Co-authors: Antony Kariri1, Joshua Kimani1, Laisa Lumumba1, Allan Maleche2, Kirsten Mathieson3, Anstes Agnew3

 

This year’s International AIDS Conference, taking place this week, rallies around the theme of “putting people first”– building health services around the needs of those most affected. This is at the heart of our work in Kenya where we are putting communities at the centre of digital health transformation to expand primary healthcare to reach Universal Health Coverage (UHC) by 2030. 

Digital health solutions like e-pharmacy, telemedicine, and other digital health applications can help  extend the reach of health services to underserved and marginalised populations. This can help improve health outcomes for people living with HIV (PLHIV) and key at-risk populations in several ways:

  1. Increasing medication access and adherence: Mobile apps, text message reminders, and electronic pill dispensers can improve adherence to antiretroviral therapy (ART). Studies have shown that these tools can increase the proportion of people reporting good adherence to HIV pre-exposure prophylaxis (PrEP) by over 11%.
  2. Improving access to testing and care: Digital platforms can provide information about HIV testing services, connect individuals to nearby clinics, and facilitate online consultations with healthcare providers. For example, with the introduction of the Kenya Digital Health Act, the centralisation of real time facility level data will improve logistical management of health products such as ART and testing kits by suppliers.
  3. Supporting prevention and health literacy: Digital interventions can deliver targeted prevention messaging and interactive educational content, promote condom use, and increase awareness and uptake of PrEP and self-care strategies among PLHIV and at-risk populations.1
  4. Reducing stigma and discrimination: By providing anonymous or confidential access to information and services, digital health tools can help overcome barriers related to stigma and discrimination that often prevent key populations from seeking care.

But there are also challenges:

  1. Access and equity: Without intentional efforts to meaningfully engage PLHIV in the design and implementation of digital tools, solutions may not meet the needs of users.
  2. Data privacy and security: PLHIV are concerned about the risk of data breaches and unintended disclosure of their HIV status resulting from digital health systems and subsequent discrimination, including in accessing government services.  Our research in Kenya indicates that 50% of key populations are concerned about data privacy and security, with 30% reporting instances of data breaches or misuse. 
  3. Digital divide: Technology availability, internet connectivity, digital literacy, affordability, geographical location, and socioeconomic conditions impact how digital services are accessed by key populations.

In harnessing the benefits of digital health tools, this must go hand-in-hand with efforts to strengthen privacy protections. This is important to build trust and encourage uptake of digital tools among vulnerable populations. 

 

Digital health technologies for key populations in Kenya

Approximately 1.4 million adults and children are living with HIV in Kenya, with the HIV prevalence rate among adults (aged 15-49) around 4.5%. HIV prevalence among key populations is significantly higher (estimated at 29.3% for female sex workers, 18.2% for men who have sex with men, and 18.3% for people who inject drugs, according to the latest available data from UNAIDS).2

A soon-to-be-published community-based participatory research study by Partners for Health and Development in Africa (PHDA), a member of Transform Health Kenya, looked at the development and use of digital health technologies among key populations (KPs) in Kenya – sex workers, men who have sex with men (MSM), transgender individuals, and people who inject drugs (PWID). The research identified a variety of tools currently utilised by key populations, including mobile health applications, telemedicine platforms, and online health information portals. These are instrumental in providing essential health services and information to KPs, such as access to pre- and post-exposure prophylaxis (PrEP, PEP), HIV self-test kits, medical consultations, mental health support, and community engagement. 

“I find it easier to get information on sexual health through the mobile app because I can use it anywhere and nobody can know what I am accessing” Female Sex Worker, Age group 18-24 years, Machakos county,”

Accessibility and usability remain a challenge, particularly in rural and underserved areas where digital infrastructure is less developed. The research found that socioeconomic factors like age, digital literacy, education, and geography impacted how different populations were able to engage with technologies. 65% of respondents expressed the need for more tailored digital tools, highlighting the importance of ongoing feedback and adaptation. 

 

Ensuring the digital health transformation responds to the needs of key populations

Kenya has made significant strides in the development of a legally enabling environment for digital health. Transform Health Kenya and partners urge the government to: 

  1. Put people first in the implementation of the recently enacted Digital Health Act, ensuring it meets the needs of all people, including key populations.
  2. Develop and enforce legal and policy frameworks that safeguard privacy and confidentiality. To build trust and ensure the safe use of digital tools, it is essential to put in place stringent security protocols including end-to-end encryption and anonymization or de-identification for sensitive health data, aligned to clear guidelines and standards for data protection, such as the rights-based health data governance principles and draft Model Law on Health Data Governance which seeks to set a global standard for health data legislation.
  3. Ensure User Centred Design and meaningfully engage key populations, vulnerable and marginalised populations when designing and implementing digital tools, especially those that will be used by the key populations or store and process their data. 
  4. Conduct targeted campaigns to raise awareness and provide digital literacy training and ongoing support to key populations. 
  5. Improve internet access and affordability, especially in rural areas. Consider subsidised or zero-rated internet costs for key population apps or develop offline or low data-use features. 

By prioritising privacy, inclusivity, and user-centred design, Kenya can harness the full potential of digital health tools to achieve UHC and end the AIDS epidemic by 2030. Together, we can create a future where digital health supports and safeguards every person, ensuring no one is left behind.

1 Cao B, Bao H, Oppong E, Feng S, Smith KM, Tucker JD, Tang W. Digital health for sexually transmitted infection and HIV services: a global scoping review. Curr Opin Infect Dis. 2020 Feb;33(1):44-50. doi: 10.1097/QCO.0000000000000619. PMID: 31789695; PMCID: PMC7152691.Orii, L. et al. (2024) ‘HIV client perspectives on Digital Health in Malawi’, Proceedings of the CHI Conference on Human Factors in Computing Systems [Preprint]. doi:10.1145/3613904.3642245.

2 UNAIDS Country Fact Sheet (2022): https://www.unaids.org/en/regionscountries/countries/kenya. UNAIDS Key Populations Atlas: https://kpatlas.unaids.org/

 

 

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  1. Partners for Health and Development in Africa (PHDA) is a non-profit organisation working in the health and development fields in Kenya and elsewhere in Africa. PHDA works for and with Key Populations in Kenya to deliver HIV prevention and care services. PHDA strives to leverage on Digital Health Technologies while upholding, safeguarding and advocating for Key Population’s fundamental rights to privacy and confidentiality to deliver and improve access to healthcare for KPs. PHDA has developed its comprehensive Data Protection Policy (DPP), aligned to Kenya’s Data Protection Act (DPA) 2019, to ensure the appropriate safeguards are in place in handling of all client information, and has been registered as a Data Controller by the Data Commissioner’s Office. PHDA is also working on a concept paper to partner with the Data Protection Commissioner to develop a DPA compliance roadmap to help KP implementing partners comply with Kenya’s data protection act. A list of resources can be found here. 
  1. The Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN) believes in a world where no one lives in fear or oppression; where all have access to decent standard of healthcare and life; a world where everyone is treated with dignity and respect. To achieve this, we engage in long-term human based approach work, build resilience, respond to health violation situations, and seek to address the root cause of health violations through our advocacy work. 
  1. Transform Health is a global coalition of organisations dedicated to achieving health for all in the digital age. Transform Health sets out to build a global movement that brings together organisations and institutions across different sectors, committed to achieving universal health coverage by 2030 by expanding the use of digital technology and increasing access to data. We campaign and collaborate with the individuals, communities, governments, organisations and institutions that are most affected by the lack of access to equitable, affordable and high-quality healthcare.