Acceptability and Use Determinants for Digital Health Technologies for HIV Services: A Qualitative Study of Emergency Care Patients in Nairobi, Kenya

Joshua Smith-Sreen^1*Benson Timothy²Beatrice Ngila²John Wamutitu Maina²Sankei Pirirei²John Kinuthia^2,3David E Bukusi²Harriet Waweru²Rose Bosire²Carey Farquhar³Michael Mello⁴Adam Russell Aluisio⁴

• ¹Brown University Warren Alpert Medical School, Providence, United States
• ²Kenyatta National Hospital, Nairobi, Kenya
• ³University of Washington Department of Global Health, Seattle, United States
• ⁴Brown University Department of Global Emergency Medicine, Providence, United States

Digital health technologies (DHTs) to improve access to HTS (HIV testing services) may enable reaching higher-risk populations missed by current programming, including young adults < 25 years. In 2017, Kenya’s Ministry of Health introduced BeSureTM, a DHT providing information on HIV, self-testing, and facility geo-location. Given increased risks for HIV among injured populations, this study aimed to assess the acceptability of BeSureTM as an example DHT for enhancing HTS in this population at a Kenyan emergency department (ED). Purposive sampling was used and after providing a brief description of the tool to participants, in-depth interviews (IDIs) were completed using a semi-structured guide between August and November 2023. Deductive and inductive analysis were applied using a codebook based on a published framework for healthcare intervention acceptability, using core themes of affect, burden, ethicality, coherence, opportunity cost, and perceived effectiveness. Among 24 participants, the median age was 25, half were female, and 58% had achieved a level of education of secondary school or below. Few participants (21%) were aware of BeSureTM prior to completing data collection. Participants highlighted barriers to awareness, including the lack of widespread marketing of the tool and apathy towards health-related matters, though strategic advertisement within healthcare encounters and using social media platforms including TikTok and Facebook (especially for young adult participants) could facilitate awareness. Participants underscored barriers to potential use, including low access to technology in rural communities, persisting stigma towards HIV and low perceived HIV risk (especially among older participants). Participants of all age groups examined found the tool widely acceptable across the predetermined domains. These qualitative data highlight the acceptability DHTs for HTS enhancement among injured populations in Nairobi, Kenya. They also underscore the lack of awareness of BeSureTM among this population with a higher-risk HIV profile, suggesting that targeted advertisement, demand creation, stigma consideration may be critical to the implementation of these technologies.