Helping family planning clients self-assess HIV vulnerability: User testing a waiting area chatbot in Zambia

Abstract

M AY 2 02 1 Women who are at risk of unintended pregnancy also may be vulnerable to HIV and other sexually transmitted infections (STIs), and there is international consensus about the importance of integrating HIV and FP services. In FP service delivery settings, traditionally, efforts to incorporate HIV into contraceptive counseling has focused on assessing women’s need for and interest in HIV services, such as HIV testing. Less attention has been paid to helping FP clients to assess whether and how their HIV vulnerability may influence their contraceptive choices. For example, some options offer dual protection against pregnancy as well as disease. Ideally, FP providers can help clients decide which method to choose, by helping her think about personal and interpersonal characteristics and behaviors—such as having multiple partners, STI history, substance use, or partners’ sexual behaviors—that may increase her vulnerability to HIV. However, FP providers often have limited time to delve into these topics, and clients may not proactively discuss these potentially sensitive issues. In recent years, in the United States and sub-Saharan Africa, recognizing the time and resource constraints faced by providers, researchers have tested self-care and self-assessment strategies that FP clients can employ during pre-consultation time (i.e., the time when clients are waiting their turn to see providers). These interventions include interactive mobile applications that walk women through contraceptive options before her provider visit, and web-based tools that introduce FP clients to pre-exposure prophylaxis (PrEP) while they wait their turn to see providers.1–4