Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Trials for LLM-supported clinical decisions in African primary healthcare

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

Subjects

Access through your institution
Buy or subscribe

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.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

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

References

  1. Langlois, E. V., McKenzie, A., Schneider, H. & Mecaskey, J. W. Bull. World Health Organ. 98, 781 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ameh, S. et al. BMC Fam. Pract. 22, 45 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Singhal, K. et al. Nat. Med. 31, 943–950 (2025).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Goh, E. et al. Nat. Med. 31, 1233–1238 (2025).

    Article  CAS  PubMed  Google Scholar 

  5. Han, R. et al. Lancet Digit. Health 6, e367–e373 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Menon, V. et al. Preprint at https://doi.org/10.5281/zenodo.15270828 (2025).

  7. Siontis, K. C., Siontis, G. C., Contopoulos-Ioannidis, D. G. & Ioannidis, J. P. J. Clin. Epidemiol. 67, 612–621 (2014).

    Article  PubMed  Google Scholar 

  8. Menon, V. et al. Preprint at https://doi.org/10.5281/zenodo.15498494 (2025).

  9. Menon, V. et al. Preprint at https://doi.org/10.5281/zenodo.15493572 (2025).

  10. Alhanai, T. et al. Proc. AAAI Conf. Artif. Intell. 39, 27802–27812 (2025).

    Google Scholar 

Download references

Author information

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

Authors
  1. Bilal A. Mateen
    View author publications

    Search author on:PubMed Google Scholar

  2. Vaishnavi Menon
    View author publications

    Search author on:PubMed Google Scholar

  3. Ambrose Agweyu
    View author publications

    Search author on:PubMed Google Scholar

  4. Robert Korom
    View author publications

    Search author on:PubMed Google Scholar

  5. Elizabeth Omoluabi
    View author publications

    Search author on:PubMed Google Scholar

  6. David McAfee
    View author publications

    Search author on:PubMed Google Scholar

  7. Natnael Shimelash
    View author publications

    Search author on:PubMed Google Scholar

  8. Samuel Rutunda
    View author publications

    Search author on:PubMed Google Scholar

  9. Crystal Rugege
    View author publications

    Search author on:PubMed Google Scholar

  10. Gwydion Williams
    View author publications

    Search author on:PubMed Google Scholar

  11. Mira Emmanuel-Fabula
    View author publications

    Search author on:PubMed Google Scholar

  12. Alastair K. Denniston
    View author publications

    Search author on:PubMed Google Scholar

  13. Xiaoxuan Liu
    View author publications

    Search author on:PubMed Google Scholar

  14. Melissa Miles
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Bilal A. Mateen.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41591-025-03815-3

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing