Developing and Testing a Chatbot to Integrate HIV Education Into Family Planning Clinic Waiting Areas in Lusaka, Zambia

Eileen A. Yam; Edith Namukonda; Tracy McClair; Samir Souidi; Nachela Chelwa; Nelly Muntalima; Michael Mbizvo; Ben Bellows

doi:10.9745/GHSP-D-21-00721

Key Findings

There remains a notable gap in decision aids that support family planning (FP) clients to consider how HIV vulnerability may influence contraceptive method choice. Calls for integrating HIV prevention information into FP services have been limited by several factors, including providers’ lack of time for counseling.
A chatbot can help alleviate provider burden and leverage the underutilized pre-consultation time while clients wait to see providers. Chatbots can guide FP clients through a digital conversation on preventing both HIV and pregnancy and conveying information on HIV.
Among FP clients in Lusaka, Zambia, who tested a waiting-area chatbot, most reported learning new HIV information, such as pre-exposure prophylaxis, and nearly all reported subsequently discussing HIV content that they learned from the chatbot with the FP provider.

Key Implications

Time spent waiting to see providers can be used to prepare FP clients to think about HIV vulnerability and how it may affect their contraceptive method choice.
Chatbots that provide relevant health information in waiting areas are feasible and promising in urban low- and middle-income country settings.

ABSTRACT

Background:

To maximize protection against both unintended pregnancy and HIV, it is important that family planning (FP) services integrate HIV counseling, both to support method choice and identify potential HIV services of interest, such as pre-exposure prophylaxis (PrEP). However, FP providers often lack sufficient time and knowledge to address HIV vulnerability with clients. To potentially offload some of the initial HIV counseling burden from FP providers, we developed and tested a chatbot that provided information about HIV and dual protection to FP clients in waiting areas of FP clinics in Lusaka, Zambia.

Chatbot Development:

We drafted a scripted conversation and tested it in English in formative workshops with Zambian women between the ages of 15 and 49 years. After translating the content to Bemba and Nyanja, we conducted a second round of workshops to validate the translations, before uploading the content into the chatbot platform.

Chatbot User Test:

Thirty volunteers tested the chatbot in 3 Lusaka FP clinics, completing an exit survey to provide feedback. A large majority (83%) said they learned new HIV information from the chatbot. Twenty (67%) learned about PrEP for the first time through the chat. Most (96%) reported discussing HIV with the provider, after engaging with the chatbot. In response to an open-ended question, several testers volunteered that they wanted to learn more about PrEP.

Conclusions:

Pre-consultation waiting-area time is an underutilized opportunity to impart HIV information to FP clients, thereby preparing them to discuss their dual HIV and pregnancy prevention needs when they see their providers. FP clients expressed particular interest in learning more about PrEP, underscoring the importance of integrating HIV into FP services.

Received: April 11, 2022.
Accepted: August 15, 2022.
Published: October 31, 2022.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00721

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