicay (dolutegravir) available in Botswana. It is the first time that Tivicay will be made available as part of a national health programme in Sub- Saharan Africa. This is a huge beneficial advancement for medication in Botswana. 

What inspired the project?

Several things inspired the project, in particular the topic of mental health. Through research, we determined it is a subject often left unaddressed especially when to do with an illness like HIV. We were also inspired by social movements such as Humans Of New York by Brandon Stanton. We found the images and stories featured by Brandon can often bring awareness to illness and social issues as well as providing an insight into the life of someone else, often resulting in empathy and understanding of others.

What kind of research did you do?

Primary research consisted of emails and skype calls with people working in healthcare in Africa and those who had experience of working there. We also spoke to the Irish public to get a sense of the stigma surrounding HIV and Aids in Ireland in order to make research led design decisions.

Secondary research included studying reports published about HIV issues in Africa and various other relevant articles.

What experts did you speak to?

We first contacted friends and family members who had medical experience in Sub-Saharan Africa. We then made valuable links with industry professionals such as Dr Shelagh Parkinson (Zambia), Greg Anderson (GSK), Michelle Kennedy (St James Hospital, Dublin) and various Peace Corps volunteers in Botswana. We also spoke to street photographers like Maitham Basha-Agha who curates the People of Botswana page on Facebook and HIV+ advocates local to Botswana and South Africa.

What kinds of questions did you ask to find out what you needed to include in the design?

We asked friends and family their opinions on and their understanding of HIV. Industry professionals clarified the technicalities of antiretroviral’s from manufacture to when they are delivered to the consumer. HIV+ advocates advised us of the extent of the negative stigma in Sub-Saharan Africa.

Did you learn anything that surprised you

What surprised us most is the extent of the negative stigma that surround HIV in Africa, as well as in Ireland. Treatment of the disease has made huge advancements, and patients who are HIV+ can live regular lives with proper treatment, yet we found that public acceptance of those patients has remained very low. 

Have you spent time in Africa?

Megan Sands: I actually grew up in Botswana, so this project was very close to my heart. I was lucky to have the opportunity to travel home to Botswana whilst doing this project and speak with experts and HIV advocates in the country. 

What does winning the RSA Student Design Award mean to you?

It is an honour to be awarded a RSA Student Design Award. We want to take the opportunity that has been given to us and use it as a stepping stone into our careers. We have been inspired by previous winners such as Jonathan Ive and Richard Clarke who have gone on to have influential careers in design.

Do you know where will you go on to work next?

We are going to start an internship with GSK in August. This will be a great opportunity to gain experience in the medical design industry and to improve our skills in a large company.

What design field do you want to go into?

An aspect of this project that we really enjoyed was understanding the user experience and focusing on how it could be improved. We both would love to work on more projects where the focus is placed on the quality of the user experience and creating culturally relevant solutions.

Do you intend to take the Positive Future product further?

We hope to have the opportunity to further our project during our internship with GSK this August.

What do you understand the role of the designer to be today?

We believe the role of the designer is to address social issues and design in a sustainable way.

What inspires you?

I think we find most of our inspiration from other people and designers. Travelling to international design events such as Milan Design Week and Dutch Design Week in Eindhoven really inspired us by highlighting different cultures, architecture and design approaches that inevitably influence the style and execution of our work.  

What are your three biggest learnings from studying design - what (methodologies or philosophies) do you hope to take with you?

I think what worked really well in this project was our ability to bounce ideas and thoughts off each other. We spoke to as many professionals and anyone who might have any knowledge on the subject as we could, and we found this was a great way to direct our design the right way. My advice to any designer would be not to settle on your first idea and to keep an open mind. There is always space for improvement and talking to others for inspiration or clarification can be so beneficial.