In an era where digital connectivity is often equated with access to essential healthcare services, the persistent digital divide continues to exacerbate health inequities, especially among marginalized populations. Recent research published in the International Journal for Equity in Health sheds light on innovative strategies aimed at overcoming digital barriers experienced by people living with HIV and viral hepatitis who are further marginalized by criminalization. This new study not only highlights the complex interplay between digital exclusion and healthcare access but also evaluates quality improvement initiatives designed to bridge this gap through a mixed-methods approach.
The study, conducted by Tiwana et al., delves into the troubling reality that criminalization—whether related to drug use, sex work, or other legal circumstances—significantly impedes individuals’ ability to engage with digital health services. This criminalization compounds stigma and presents systemic challenges that inhibit seamless access to vital HIV and hepatitis care. Importantly, these obstacles are not merely about physical healthcare availability but extend profoundly into digital realms where many modern health interventions and communications occur.
Digital exclusion, the study explains, refers to the lack of reliable access to internet technologies, digital literacy, and digital-based healthcare resources. For people experiencing criminalization, these barriers often combine with socio-economic difficulties and social stigmatization, creating a layered exclusion from the health system. This exclusion is particularly ironic given the increasing reliance on telehealth platforms, mobile health apps, and online support networks that have become prominent in recent years.
Tiwana and colleagues implemented a series of quality improvement interventions targeted at reducing digital exclusion. These interventions ranged from the provisioning of digital devices and internet access to personalized digital literacy training, paired with tailored support systems designed to build trust and mitigate the fear of engagement due to criminalization. Their mixed methods evaluation employed both quantitative data, tracking healthcare engagement metrics and digital uptake, and qualitative insights from interviews capturing lived experiences of affected individuals.
One of the critical findings emphasized how device access alone is insufficient if digital literacy and trust are not simultaneously cultivated. The research team identified that marginalized populations not only lacked consistent internet connectivity but also faced intimidation and confusion about online health services, often due to complex interfaces or the broader distrust toward institutions linked to criminal justice systems. Thus, the quality improvement project prioritized holistic support rather than piecemeal technical solutions.
Moreover, the study revealed that fostering digital inclusion requires careful attention to privacy and data security concerns, particularly in contexts where individuals’ health status or legal risks are sensitive. Many participants expressed fear that engaging digitally might expose them to legal repercussions or social harm. By designing confidentiality safeguards and transparent communication strategies, the program succeeded in alleviating some of these fears, enabling more meaningful and confidential online interactions.
The mixed-methods evaluation highlighted positive trends such as increased retention in care, more consistent adherence to antiretroviral therapy, and improvements in viral load suppression among participants who received the digital inclusion interventions. These clinical outcomes are significant because they demonstrate not just improved digital connectivity but consequential enhancements in health and wellbeing for a population that often remains invisible in conventional healthcare metrics.
Another dimension the researchers explored was the role of community-based organizations and peer networks in facilitating digital access. These groups often serve as trusted intermediaries, helping to navigate bureaucratic systems and providing culturally sensitive support. Integrating these social infrastructures into digital health initiatives emerged as a powerful lever to enhance outreach and engagement, effectively bridging technological resources with human connection.
The project further underscored the undeniable intersectionality of digital exclusion with other axes of inequality, including race, gender, and socio-economic status. For instance, women who had experienced criminalization faced distinct challenges related to caregiving responsibilities and precarious housing that complicated their digital access and continuity of care. This insight encourages future interventions to adopt nuanced, intersectional frameworks in addressing digital health disparities.
Importantly, the research team reflected on the sustainability and scalability of digital inclusion efforts. While pilot projects showed promising outcomes, systemic change requires broad policy shifts and investment in infrastructural supports. Digital inclusion must be embedded within broader public health strategies rather than be relegated to ad hoc projects. This involves cross-sector collaboration between healthcare providers, digital service companies, policymakers, and community advocates.
The study’s approach illuminates how quality improvement methodologies, traditionally used for clinical process enhancements, can effectively be adapted to address social determinants like digital exclusion. By incorporating iterative feedback loops and ongoing stakeholder engagement, the project maintained responsiveness to participants’ evolving needs, proving that healthcare quality and equity are deeply intertwined with socio-technical innovations.
Furthermore, the findings prompt urgent reconsideration of digital health equity as a public health priority, especially as virtual care modalities continue to expand post-pandemic. Without targeted efforts, the shift toward digital health risks entrenching existing disparities, leaving criminalized and marginalized populations behind. This research offers a roadmap for more inclusive designs that center the voices and realities of those most affected.
This study represents a critical contribution to the field of health equity and digital health, revealing that technological solutions must be paired with social and structural reforms to be truly effective. By directly addressing digital exclusion in a population burdened by both illness and criminalization, Tiwana et al. pave the way for more equitable access to lifesaving care and improved health outcomes on a global scale.
As digital health innovation rapidly evolves, this research emphasizes that no one can be left offline in the pursuit of universal healthcare access. It challenges healthcare systems to rethink how digital tools are deployed and advocates for more comprehensive, empathetic, and justice-oriented approaches in the design of health services.
The message is clear: digital inclusion is not a luxury but a necessity in modern healthcare, and addressing it meaningfully can transform the lives of some of the most vulnerable populations. As we look toward a future shaped by technology, studies like this underscore the importance of integrating equity into every byte of the healthcare journey.
Subject of Research: Addressing digital exclusion to improve access to HIV and viral hepatitis care among people experiencing criminalization.
Article Title: Addressing digital exclusion to improve access to HIV and viral hepatitis care for people who experience criminalization: a mixed methods evaluation of a quality improvement project.
Article References:
Tiwana, A., Gale, N., Mahay, M. et al. Addressing digital exclusion to improve access to HIV and viral hepatitis care for people who experience criminalization: a mixed methods evaluation of a quality improvement project. Int J Equity Health 24, 337 (2025). https://doi.org/10.1186/s12939-025-02648-3
Image Credits: AI Generated
DOI: https://doi.org/10.1186/s12939-025-02648-3
