Validating WhatsApp Chat for Digital Self-Care in Kenya

In 2020, Population Services Kenya (PS Kenya) and Aviro Health joined on a Children's Investment Fund Foundation-funded project to increase HIV testing among men and connect them to HIV services in Kenya.

PS Kenya is Kenya's leading social and behavioural change, social marketing, and franchising organisation, with a 31-year track record of helping the Ministry of Health (MoH) address public health priorities in HIV/AIDS, tuberculosis, malaria, reproductive health, maternal and child health, water and sanitation, nutrition, and non-communicable diseases.

Aviro Health worked to adjust their Pocket Clinic platform to the demands of PS Kenya's clientele between June 2020 and December 2021. Pocket Clinic was easily customised to engage, interest, and support Kenyan males during HIV self-testing. As a result, patients who wanted to test for HIV could do it through Pocket Clinic as an automated chatbot that functioned via WhatsApp. Since the chatbot optimises patient onboarding, counselling, and testing, the patients could enjoy a private and safe self-testing experience, thus freeing health workers to focus on those who need more active support.

In Kenya, the use of chatbots is still relatively new, however, we noticed that its use increased as a result of the COVID restrictions. A high engagement from users with the Pocket Clinic Chatbot allowed us to grow the offering. Starting with only HIV self-testing support, the service grew to include kit self-test kit ordering, linkage to care, self-testing certificates and connection to HIV negative services such as PrEP and educational resources.

We learned that using WhatsApp to facilitate HIV self-testing was feasible as a result of its expanding uptake, since it assisted approximately 9,000 users in Kenya over the course of 18 months, with over 3,000 submitting their test results, including 215 positives. We also learned that self-initiated users had nearly twice the positivity rate as CBO-initiated users, and users under the age of 20 had nearly twice the positivity rate as well.

Pocket Clinic's success in Kenya was largely due to our ability to listen and iterate. We focused on making the project particularly responsive to the needs of users, healthcare workers and project management. We conducted periodic feedback collection sessions in diverse manners. 

For users, we called upon them to consent for feedback regarding their experience with the chatbot. We also engaged with healthcare workers to learn about their observations regarding clients who returned to link to care, to gain more insight on the effectiveness of the “confirm link to care” prompt on the platform. Through this prompt, users were able to report a reactive result and were encouraged to attend a healthcare facility for a confirmatory test and treatment initiation. 

“Beyond it being a successful and impactful partnership, PS Kenya was deeply impressed with the passionate, collaborative and proactive approach that Aviro takes, and their ability to both listen and lead in digital initiatives, to the benefit of the program and the patients.” - PS Kenya COO, Dr Margaret Njenga

Since PS Kenya was aiming to increase self-testing among Kenyan men, establishing trust with patients became paramount. Generally, HIV is stigmatised and many men in Kenya value their confidentiality. To gain trust, we had to be mindful of our tone, character and language. What also worked to our advantage was that we were leveraging an already established and well known HIV Self-Testing campaign.

Over the 18 months that the project was active in Kenya, the Pocket Clinic WhatsApp to support HIV self-testing helped nearly 9000 users, with over 3000 reporting their results and 215 positive outcomes. Aviro worked with 7 Community-Based Organisation (CBOs), 3 in Nairobi, 3 in Kisumu, and 1 in Kiambu, supporting HIVSS distribution at community hotspots and workplaces and promoting chatbot uptake. Beyond showing that support and reporting via WhatsApp is feasible, the programme also validated automated linkage to care, demand for self-test kit ordering and delivery as well as demand for prevention information and linkage to services such as PrEP. This partnership proved that with engagement and constant iteration WhatsApp can prove to be a strong digital self-care intervention.

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