Amanda Selfie, a transgender chatbot to create demand and access to PrEP by adolescents men who have sex with men (MSM) and transgender women (TGW) in Brazil (Preprint)

BACKGROUND HIV incidence rates has increased in adolescents men who have sex with men (aMSM) and transgender women (aTGW). HIV prevention including pre-exposure prophylaxis (PrEP) is little known in these groups. Artificial intelligence (AI) and virtual social platforms have been used to create demand and access to health care. Objective: This study aims to describe the participative process to develop a chatbot for creating demand for PrEP among aMSM and aTGW in Brazil and to analyze the chatbot’s acceptability and reach. OBJECTIVE This study aims to describe the participative process to develop a chatbot for creating demand for PrEP among aMSM and aTGW in Brazil and to analyze the chatbot’s acceptability and reach. METHODS The chatbot named Amanda Selfie was developed as part of demand creation strategies (DCS) of the PrEP1519 Project. She was conceived as a black transgender women, to have the role of a virtual peer educator. The development process lasted 21 months. Acceptability and usability were evaluated from an analysis of accesses and interactions with Amanda Selfie. In-depth interviews were also conducted with adolescents MSM and TGW after their interactions with the chatbot. Reach was evaluated using demographics and the enrolment in PrEP after interaction. These data were compared with other DCS. RESULTS Amanda Selfie was well accepted as peer clearly and objectively communicating topics, such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved to be appropriate for answering questions in an agile, confidential manner, with language used by adolescents MSM and TGW, and greater sense of security and less judgment. It was better evaluated when combined with interactions with a health professional. When compared with other virtual DCS, the chatbot was able to reach almost twice as many people (62% of 1239); however, the strategy was less efficient in promoting PrEP enrolment (17.4% of 109) The adolescents reached by Amanda Selfie was associated (p < 0.001) with a higher proportion of aTGW (15,4%), higher education, (35,4%) and white race/color (52,3%). CONCLUSIONS The use of AI to PrEP demand-creation among aMSM and aTGW was well accepted, and a complimentary dialog with a health professional promoted greater access. The characterization of the chatbot persona as a peer of the most vulnerable groups contributed to reaching the intended audience.