This study was conducted as part of a quality improvement initiative under the University of Nairobi CRISSP+ (Central Kenya Response: Integration, Strengthening, and Sustainability - Plus) Project. The project received ethics approval from the AMREF Health Africa Ethics and Scientific Review Committee (ESRC), with final approval granted in April 2022 (Ref: ESRC P1164/2022). All procedures were carried out in accordance with institutional and national ethical standards, and conformed to the principles outlined in the Declaration of Helsinki. As this was a quality improvement initiative involving minimal risk, and consistent with ESRC guidance, a waiver of written informed consent was granted. Nonetheless, participants were informed about the purpose of the initiative, assured of confidentiality, and given the option to decline participation without penalty.

This feasibility study uses a mixed methods approach, incorporating both quantitative and qualitative components. The larger trial for which this study provides preliminary data has a computed sample size of 480 participants, with follow-up planned for 12 months [1].

For the quantitative component of this study, Cochran formula was used to determine the appropriate sample size [9]:

where:

Given the finite population of 2647 young people in the study sites, the sample size was adjusted using the finite population correction:

This yielded a minimum sample size of approximately 93 participants. Our survey included 163 participants.

The dataset underwent rigorous cleaning and coding processes prior to analysis to ensure accuracy and integrity. Univariate analyses were conducted to summarize participant characteristics and key variables of interest. Continuous variables, such as age, were described using medians and ranges, while categorical variables, such as sex, education level, and clinic type, were summarized using frequencies and percentages. The results of these univariate analyses were presented in tables and figures for clarity and ease of interpretation.

Bivariate analyses were then conducted to explore associations between participant demographic characteristics and their preferences or readiness to use the web-based health portal. The chi-square test was used to examine relationships between categorical variables, such as sex, education level, and employment status, with outcomes such as portal preference and perceived ease of use. For continuous variables like age, the mean and variance were calculated and compared across subgroups where relevant.

All statistical analyses were performed using Stata (version 13; StataCorp LP) [10].

The study included 163 participants aged 15‐24 years from diverse settings within Kiambu and Kirinyaga counties, including urban, peri-urban, rural, and informal settlements (Table 1).

A total of 60% (98/163) of the participants were female, 15% (24/163) of the participants attended prevention of mother to child transmission clinics, while 3% (5/163) of the participants had high viral loads. The median age was 18 years (Table 2). Educational backgrounds varied, with most participants (81/163, 51%) having completed secondary school. Most participants were students (72/163, 45%).

In this second section, participants were asked to assess their ability to understand medical information, readiness to adopt a web-based health portal, and the ease of use of the portal prototype. Approximately 17% (27 of 163) of respondents reported frequent difficulties in understanding written medical information (Table 3).

A majority (146/160, 91%) expressed a preference for using a web-based health portal to manage their health (Table 4), and 78% (124 of 159) found the prototype demonstrated during the PSSG meetings to be user-friendly (Table 5).

More than half of the participants (90/161, 56%) anticipated weekly use of the portal once implemented (Table 6).

Bivariate analysis using chi-square tests revealed no statistically significant associations between portal preference and demographic factors such as age (P=.82), sex (P=.62), education level (P=.58), or employment status (P=.25).

Section 3 explored the specific features respondents desired in the portal, their concerns about privacy and security, and how they envisioned using the platform, including use frequency and access rights. Features such as appointment management, access to medical records and test results, and communication with health care providers were rated the highest (Table 7).

Additionally, the majority of respondents (105/159, 66%) indicated a willingness to grant access rights to a family member (Table 8).

Section 4 aimed to identify key life-stage concerns of young individuals to determine the most valuable content areas for inclusion as “health tips” and to assess preferred methods for content delivery. Participants evaluated the extent to which the portal prototype might enhance various aspects of their health care experience, including the quality of patient-provider communication, their understanding of health, sense of control, reduction of worries, satisfaction with care, and the safeguarding of data privacy and confidentiality (Table 9).

Participants then rated the importance of content related to their disease, overall health, symptomatology, progression of their condition over time, and aspects of psychosocial, physical, and financial well-being (Table 10).

To evaluate the utility of proposed digital tools—such as the PHQ-9 for depression screening and the CRAFFT for identifying alcohol use disorders—participants were asked to rate their emotional well-being. Of the 156 adolescents and young people living with HIV who participated, 59% reported some level of difficulty coping emotionally with their condition. Specifically, 23% found it somewhat difficult, 21% found it difficult, and 15% found it very difficult. Conversely, 30% found it easy, and 11% very easy to manage the emotional impact of their diagnosis.

Since the portal was designed to include a symptom diary and a Tuberculosis screening tool, participants were asked to rate the importance of disease symptom awareness (Table 11).

To determine the most effective format for delivering content through the portal, participants were asked to rate common delivery methods. Video, SMS, and question-and-answer formats emerged as the most preferred options, while role-playing, animations, and storytelling were the least favored (Table 12).

This preliminary investigation explores the perspectives of young people on a digital health portal designed to enhance sustained engagement in HIV care and improve treatment outcomes. Our findings suggest that the portal is both timely and feasible, addressing a critical gap identified in a systematic review, which noted that many mobile health interventions fall short of aligning with user preferences [11].

Participants were recruited from a range of settings—urban, peri-urban, rural, and informal settlements—capturing the diversity of clinic populations typical of sub-Saharan Africa. The gender distribution reflects the elevated HIV burden among adolescent girls and young women aged 15‐24, who remain disproportionately affected relative to their male peers [12]. Perspectives from subgroups such as antenatal clinic attendees, individuals with high viral loads, and those from varied occupational backgrounds further underscore the portal’s broad relevance and adaptability.

Approximately 60% of participants reported difficulty navigating traditional medical information formats. This finding echoes research from a high HIV-burden county in Kenya, where low functional health literacy hindered tasks like interpreting appointment cards and understanding medical forms [13,14]. These results highlight the importance of integrating audio-visual formats tailored to young users’ learning preferences, an approach reinforced by a Nairobi-based study that advocates for participatory and engaging educational methods to enhance comprehension and user involvement [15].

Participants showed high readiness to adopt the portal, with overwhelmingly positive feedback on its usability—an encouraging sign for scalability. This reception aligns with the e-commerce acceptance model, where perceived ease of use and perceived usefulness are critical determinants of technology adoption [16]. Nevertheless, nearly 20% of respondents anticipated challenges in using the portal, emphasizing the need for ongoing user feedback and iterative refinement to uphold a human-centered design approach [17].

Encouragingly, 80% of participants indicated they would engage with the portal at least once a month, offering the content management team a basis for update scheduling. Essential features—such as appointment reminders, access to medical records, and test results—were purposefully integrated to align with existing clinic electronic medical records. Notably, 62% of participants expressed willingness to share access with family members, suggesting the need for built-in guidance on disclosure practices. In similar Kenyan settings, structured disclosure services have been associated with improved viral suppression among adolescents [18].

Emotional wellness features also resonated strongly with participants. Tools such as the mood tracker, PHQ-9 questionnaire, and coping resources were particularly well-received. Their inclusion was guided by national guidelines and reinforced by previous studies demonstrating the centrality of emotional support in adolescent HIV care [6-8,19]. Likewise, the expressed interest in a “symptom diary” underscores the value of early symptom detection—especially for comorbid conditions such as tuberculosis—where mobile applications have proven effective in enhancing screening and accelerating treatment initiation [20,21].

Beyond clinical features, participants prioritized content on nutrition and physical fitness, mirroring global trends in youth health information needs [11,22]. Moreover, strong demand for content addressing social and financial security points to broader age-specific concerns, including the economic burdens of chronic disease management. These findings are aligned with initiatives like DREAMS (determined, resilient, empowered, AIDS-free, mentored, and safe), which seek to mitigate structural drivers of HIV risk—such as poverty and gender inequality—among adolescent girls and young women [23-25]. Emerging evidence continues to support the effectiveness of this integrated, multisectoral approach [26].

This survey, as a preliminary step to inform a controlled trial, relied on a convenience sample of 163 participants, representing approximately 6% of the target population. The use of a convenience sampling approach may limit the generalizability of the findings. As such, the perspectives of some young individuals living with HIV in Kenya or other contexts may not have been fully captured. Additionally, potential selection bias may have influenced the results, as participants attending PSSG meetings might differ systematically from those not engaged in these support structures. Future studies should consider random sampling strategies and broader recruitment frameworks to enhance external validity.

Although the study included qualitative data from FGDs, this paper focuses solely on the quantitative results. The number of FGDs conducted and their composition were aligned with programmatic groupings, and while they provided valuable design insights, thematic saturation was not explicitly assessed.

This study underscores the potential benefits of the proposed web-based portal as a tool for improving HIV care among young individuals. By leveraging user-centered design principles and integrating practical, engaging features, the portal can address critical gaps in HIV care. Future developers of digital health solutions should prioritize feasibility studies to ensure interventions align with user expectations and capabilities.