JMIR Publications

ABSTRACT

Background:

Timely linkage to HIV prevention and treatment services following HIV self-testing (HIVST) remains a challenge in many countries. While HIVST offers privacy and convenience for individuals to know their HIV status, many do not engage in follow-up care due to behavioural barriers like uncertainty about next steps, stigma, and privacy concerns.

Objective:

This study evaluated the acceptability, usability, and clinical appropriateness of Your Path, an Artificial Intelligence (AI)-powered tool designed to facilitate linkage to appropriate HIV services following HIVST.

Methods:

This study was conducted with community members (CMs) and healthcare providers (HCPs), recruited from Indlela’s Behavioural Hub (B-Hub) in Gauteng province, South Africa. CMs were randomly assigned a mock HIV test result and completed a pre-test survey assessing intentions to seek HIV services, followed by a simulated HIVST session guided by Your Path. A post-test survey then evaluated changes in intention to seek care (a proxy for uptake of care) and a System Usability Scale (SUS) measured usability of the tool. A sub-sample of 25 CMs completed in-depth interviews exploring their experience with Your Path. HCPs reviewed transcripts of CM tool interactions to assess clinical appropriateness, completeness and relevance of the generated summaries. Qualitative data were analysed thematically, and results aligned with the Theoretical Framework of Acceptability (TFA).

Results:

Of the 100 enrolled CMs, 59.0% were female and 51.0% received a mock HIV-negative result. After interacting with Your Path, 91.0% of CMs reported that it positively influenced their intention to access HIV services. The tool demonstrated high usability, with a mean SUS score of 81.6 (SD 17.5). Most found Your Path easy to use (83.7%) and did not need assistance (76.4%), and 94.9% expressed willingness to use it again. However, 15.3% noted that it did not always provide consistent responses to questions and that responses varied or were unclear. CMs described Your Path as a helpful guide with a user-friendly design. Most appreciated its private, non-judgmental tone, which helped reduce stigma during interactions. Some valued the sense of confidentiality offered by the tool, while others expressed concerns about the protection of their information. HCPs found the conversational summaries clinically appropriate, and cited the tool as informative and beneficial for supporting linkage to HIV care. However, limitations in emotional responsiveness and potential language barriers were noted.

Conclusions:

Your Path was acceptable, usable, and clinically appropriate for supporting linkage to HIV services after HIVST, and showed potential to support intentions to seek HIV care. Larger in-field studies are needed to understand the implementation, cost and sustainability of digital interventions in public health. Clinical Trial: N/A