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Kamitani E, Mizuno Y, Khalil GM, Viguerie A, DeLuca JB, Mishra N. Improving HIV preexposure prophylaxis uptake with artificial intelligence and automation: a systematic review. AIDS 2024; 38:1560-1569. [PMID: 38788206 PMCID: PMC11239277 DOI: 10.1097/qad.0000000000003935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
OBJECTIVES To identify studies promoting the use of artificial intelligence (AI) or automation with HIV preexposure prophylaxis (PrEP) care and explore ways for AI to be used in PrEP interventions. DESIGN Systematic review. METHODS We searched in the US Centers for Disease Control and Prevention Research Synthesis database through November 2023; PROSPERO (CRD42023458870). We included studies published in English that reported using AI or automation in PrEP interventions. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using either the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials or an adapted Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies. RESULTS Our search identified 12 intervention studies (i.e., interventions that used AI/automation to improve PrEP care). Currently available intervention studies showed AI/automation interventions were acceptable and feasible in PrEP care while improving PrEP-related outcomes (i.e., knowledge, uptake, adherence, discussion with care providers). These interventions have used AI/automation to reduce workload (e.g., directly observed therapy) and helped non-HIV specialists prescribe PrEP with AI-generated clinical decision-support. Automated tools can also be developed with limited budget and staff experience. CONCLUSIONS AI and automation have high potential to improve PrEP care. Despite limitations of included studies (e.g., the small sample sizes and lack of rigorous study design), our review suggests that by using aspects of AI and automation appropriately and wisely, these technologies may accelerate PrEP use and reduce HIV infection.
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Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
| | - Yuko Mizuno
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
| | - George M. Khalil
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
| | - Alex Viguerie
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
| | - Julia B. DeLuca
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
| | - Ninad Mishra
- Division of HIV Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, U.S. 30329-4027
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Laymouna M, Ma Y, Lessard D, Schuster T, Engler K, Lebouché B. Roles, Users, Benefits, and Limitations of Chatbots in Health Care: Rapid Review. J Med Internet Res 2024; 26:e56930. [PMID: 39042446 PMCID: PMC11303905 DOI: 10.2196/56930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/07/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs. However, no comprehensive synthesis of health care chatbots' roles, users, benefits, and limitations is available to inform future research and application in the field. OBJECTIVE This review aims to describe health care chatbots' characteristics, focusing on their diverse roles in the health care pathway, user groups, benefits, and limitations. METHODS A rapid review of published literature from 2017 to 2023 was performed with a search strategy developed in collaboration with a health sciences librarian and implemented in the MEDLINE and Embase databases. Primary research studies reporting on chatbot roles or benefits in health care were included. Two reviewers dual-screened the search results. Extracted data on chatbot roles, users, benefits, and limitations were subjected to content analysis. RESULTS The review categorized chatbot roles into 2 themes: delivery of remote health services, including patient support, care management, education, skills building, and health behavior promotion, and provision of administrative assistance to health care providers. User groups spanned across patients with chronic conditions as well as patients with cancer; individuals focused on lifestyle improvements; and various demographic groups such as women, families, and older adults. Professionals and students in health care also emerged as significant users, alongside groups seeking mental health support, behavioral change, and educational enhancement. The benefits of health care chatbots were also classified into 2 themes: improvement of health care quality and efficiency and cost-effectiveness in health care delivery. The identified limitations encompassed ethical challenges, medicolegal and safety concerns, technical difficulties, user experience issues, and societal and economic impacts. CONCLUSIONS Health care chatbots offer a wide spectrum of applications, potentially impacting various aspects of health care. While they are promising tools for improving health care efficiency and quality, their integration into the health care system must be approached with consideration of their limitations to ensure optimal, safe, and equitable use.
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Affiliation(s)
- Moustafa Laymouna
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Yuanchao Ma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic and Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Sousa ARD, Silva LAVD, Brasil SA, Zucchi EM, Ferraz DADS, Magno L, Grangeiro A, Dourado I. "It was unusual but amazing": demand creation for PrEP among adolescents' men who have sex with men (MSM) and transgender women (TGW) in Brazil. CAD SAUDE PUBLICA 2024; 40:e00066423. [PMID: 38775571 PMCID: PMC11105349 DOI: 10.1590/0102-311xen066423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to analyze the challenges in demand creation for participation in an HIV pre-exposure prophylaxis (PrEP) project in two Brazilian capitals. This qualitative study was conducted with men who have sex with men and transgender women aged 15 to 19 years who lived in two Brazilian state capitals. For this analysis, 27 semi-structured interviews carried out from 2019 to 2020 were evaluated by reflexive thematic content analysis. For participants, PrEP demand creation was essential for their interaction, mediation, bonding, and attachment and proved effective for PrEP acceptability and adherence. Adolescents' narratives showed that the strategies promoted HIV combination prevention, opened up opportunities for recruitment meetings, helped to negotiate with and convince individuals to use PrEP, strengthened peer education, and evoked a feeling of "being with" and "walking together" despite the challenges. Face-to-face or online interactions using social technologies played a crucial role in recruiting adolescents for the project, expanding knowledge on PrEP and other combination prevention strategies and access to health services and self-care.
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Affiliation(s)
| | | | - Sandra Assis Brasil
- Instituto de Saúde Coletiva, Universidade do Estado da Bahia, Salvador, Brasil
| | - Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Laio Magno
- Instituto de Saúde Coletiva, Universidade do Estado da Bahia, Salvador, Brasil
| | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade do Estado da Bahia, Salvador, Brasil
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Cascalheira CJ, Pugh TH, Hong C, Birkett M, Macapagal K, Holloway IW. Developing technology-based interventions for infectious diseases: ethical considerations for young sexual and gender minority people. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1303218. [PMID: 38169805 PMCID: PMC10759218 DOI: 10.3389/frph.2023.1303218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/20/2023] [Indexed: 01/05/2024] Open
Abstract
Compared to their heterosexual and cisgender peers, young sexual and gender minority (YSGM) people are more likely to contract sexually transmitted infections (STIs; e.g., HIV) and to face adverse consequences of emerging infections, such as COVID-19 and mpox. To reduce these sexual health disparities, technology-based interventions (TBIs) for STIs and emerging infections among YSGM adolescents and young adults have been developed. In this Perspective, we discuss ethical issues, ethical principles, and recommendations in the development and implementation of TBIs to address STIs and emerging infections among YSGM. Our discussion covers: (1) confidentiality, privacy, and data security (e.g., if TBI use is revealed, YSGM are at increased risk of discrimination and family rejection); (2) empowerment and autonomy (e.g., designing TBIs that can still function if YSGM users opt-out of multiple features and data collection requests); (3) evidence-based and quality controlled (e.g., going above and beyond minimum FDA effectiveness standards to protect vulnerable YSGM people); (4) cultural sensitivity and tailoring (e.g., using YSGM-specific models of prevention and intervention); (5) balancing inclusivity vs. group specificity (e.g., honoring YSGM heterogeneity); (6) duty to care (e.g., providing avenues to contact affirming healthcare professionals); (7) equitable access (e.g., prioritizing YSGM people living in low-resource, high-stigma areas); and (8) digital temperance (e.g., being careful with gamification because YSGM experience substantial screen time compared to their peers). We conclude that a community-engaged, YSGM-centered approach to TBI development and implementation is paramount to ethically preventing and treating STIs and emerging infections with innovative technology.
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Affiliation(s)
- Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, United States
| | - Tyler H. Pugh
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Chenglin Hong
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle Birkett
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Kathryn Macapagal
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, United States
| | - Ian W. Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
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5
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Bragazzi NL, Crapanzano A, Converti M, Zerbetto R, Khamisy-Farah R. The Impact of Generative Conversational Artificial Intelligence on the Lesbian, Gay, Bisexual, Transgender, and Queer Community: Scoping Review. J Med Internet Res 2023; 25:e52091. [PMID: 37864350 PMCID: PMC10733821 DOI: 10.2196/52091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Despite recent significant strides toward acceptance, inclusion, and equality, members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community still face alarming mental health disparities, being almost 3 times more likely to experience depression, anxiety, and suicidal thoughts than their heterosexual counterparts. These unique psychological challenges are due to discrimination, stigmatization, and identity-related struggles and can potentially benefit from generative conversational artificial intelligence (AI). As the latest advancement in AI, conversational agents and chatbots can imitate human conversation and support mental health, fostering diversity and inclusivity, combating stigma, and countering discrimination. In contrast, if not properly designed, they can perpetuate exclusion and inequities. OBJECTIVE This study aims to examine the impact of generative conversational AI on the LGBTQ community. METHODS This study was designed as a scoping review. Four electronic scholarly databases (Scopus, Embase, Web of Science, and MEDLINE via PubMed) and gray literature (Google Scholar) were consulted from inception without any language restrictions. Original studies focusing on the LGBTQ community or counselors working with this community exposed to chatbots and AI-enhanced internet-based platforms and exploring the feasibility, acceptance, or effectiveness of AI-enhanced tools were deemed eligible. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS Seven applications (HIVST-Chatbot, TelePrEP Navigator, Amanda Selfie, Crisis Contact Simulator, REALbot, Tough Talks, and Queer AI) were included and reviewed. The chatbots and internet-based assistants identified served various purposes: (1) to identify LGBTQ individuals at risk of suicide or contracting HIV or other sexually transmitted infections, (2) to provide resources to LGBTQ youth from underserved areas, (3) facilitate HIV status disclosure to sex partners, and (4) develop training role-play personas encompassing the diverse experiences and intersecting identities of LGBTQ youth to educate counselors. The use of generative conversational AI for the LGBTQ community is still in its early stages. Initial studies have found that deploying chatbots is feasible and well received, with high ratings for usability and user satisfaction. However, there is room for improvement in terms of the content provided and making conversations more engaging and interactive. Many of these studies used small sample sizes and short-term interventions measuring limited outcomes. CONCLUSIONS Generative conversational AI holds promise, but further development and formal evaluation are needed, including studies with larger samples, longer interventions, and randomized trials to compare different content, delivery methods, and dissemination platforms. In addition, a focus on engagement with behavioral objectives is essential to advance this field. The findings have broad practical implications, highlighting that AI's impact spans various aspects of people's lives. Assessing AI's impact on diverse communities and adopting diversity-aware and intersectional approaches can help shape AI's positive impact on society as a whole.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, CA, United States
| | - Manlio Converti
- Department of Mental Health, Local Health Unit ASL Napoli 2 Nord, Naples, Italy
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van Heerden A, Bosman S, Swendeman D, Comulada WS. Chatbots for HIV Prevention and Care: a Narrative Review. Curr HIV/AIDS Rep 2023; 20:481-486. [PMID: 38010467 PMCID: PMC10719151 DOI: 10.1007/s11904-023-00681-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW To explore the intersection of chatbots and HIV prevention and care. Current applications of chatbots in HIV services, the challenges faced, recent advancements, and future research directions are presented and discussed. RECENT FINDINGS Chatbots facilitate sensitive discussions about HIV thereby promoting prevention and care strategies. Trustworthiness and accuracy of information were identified as primary factors influencing user engagement with chatbots. Additionally, the integration of AI-driven models that process and generate human-like text into chatbots poses both breakthroughs and challenges in terms of privacy, bias, resources, and ethical issues. Chatbots in HIV prevention and care show potential; however, significant work remains in addressing associated ethical and practical concerns. The integration of large language models into chatbots is a promising future direction for their effective deployment in HIV services. Encouraging future research, collaboration among stakeholders, and bold innovative thinking will be pivotal in harnessing the full potential of chatbot interventions.
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Affiliation(s)
- Alastair van Heerden
- Center for Community Based Research, Human Sciences Research Council, Old Bus Depot, Pietermaritzburg, 3201, South Africa.
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Shannon Bosman
- Center for Community Based Research, Human Sciences Research Council, Old Bus Depot, Pietermaritzburg, 3201, South Africa
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Dourado I, Soares F, Magno L, Amorim L, Eustorgio Filho M, Leite B, Greco D, Westin M, Tupinambás U, Massa P, Miura Zucchi E, Grangeiro A. Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study). J Adolesc Health 2023; 73:S33-S42. [PMID: 37953006 DOI: 10.1016/j.jadohealth.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To evaluate the adherence, safety, and feasibility of pre-exposure prophylaxis (PrEP) in real-world settings among adolescent men who have sex with men (AMSM) and transgender women (ATGW). METHODS PrEP1519 is a single-arm, multicentric demonstration cohort study of daily oral PrEP among AMSM and ATGW aged 15 to 19 years in Brazil. Study visits occurred at baseline, weeks 4, 12, and then quarterly until 96 weeks. Descriptive statistics and a mixed logistic model for longitudinal data evaluated the factors associated with high adherence. RESULTS One thousand sixteen AMSM and ATGW accessed the PrEP1519 clinics. Of those, 998 (98.2%) underwent clinical triage. Forty one were diagnosed with human immunodeficiency viruses (HIV) at baseline (4.0%) and 79 (7.9%) were not eligible for PrEP. Of the 878, 795 (90.5%) enrolled in PrEP, 82 (10.3%) were lost to follow-up, and 713 were included. There was no significant decrease in creatinine clearance; only two participants had grade-III aspartate aminotransferase elevation. Incident HIV infection occurred in eight participants (incidence rate [IR] = 1.64 per 100 person-years [PY]): two in 15-17 years (IR = 2.24 per 100 PY) and six in 18-20 years (IR = 1.51 per 100 PY). PrEP adherence was higher among those with more years of schooling, those reporting no difficulties in PrEP use due to side effects, and who had low HIV risk perception in the past three months. DISCUSSION PrEP for AMSM and ATGW was safe and feasible in real-world settings. However, a higher IR among young adolescents and a higher adherence among less vulnerable people indicate the need for greater care, considering the specificities of this age group.
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Affiliation(s)
- Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Leila Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Marcos Eustorgio Filho
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Beo Leite
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Dirceu Greco
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mateus Westin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Unaí Tupinambás
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula Massa
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, São Paulo, Brazil
| | - Alexandre Grangeiro
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Lee JJ, Li Verdugo J, Xiao AY, Vo K. Digital Interventions to Enhance PrEP Uptake and Adherence Through Stigma Reduction. Curr HIV/AIDS Rep 2023; 20:458-469. [PMID: 38057685 DOI: 10.1007/s11904-023-00685-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Although pre-exposure prophylaxis (PrEP) is effective for reducing risk of HIV transmission, stigma persists as a barrier to HIV prevention. Digital technologies present opportunities to access hard-to-reach populations and increase the efficiency of established interventions. This review examines current digital interventions addressing stigma to improve PrEP-related outcomes. RECENT FINDINGS Digital technologies are increasingly used for HIV prevention and include a wide range of formats. Recent interventions focused on stigma and PrEP tend to engage mobile phone-related technology and focus on younger populations with particular attention to men who have sex with men and transgender women. Digital interventions that address stigma are promising for improving PrEP-related outcomes. No single technology currently demonstrates consistent superiority. Limited access to PrEP and heightened stigma in under-resourced countries present challenges for interventions supporting diverse communities. Further research should examine how digital interventions can reduce stigma beyond the individual level to enhance PrEP use and explore opportunities to improve and integrate approaches to stigma measurement.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
| | - Juliann Li Verdugo
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA
| | | | - Katie Vo
- School of Public Health, University of Washington, Seattle, WA, USA
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