Evidence brief: Multilingual voice-enabled informatics tools: Catalyst for equitable AI in HIV and HIV-comorbidity healthcare management

Abstract

Human Immunodeficiency Virus (henceforth HIV) is a global health problem, presently with no known cure. Africa has one of the highest incidences of HIV. Nigeria, within the West African (WA) region, is one of the largest economies on the continent. However, the country continues to struggle with HIV, with approximately 2 million individuals currently infected and experiencing ongoing transmissions. Management of the disease has been difficult due to communication barriers between English-speaking medical practitioners and indigenous patients in rural and suburban regions of the country and bordering countries. In this paper, we used fuzzy logic and voice-enabled technology to create WAHMIDS (West African HIV and HIV-comorbidity Multilingual Indigenous Diagnostic Software) and WAHMIMA (West African HIV Multilingual Informatics Mobile Application), which are health apps designed to help diagnose HIV and manage related health issues in both rural and urban areas for people who speak different indigenous languages in West Africa. Additionally, illustrations of the application of this tool to HIV diagnosis, using existing HIV data, are demonstrated. We expect that these tools will assist English-speaking medical workers and inhabitants of West African communities in their efforts to control HIV transmissions. These informatics tools have the potential to help prescribe medications for HIV and HIV-comorbidity patients. We anticipate that these informatics tools will help address healthcare disparities and promote diversity, equality, and inclusion by reducing the gaps in healthcare delivery between different regions and facilitating the collection of diverse patient data, which is essential for developing and planning more inclusive and accurate healthcare strategies in the West African sub-region.

1. Introduction

A primary obstacle in addressing diseases in the West African subregion is the linguistic barrier resulting from the multitude of indigenous languages spoken throughout the region. These languages are commonly used in both countryside and city areas, and the differences between them have led to delays in HIV diagnoses and limited help for people with HIV and related health issues in rural and semi-urban areas [1–7]. West Africa hosts numerous indigenous languages, notably Yoruba, Hausa, and Igbo, which are prevalent in multiple countries within the region. The Yoruba language is primarily spoken in Southwestern Nigeria, with substantial numbers in other West African nations, including Ghana, the Republic of Benin, Togo, and Sierra Leone [8–15]. Similarly, numerous rural regions across various West African countries extensively utilize Igbo and Hausa as local languages [16–19].

Another barrier to the fight against HIV is the emigration of medical professionals out of the West African region to seek better remunerations and opportunities in advanced countries [16–19]. In the fight against HIV, English-speaking medical doctors whose places of duty are in rural communities of West African countries frequently have difficulty communicating with local patients during HIV diagnosis and HIV-comorbidity treatments. Occasionally there is no communication at all [20]. Generally, a lack of proper communication channels is considered an impediment to the effective treatment and management of HIV and HIV-comorbidity in resource-poor communities and resource-limited settings [21]. Many rural areas in West African countries and many communities in Nigeria often use Yoruba, Igbo, and Hausa as their major indigenous languages of communication. The major languages of communication are also common at rural health centers [16–19]. These language limitations waste time and effort and at times lead to delayed treatments and diagnoses. These limitations significantly affect English-speaking medical personnel working in these regions, particularly when interpreters are unavailable due to limited resources. Communication barriers can result in time wastage, frustration, delayed treatments, and, in extreme cases, without HIV test kits, wrong diagnoses. The emigration of medical doctors and personnel has led to the problem of brain drain [22–26]. Brain drains have led to an insufficient number of university lecturers, medical experts, and medical doctors in rural areas to manage HIV care and HIV-comorbidity treatments [27–36]. Brain drains have led to a scarcity of university medical specialists, consultants, and medical personnel who can help manage cases of HIV patients. The third problem is the lack of sufficient HIV testing kits and services. This scenario is especially common in rural areas [37]. Knowledge of HIV-positive status among inhabitants of some West African countries is low [38,39]. An estimated 25.6 million people live with HIV in Sub-Saharan Africa, a representation of two-thirds of the global total [40]. Currently research indicates that 60% of people living with HIV (PLWHIV) are aware of their status. The remaining 40% are ignorant of their HIV status, perhaps due to their inability to access proper HIV testing services. Many West African rural and suburban dwellers lack access to HIV diagnostic and testing services. For instance, there is a high incidence of HIV in the Northern region of Nigeria, as well as in the Southeast region of the country [41–45]. West African countries like Ghana, Togo, the Republic of Benin, and Sierra Leone also experience some incidences of HIV and increased new HIV infections, particularly in rural and suburban areas where locals speak indigenous languages such as Yoruba, Hausa, and Igbo [46–60]. In these rural and suburban regions, there are insufficient HIV test kits, insufficient provision of antiretroviral therapy (ART) to the HIV population, expensive costs of HIV test kits, and low levels of literacy. These obstacles hinder the effective management of the disease [61–63].