Convenient but Constrained: Acceptability and Feasibility of mHealth Care for Adolescents with HIV in South Africa

Abstract Background South Africa has the highest number of adolescents and young adults (15–24 years) living with HIV (ALHIV). In many settings, ALHIV face significant barriers to engagement in care. Mobile health (mHealth) technology has potential to improve access and retention; however, evidence on experiences with tele- and video-based HIV care for ALHIV in low-resource settings remains limited. Methods We conducted a mixed-methods study among 20 ALHIV and 10 healthcare providers in eThekwini, South Africa. Adolescents completed routine HIV follow-up visits via voice calls or WhatsApp video calls. Participants then completed exit questionnaires and in-depth interviews evaluating satisfaction, acceptability, and feasibility of mHealth visits. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analyzed thematically using a modified Unified Theory of Acceptance and Use of Technology (UTAUT). Results Adolescent participants had a median age of 19 years (IQR: 17–20); 50% were female. Among providers, 40% were nurses and 80% were female. Acceptability of Intervention Measure (AIM) and Feasibility of Intervention Measure (FIM) median composite scores were high among adolescents (4 and 4.3, respectively) and providers (4.8 and 4.6). Participants described mHealth visits as a convenient and time-saving alternative to in-person care. However, acceptability was limited by feasibility issues including network connectivity, concerns about privacy, and HIV disclosure. Conclusions mHealth visits are highly acceptable to ALHIV and providers and can support differentiated HIV care delivery. However, effective scale-up will require addressing structural barriers, ensuring privacy, and incorporating strategies responsive to adolescents’ social contexts.