Background: HIV testing rates in sub-Saharan Africa remain below the targeted threshold, and primary care facilities struggle to provide adequate services. Innovative approaches that leverage digital technologies could improve HIV testing and access to treatment. Objective: This study aimed to examine the feasibility and acceptability of Nolwazi_bot. It is an isiZulu-speaking conversational agent designed to support HIV self-testing (HIVST) in KwaZulu-Natal, South Africa. Methods: Nolwazi_bot was designed with 4 different personalities that users could choose when selecting a counselor for their HIVST session. We recruited a convenience sample of 120 consenting adults and invited them to undertake an HIV self-test facilitated by the Nolwazi_bot. After testing, participants completed an interviewer-led posttest structured survey to assess their experience with the chatbot-supported HIVST. Results: Participants (N=120) ranged in age from 18 to 47 years, with half of them being men (61/120, 50.8%). Of the 120 participants, 111 (92.5%) had tested with a human counselor more than once. Of the 120 participants, 45 (37.5%) chose to be counseled by the female Nolwazi_bot personality aged between 18 and 25 years. Approximately one-fifth (21/120, 17.5%) of the participants who underwent an HIV self-test guided by the chatbot tested positive. Most participants (95/120, 79.2%) indicated that their HIV testing experience with a chatbot was much better than that with a human counselor. Many participants (93/120, 77.5%) reported that they felt as if they were talking to a real person, stating that the response tone and word choice of Nolwazi_bot reminded them of how they speak in daily conversations. Conclusions: The study provides insights into the potential of digital technology interventions to support HIVST in low-income and middle-income countries. Although we wait to see the full benefits of mobile health, technological interventions including conversational agents or chatbots provide us with an excellent opportunity to improve HIVST by addressing the barriers associated with clinic-based HIV testing.

Adolescents continue to face challenges to their sexual and reproductive health (SRH) both locally and internationally. Digital technologies such as the Internet, text messaging, and social media are often viewed as valuable tools for disseminating information on SRH. Mobile health, also known as mHealth, is a medical and public health practise that uses these digital technologies to communicate information. The literature has revealed that mHealth interventions have a positive outcome in delivering SRH information to adolescents. This review aimed to synthesise empirical studies that evaluate mHealth interventions and assess the extent to which these mHealth interventions promote sexual and reproductive health outcomes among young people. This scoping review reviewed the literature across four databases, including EBSCOhost, Scopus, Proquest, and Cochrane, and included 12 articles. The findings have shown that mHealth interventions are effective in enhancing sexual and reproductive health (SRH) knowledge and attitudes among young people in both low-middle and high-income countries. However, comprehensive longitudinal studies are necessary to measure the sustainability and long-term influence of mHealth interventions on behaviour. It is recommended that with artificial intelligence (AI) improvements, there is a possible path to bolstering mHealth interventions.

Introduction: Significant progress has been made in the HIV response in South Africa; however, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. The National Department of Health (NDoH) has introduced community-based and clinic-based HIV differentiated service delivery (DSD) models to tackle suboptimal adherence and retention in care. Nevertheless, differentiated care models require adaptation to better serve clients who struggle with adherence. There is limited research on the acceptability of fee for home delivery of ART in resource-constrained settings. The current study investigates the acceptability of fee for home delivery of ART among people living with HIV in South Africa. Methods: Two mixed-gender focus group discussions (FGDs) took place between June and November 2019, consisting of 10 participants in each group. A purposive sampling strategy was employed to identify and select 10 people living with HIV who were ART-eligible but not in care, and 10 people living with HIV who were currently taking ART and in care. Participants were grouped according to their treatment status. A coding framework, informed by a priori categories and derived from topics in the interview guide, was developed and utilized to facilitate analysis. Results: Participants expressed enthusiasm for having ART home-delivered, as it would save the time spent waiting in long queues at the clinic. However, some participants raised concerns about potential payment difficulties due to high unemployment rates in the community. Some participants believed this would be acceptable, as patients already incur costs for travel and food when visiting the clinic. Participants in both FGDs expressed strong concerns about home delivery of their ART based on fear of accidental disclosure, especially for those who have not disclosed to their immediate families and partners. Conclusion: Our study suggests that charging a fee for home delivery is an acceptable and innovative approach to supporting PLHIV in maintaining adherence to their medication and remaining in care.

Message-based health information dissemination systems can potentially improve maternal and child health (MCH). By conveying health information to parents, SMS- and chatbot-based systems can support parents’ learning and empower them to make better health decisions for their children. However, there is limited design advice for creating message-based dissemination systems for MCH. To help address this gap, we conducted 14 participatory workshops with 42 parents from Portugal and South Africa, exploring how parents learned to care for their children’s health. Our findings showed how parents reflected on the health advice they received, by assessing the fit of the advice to their child’s characteristics, their values and beliefs, the advice’s feasibility, or the intention and competence of the advice giver. Based on these insights, we propose four design implications for creating message-based health information dissemination systems tailored to parents and their children.

Innovations in chatbot technology have greatly accelerated in recent years, yet challenges persist in implementing them effectively for healthcare in diverse socio-economic contexts, especially in the global south. We engaged in two sets of co-design workshops that gave insight into the preferences of parents regarding chatbot design modalities but also uncovered constraints for our design including working with low-resource languages and limited internet connectivity. Though we set out for a chatbot to support first-time parents, our co-design in Portugal and South Africa resulted in the development of a "not-so-chatty" chatbot. Our intervention, ParentCoach App, is a question-and-answer informational resource presented in a chat-like user interface with search and menus for content exploration. We discuss the challenges of designing and implementing chatbots across different geographic and socio-economic contexts, presenting our resulting intervention and the preliminary findings from a two-week feasibility pilot with first-time parents in the two countries.

Background: Pre-exposure Prophylaxis (PrEP) and Treatment as Prevention (TasP) are effective strategies to prevent HIV transmission within serodifferent couples. However, limited usage of PrEP, knowledge and interest has been amongst the barriers for men, alongside testing and treatment adherence. We explored the perceptions of PreP for HIV prevention with Men living with HIV (MWH) who have reproductive goals, to understand awareness and experiences related to PrEP use in the context of HIV prevention with their partners. Methods: We undertook a qualitative study with 25 MWH aged 18 to 65 between April and September 2021 in South Africa. Potential participants were screened for eligibility and scheduled to participate in telephonic interviews. Interviews were audio recorded, transcribed, translated and thematically analysed. Results: Themes were organized into opportunities and barriers that men with HIV articulate as important for using PrEP to meet individual, couple, and community reproductive goals. At the individual level, some men were willing to discuss PrEP with their partners to protect their partners and babies from acquiring HIV. Lack of knowledge about PrEP among men was a potential barrier to promoting PrEP among their female partners. At the couple level, PrEP use was seen as a way to strengthen relationships between partners, signifying care, trust, and protection and was seen as a tool to help serodifferent couples meet their reproductive goals safely. At the community level, PrEP was viewed as a tool to promote HIV testing and prevention efforts, especially among men, but participants emphasized the need for more education and awareness. Conclusion: Despite PrEP implementation in South Africa, awareness of PrEP among men with HIV in rural areas remains low. Engaging MWH to support their partners in accessing PrEP could be an innovative strategy to promote HIV prevention. Additionally, providing men with comprehensive reproductive health information can empower them to make more informed decisions, adopt safer sexual practices, and challenge societal norms and stigmas around HIV.