‘…it helps me to be able to do the right thing …’: pilot of a waiting area chatbot to enhance self-assessment of HIV vulnerability and motivation for PrEP use in Nigeria

Objective HIV risk perception is considered a key step in the HIV prevention cascade, a crucial motivational process through which individuals may consider their HIV prevention options. We sought to determine whether an anonymous self-administered chatbot in clinic waiting areas could improve HIV knowledge, enhance individualised HIV risk assessment and ease client-provider interactions regarding HIV prevention. Methods and analysis We piloted a digital chatbot with cisgender women and transgender men seeking HIV and sexual health services at community-based clinics and public health facilities in Lagos, Nigeria. Participants completed a self-administered survey (n=150) after their healthcare provider (HCP) visit to provide feedback on their chatbot experience. Additional follow-up indepth interviews with chatbot users (n=25) and participating HCPs (n=10) probed on their experiences with the chatbot and chatbot users and effect on the client-provider interaction. Results Participants reported gaining new knowledge about HIV and pre-exposure prophylaxis (PrEP) from the chatbot that made them consider their own HIV vulnerability and prevention options. Participants reported feeling more comfortable in discussing PrEP with HCPs and about one-half reported that they initiated a conversation about HIV prevention with their provider. HCPs reiterated that the interaction was more productive with clients who had used the chatbot vs their usual interactions. Participants requested additional health information and access to the chatbot outside of the clinic setting. Conclusion The chatbot served as a vital patient activation and self-care tool; it facilitated participants’ understanding of HIV, risk perception/vulnerability, knowledge about effective prevention options and self-efficacy to initiate discussion with HCPs—critical steps in HIV prevention.