  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.
