Acceptability, Usability, and Clinical Appropriateness of an AI-Powered Tool for Linkage to HIV Services After HIV Self-Testing in South Africa: Mixed Methods Evaluation

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 behavioral barriers like uncertainty about next steps, stigma, and privacy concerns. Objective This study evaluated the acceptability, usability, and clinical appropriateness of Your Path, an AI-powered tool designed to facilitate access to HIV services following HIVST. Methods This study was conducted with community members and health care providers, recruited from Indlela’s Behavioral Hub in South Africa. Community members were randomly assigned a mock HIV result and completed a pretest survey assessing intentions to seek HIV services, followed by a simulated HIVST guided by Your Path , delivered via WhatsApp (Meta Platforms). The tool provides guidance for HIVST support, interpretation of results, emotional support, and delivers tailored information to access HIV services through an interactive chat interface. Community members then completed a posttest survey assessing intentions to seek HIV services and usability of the tool using the System Usability Scale (SUS) questions. A subsample completed in-depth interviews exploring their experience with Your Path. Health care providers reviewed interaction transcripts, assessing clinical appropriateness, completeness, and relevance of the summaries; qualitative data underwent thematic analysis using the Theoretical Framework of Acceptability. Results A sample of 100 community members aged between 18 and 61 years was enrolled: 59 (59%) were female, and 51 (51%) were assigned a negative mock HIV result. Overall, the intervention had its strongest effect on participants’ confidence in accessing HIV services, particularly among those with HIV-negative results (Wilcoxon P =