Developing EVA: A Digital Mental Health Chatbot for Adolescents with HIV

Overview

EVA is a chatbot developed using a human-centered design approach to support Peruvian adolescents living with HIV experiencing mild to moderate depression. The chatbot delivers psychoeducation, coping strategies, and linkage to care, addressing a critical gap in mental health services for this vulnerable population.

Background

Adolescents living with HIV face elevated risks of mental health problems, particularly depression, which affects nearly 26% of this group—significantly higher than the general adolescent population. Mental health challenges can undermine adherence to antiretroviral therapy and overall health outcomes. However, access to mental health services is limited, especially in low- and middle-income countries, due to stigma, lack of integrated care, and resource constraints. Digital solutions like chatbots offer scalable, anonymous support that can overcome many of these barriers.

Data Highlights

In 2024, approximately 1.57 million adolescents aged 0-19 years were living with HIV worldwide, representing about 11% of new HIV infections. Depression prevalence among adolescents living with HIV is estimated at nearly 26%, compared to fewer than 10.5% in the general adolescent population. Preliminary data from Peru indicate that up to 92% of adolescents living with HIV presenting with depression have mild-to-moderate symptoms.

Key Findings

• Adolescents living with HIV have a high prevalence of depression, often mild to moderate, which is under-addressed in current care models.
• Stigma and lack of integrated mental health services limit adolescents’ access to needed psychological support.
• Chatbots provide a promising digital platform for delivering accessible, anonymous, and scalable mental health interventions.
• Human-centered design involving adolescents ensures the chatbot’s content, tone, and usability are culturally relevant and engaging.
• EVA was developed through iterative cycles with a Youth Advisory Board to refine its modules and enhance acceptability.
• Ethical oversight and informed consent processes were rigorously applied during chatbot development and testing.

Clinical Implications

Clinicians should consider integrating digital mental health tools like EVA to support adolescents living with HIV, especially in resource-limited settings where traditional services are scarce. Engaging adolescents in the design process enhances intervention relevance and uptake. Early identification and support for mild-to-moderate depressive symptoms can prevent progression and improve adherence to HIV treatment.

Conclusion

EVA exemplifies a practical, replicable approach to developing digital mental health interventions tailored for adolescents living with HIV. Human-centered design and ethical rigor are essential to creating effective, acceptable tools that address critical service gaps.

References

1. UNAIDS 2024 -- Global HIV statistics
2. WHO 2023 -- Mental health and HIV
3. Peruvian Ministry of Health 2023 -- Adolescent HIV and depression data
4. VÍA LIBRE 2023 -- EVA chatbot development study protocol