JMIR Publications

ABSTRACT

Background:

Digital health platforms have the potential to expand access to HIV care by reducing geographic, social, and institutional barriers. However, among key populations such as men who have sex with men and transgender people living with HIV/AIDS in Nigeria, technology adoption is shaped by more than system functionality alone. Structural stigma, criminalisation, fear of disclosure, and limited health system access continue to constrain engagement with formal healthcare services. While teleconsultation and medication-delivery platforms offer alternative pathways to care, their acceptance and intended use within marginalised populations cannot be assumed and require empirical investigation.

Objective:

This study aimed to examine the factors influencing behavioural intention to adopt TechAids, a confidentiality-oriented digital health platform designed to support HIV consultation and service access among men who have sex with men and transgender individuals in Nigeria, using an extended Unified Theory of Acceptance and Use of Technology framework.

Methods:

A cross-sectional survey was conducted among 141 platform users and 27 healthcare providers, yielding a total sample of 168 participants. The study employed an extended UTAUT model incorporating Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Conditions, alongside Trust and Perceived Stigma. Data were analysed using correlation analysis and ordinary least squares regression. Age and educational attainment were examined as potential moderating variables. Qualitative feedback was also collected to contextualise quantitative findings.

Results:

Facilitating Conditions emerged as the strongest predictor of behavioural intention to use the platform (β=0.813, p<0.001), explaining a substantial proportion of variance in adoption intention (R²=0.652). Age demonstrated a modest but statistically significant positive effect on behavioural intention (β=0.105, p=0.026). Contrary to theoretical expectations, Performance Expectancy, Effort Expectancy, Social Influence, Trust, and Perceived Stigma did not significantly predict intention to adopt the platform. Qualitative feedback highlighted practical infrastructure-related concerns, including reliable internet access, offline functionality, and availability of technical support, as more salient than psychological or feature-based considerations.

Conclusions:

In resource-constrained and highly stigmatised contexts, enabling infrastructure and practical support conditions may outweigh cognitive, social, and attitudinal determinants of technology acceptance. These findings suggest that successful digital health interventions for marginalised populations require not only privacy-conscious and user-centred design but also sustained investment in facilitating conditions that support real-world use. Designing technology for HIV care in such settings must therefore address structural and infrastructural barriers alongside behavioural and psychosocial factors.