# Acceptability and use determinants of digital health technologies for HIV services: a qualitative study of emergency care patients in Nairobi, Kenya

## TL;DR

This study explores how acceptable a digital health tool for HIV testing is among emergency care patients in Nairobi, Kenya, and identifies barriers to its use.

## Contribution

The study provides novel qualitative insights into the acceptability and use determinants of BeSure™ among higher-risk populations in Kenya.

## Key findings

- Participants found BeSure™ acceptable across key domains like affect, burden, and perceived effectiveness.
- Limited awareness of BeSure™ was due to insufficient marketing and apathy toward health matters.
- Barriers to use include stigma, low technology access in rural areas, and low perceived HIV risk.

## Abstract

Digital health technologies (DHTs) represent a promising strategy to improve access to HTS (HIV testing services), particularly among underserved higher-risk populations often missed by current programming, including young adults under 25 years. In 2017, Kenya's Ministry of Health introduced BeSure™, a DHT providing information on HIV, self-testing, and facility geo-location. Given increased risks for HIV among injured populations, this study assessed the acceptability of BeSure™ as a DHT for enhancing HTS in a Kenyan emergency department. Using purposive sampling, participants were provided a brief description of the tool BeSure™ and then completed in-depth interviews using a semistructured guide between August and November 2023. Deductive and inductive analyses were applied using a codebook based on a published framework for healthcare intervention acceptability, examining 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 secondary education or below. Few participants (21%) were aware of BeSure™ prior to data collection. Barriers to awareness included limited marketing of the tool and apathy toward health-related matters. However, strategic advertisement within healthcare encounters and through social media platforms including TikTok and Facebook (especially for young adult participants) could facilitate awareness. Barriers to potential use include low access to technology in rural communities, persisting stigma toward HIV, and low perceived HIV risk (especially among older participants). Despite these barriers, participants across age groups found the tool widely acceptable across the predetermined domains. These qualitative data highlight the acceptability of DHTs for HTS enhancement among injured populations in Nairobi, Kenya. Findings underscore the limited awareness of BeSure™ among this higher-risk population, suggesting that targeted advertisement, demand creation, and stigma reduction strategies are critical to successful implementation of these technologies.