PeerNaija: A Mobile Health Platform Incentivizing Medication Adherence Among Youth Living with HIV in Nigeria

摘要：全球抗逆转录病毒治疗(ART)的扩大代表着无与伦比的全球健康 这是一个成功的故事，导致艾滋病毒相关发病率和死亡率总体大幅下降。然而， 青少年和青壮年，特别是撒哈拉以南非洲的青少年，在很大程度上被排除在这之外 故事。虽然与艾滋病相关的死亡人数在2005-2012年间下降了30%，但在 在同一时期，艾滋病已成为非洲青年死亡的主要原因。艾滋病毒携带者阿雅 在整个护理过程中表现不佳。坚持抗逆转录病毒疗法是有效治疗艾滋病毒的核心，但阿雅 病毒学失败率高，病毒学在最初抑制后反弹，以及艾滋病毒护理的自然减退率高。 青春期和成年期的独特发展特征，如冲动、冒险和贫穷 具体的思维使日常服药在这一人群中更加具有挑战性。此外， 年轻人的态度和行为往往受到同龄人的强烈影响。这种影响可以是 被视为对期望行为的强大激励。许多文献都集中在经济激励方面， 在促进健康行为方面取得了成功。探索移动健康的数据很少 (MHealth)技术，以利用社会和财政激励，但mHealth平台允许交付 新的行为干预。年，撒哈拉以南非洲地区手机拥有量激增 一般情况下，特别是在尼日利亚，这种干预措施可以在最需要的地方提供。更多 超过75%的艾滋病毒感染者生活在撒哈拉以南非洲地区，足足10%的人居住在尼日利亚。在这项提案中，我们 将调整mHealth应用程序PEERNAJA，以利用社会和财务激励来改善 尼日利亚艾滋病毒携带者阿雅的用药依从性。我们还将与APIN的合作伙伴合作 尼日利亚公共卫生提高开展独立移动卫生研究的能力。 PERNAJA应用程序将提供常规用药提醒，以及个人依从性 使用遵守分数、匿名同伴遵守分数(来自在同一诊所就诊的同伴； 社会奖励)，以及每月以彩票为基础的奖励，奖励遵守分数最高的青少年(经济奖励 激励)。为了实现这些目标，我们将在Vanderbilt和APIN之间之前的合作基础上再接再厉 由PEPFAR支持的多站点计划，为尼日利亚超过25万艾滋病毒携带者提供服务。我们会 通过焦点小组和关键线人访谈让社区中的关键利益相关者参与进来，以指导 该应用程序的迭代改编。我们将招募50名感染艾滋病毒的阿雅来试用这款应用程序并进行评估 重要临床措施(包括依从性)的可行性、可接受性、采用率和初步疗效 和病毒学抑制)。这项拟议的研究将为移动健康的作用提供重要的初步数据 利用和提供社会和财政激励的平台，以促进遵守努力，特别是 弱势青年，以及在尼日利亚感染艾滋病毒的Aya中评估这款应用程序的更大规模的干预试验。

ABSTRACT: The scale-up of global antiretroviral therapy (ART) represents an unparalleled global health success story, leading to impressive overall reductions in HIV-related morbidity and mortality. However, adolescents and young adults (AYA), especially those in Sub-Saharan Africa, have largely been left out of this story. While AIDS-related deaths declined by 30% for adults from 2005-2012, they increased by 50% among AYA over the same period, making AIDS the leading cause of death among African youth. AYA living with HIV perform poorly across the entire care continuum. ART adherence is central to effective HIV treatment, but AYA have high rates of virologic failure, virologic rebound after initial suppression, and attrition from HIV care. Unique developmental features of adolescence and young adulthood such as impulsivity, risk-taking, and poor concrete thinking make daily medication adherence even more challenging in this population. In addition, the attitudes and behaviors of young people are often strongly influenced by their peers. This influence can be seen as a powerful incentive for desired behaviors. Much of the literature has focused on financial incentives, which have shown success in promoting health behaviors. There are few data exploring mobile health (mHealth) technologies to exploit social and financial incentives, yet mHealth platforms allow for the delivery of novel behavioral interventions. With the proliferation of mobile phone ownership in Sub-Saharan Africa in general and in Nigeria in particular, such interventions can be delivered where there is greatest need. More than 75% of HIV-infected AYA live in Sub-Saharan Africa, and fully 10% reside in Nigeria. In this proposal, we will adapt an mHealth application, PEERNaija, to leverage both social and financial incentives to improve medication adherence among AYA living with HIV in Nigeria. We will also work with our partners at APIN Public Health in Nigeria to improve capacity to conduct independent mHealth research. The PEERNaija application will feature routine medication reminders, along with individual adherence monitoring with adherence scores, anonymized peer adherence scores (from peers attending the same clinic; social incentive), and a monthly lottery-based prize for youth with the highest adherence scores (financial incentive). To accomplish these aims, we will build on previous collaborations between Vanderbilt and APIN, a multi-site PEPFAR-supported program serving more than 250,000 persons living with HIV in Nigeria. We will engage key stakeholders in the community through focus groups and key informant interviews to guide iterative adaptation of the app. We will recruit a cohort of 50 HIV-infected AYA to pilot the app and assess feasibility, acceptability, adoption, and preliminary efficacy of important clinical measures (including adherence and virologic suppression). The proposed study will provide important preliminary data for the role of mHealth platforms to harness and deliver social and financial incentives to promote adherence efforts, especially for vulnerable youth, and for a larger intervention trial evaluating this app among HIV-infected AYA in Nigeria.