App-Guided Hepatitis Self-Testing Versus Provider-Administered Rapid Testing Among Out-of-School Young Adults in Ibadan, Nigeria

Background: Hepatitis B virus (HBV) seroprevalence reaches 10--12% among out-of-school youths in urban Southwest Nigeria, yet fewer than three in ten in this demographic have ever undergone HBV testing. E-health self-testing applications offer an accessible alternative delivery modality for hepatitis screening, but direct evidence comparing their acceptance against traditional laboratory-based delivery in informal commercial settings is lacking. Objective: To determine whether e-health app-guided hepatitis self-testing achieves equivalent disease detection and superior acceptance outcomes compared with traditional laboratory-based screening among out-of-school youths in a high-footfall commercial site in Ibadan, Nigeria. Methods: A cross-sectional parallel-arm pilot study recruited 120 out-of-school youths at commercial premises on Iwo Road, Ibadan (test group: n=60, e-health app-guided hepatitis B and C self-testing; control group: n=60, traditional laboratory-based testing using identical rapid diagnostic kits). Pre- and post-test structured questionnaires assessed technology readiness, behavioural intention, perceived ease of use, and adoption barriers. The Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT) provided the analytical framework. Group comparisons used chi-square and Fisher's exact tests (=0.05). Results: HBV seroprevalence was 10.0% in the test group and 11.7% in the control group (X2=0.087, p=0.769), confirming statistically equivalent detection across modalities. Hepatitis C virus was undetected in both groups. The test group demonstrated greater willingness to use e-health testing over traditional laboratory services (81.6% vs 70.0%), higher comfort with mobile health technology (75.0% vs 71.7%), and equivalent recommendation intent (93.3% vs 95.0%). Prior e-health service use was significantly higher in the test group (28.3% vs 13.3%; X2=4.09, p=0.043). Anticipated ease of use (75.0% "very comfortable") substantially exceeded experienced ease post-use (41.7% "very or extremely easy"). Privacy concern was the leading adoption barrier in both groups (30.0% vs 36.7%), outranking cost (25.0% vs 15.0%). Conclusions: E-health self-testing achieves non-inferior hepatitis B detection compared with traditional laboratory delivery while generating comparable acceptance outcomes. The gap between anticipated and experienced ease of use identifies usability as the primary design target. Privacy-centred tool design, not cost reduction alone, is the critical condition for scaling hepatitis e-health self-testing among out-of-school youths in urban Nigeria.