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Trials for LLM-supported clinical decisions in African primary healthcare

Nature Medicine volume 31, pages 2833–2835 (2025)Cite this article

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Primary healthcare systems in sub-Saharan Africa face considerable challenges, particularly constrained clinical capacity1 and variable quality-of-care delivery2. Large language models (LLMs) represent a potentially transformative solution for clinical decision-making. Some LLMs have shown that they can recall clinical knowledge at expert level3 and can diagnose clinical vignettes (in simulated settings) more accurately than clinicians4. However, despite the fact that LLMs have shown promise, there is a striking lack of real-world evidence for their safe and effective use in clinical settings in Africa. Thus far, only handful of randomized trials of artificial intelligence (AI) for health (and none for generative AI tools) have been conducted on the continent5.

In Kenya, a pragmatic randomized controlled trial (RCT) has been embedded into routine care delivery undertaken at 16 of Penda Health’s clinics6, a Nairobi-based social enterprise that provides primary care services across all socioeconomic groups, from state social insurance recipients to privately insured and out-of-pocket payers. The trial aims to enroll 9,000 patients. The solution being trialed is an LLM-based ‘co-pilot’ feature that has been integrated directly into Penda’s electronic medical record system. Clinicians randomly assigned to the intervention arm receive automated, real-time suggestions for diagnosis, treatment planning and lab interpretation during patient consultations.

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Fig. 1: LLM-based clinical decision support systems in Africa.

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Authors and Affiliations

  1. PATH, Seattle, WA, USA

    Bilal A. Mateen, Gwydion Williams & Mira Emmanuel-Fabula

  2. University of Birmingham, Birmingham, UK

    Bilal A. Mateen, Vaishnavi Menon, Alastair K. Denniston & Xiaoxuan Liu

  3. Kenya Paediatric Research Consortium (Keprecon), Nairobi, Kenya

    Ambrose Agweyu

  4. London School of Hygiene & Tropical Medicine, London, UK

    Ambrose Agweyu

  5. KEMRI–Wellcome Trust Research Programme, Nairobi, Kenya

    Ambrose Agweyu

  6. Penda Health, Nairobi, Kenya

    Robert Korom

  7. Centre for Research Evaluation Resources and Development, Abuja, Nigeria

    Elizabeth Omoluabi

  8. Viamo, Saskatoon, Saskatchewan, Canada

    David McAfee

  9. University of Global Health Equity, Kigali, Rwanda

    Natnael Shimelash

  10. Digital Umuganda, Kigali, Rwanda

    Samuel Rutunda

  11. Centre for the Fourth Industrial Revolution, Kigali, Rwanda

    Crystal Rugege

  12. FATH, Geneva, Switzerland

    Mira Emmanuel-Fabula

  13. Gates Foundation, Seattle, WA, USA

    Melissa Miles

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  1. Bilal A. Mateen
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  2. Vaishnavi Menon
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  14. Melissa Miles
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Corresponding author

Correspondence to Bilal A. Mateen.

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Competing interests

M.M. is an employee of the primary funder of the studies but made substantial (independent) intellectual contributions to the design of the grant and studies. The decision to publish this piece was not in any way unduly influenced by the funder, nor do the views expressed necessarily reflect those of the funder. The other authors declare no competing interests.

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Mateen, B.A., Menon, V., Agweyu, A. et al. Trials for LLM-supported clinical decisions in African primary healthcare. Nat Med 31, 2833–2835 (2025). https://doi.org/10.1038/s41591-025-03815-3

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