HIV Client Perspectives on Digital Health in Malawi

eHealth has strong potential to advance HIV care in low- and middle-income countries. Given the sensitivity of HIV-related information and the risks associated with unintended HIV status disclosure, clients' privacy perceptions towards eHealth applications should be examined to develop client-centered technologies. Through focus group discussions with antiretroviral therapy (ART) clients from Lighthouse Trust, Malawi's public HIV care program, we explored perceptions of data security and privacy, including their understanding of data flow and their concerns about data confidentiality across several layers of data use. Our findings highlight the broad privacy concerns that affect ART clients' day-to-day choices, clients' trust in Malawi's health system, and their acceptance of, and familiarity with, point-of-care technologies used in HIV care. Based on our findings, we provide recommendations for building robust digital health systems in low- and middle-income countries with limited resources, nascent privacy regulations, and political will to take action to protect client data.