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. 2023 Jun 23:25:e41881.
doi: 10.2196/41881.

A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results

Paula Massa #  1 , Dulce Aurélia de Souza Ferraz  2   3 , Laio Magno  4   5 , Ana Paula Silva  6 , Marília Greco  6 , Inês Dourado  4 , Alexandre Grangeiro  1
Affiliations

A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results

Paula Massa et al. J Med Internet Res. .

Abstract

Background: HIV incidence rates have increased in adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). Thus, it is essential to promote access to HIV prevention, including pre-exposure prophylaxis (PrEP), among these groups. Moreover, using artificial intelligence and online social platforms to create demand and access to health care services are essential tools for adolescents and youth.

Objective: This study aims to describe the participative process of developing a chatbot using artificial intelligence to create demand for PrEP use among AMSM and ATGW in Brazil. Furthermore, it analyzes the chatbot's acceptability, functionality, and usability and its results on the demand creation for PrEP.

Methods: The chatbot Amanda Selfie integrates the demand creation strategies based on social networks (DCSSNs) of the PrEP1519 study. She was conceived as a Black transgender woman and to function as a virtual peer educator. The development process occurred in 3 phases (conception, trial, and final version) and lasted 21 months. A mixed methodology was used for the evaluations. Qualitative approaches, such as in-depth adolescent interviews, were used to analyze acceptability and usability, while quantitative methods were used to analyze the functionality and result of the demand creation for PrEP based on interactions with Amanda and information from health care services about using PrEP. To evaluate Amanda's result on the demand creation for PrEP, we analyzed sociodemographic profiles of adolescents who interacted at least once with her and developed a cascade model containing the number of people at various stages between the first interaction and initiation of PrEP (PrEP uptake). These indicators were compared with other DCSs developed in the PrEP1519 study using chi-square tests and residual analysis (P=.05).

Results: Amanda Selfie was well accepted as a peer educator, clearly and objectively communicating on topics such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved appropriate for answering questions in an agile and confidential manner, using the language used by AMSM and ATGW and with a greater sense of security and less judgment. The interactions with Amanda Selfie combined with a health professional were well evaluated and improved the appointment scheduling. The chatbot interacted with most people (757/1239, 61.1%) reached by the DCSSNs. However, when compared with the other DCSSNs, Amanda was not efficient in identifying AMSM/ATGW (359/482, 74.5% vs 130/757, 17.2% of total interactions, respectively) and in PrEP uptake (90/359, 25.1% vs 19/130, 14.6%). The following profiles were associated (P<.001) with Amanda Selfie's demand creation, when compared with other DCS: ATGW and adolescents with higher levels of schooling and White skin color.

Conclusions: Using a chatbot to create PrEP demand among AMSM and ATGW was well accepted, especially for ATGW with higher levels of schooling. A complimentary dialog with a health professional increased PrEP uptake, although it remained lower than the results of the other DCSSNs.

Keywords: HIV; HIV pre-exposure prophylaxis; PrEP; acceptability; adolescent; artificial intelligence; chatbot; men who have sex with men; prevention; prophylaxis; transgender; transgender women.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Stages of Amanda Selfie's participative development. PrEP: pre-exposure prophylaxis.
Figure 2
Figure 2
Illustrations of Amanda Selfie’s prototype persona during the development process. PrEP: pre-exposure prophylaxis.
Figure 3
Figure 3
First image of Amanda Selfie. PrEP: pre-exposure prophylaxis.
Figure 4
Figure 4
Final image of Amanda Selfie.
Figure 5
Figure 5
A: Setting a daily reminder for the user to take their pills. B: Amanda’s message to remind the user to take the pills. C: Setting a reminder that the pills are about to run out. PrEP: pre-exposure prophylaxis.
Figure 6
Figure 6
Example of question from a user answered by Amanda. PrEP: pre-exposure prophylaxis; STD: sexually transmitted disease; STI: sexually transmitted infection.
See this image and copyright information in PMC

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