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）的规模扩大代表了前所未有的全球健康 这是一个成功的故事，导致与艾滋病毒有关的发病率和死亡率全面下降，令人印象深刻。然而，在这方面， 青少年和年轻人（AYA），特别是撒哈拉以南非洲的青少年和年轻人，在很大程度上被排除在外 故事虽然从2005年到2012年，成人艾滋病相关死亡人数下降了30%， 在同一时期，艾滋病成为非洲青年死亡的主要原因。艾滋病毒携带者 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AYA 有很高的病毒学失败率、初始抑制后的病毒学反弹率和HIV护理的损耗率。 青春期和青年期的独特发展特征，如冲动，冒险和贫穷 具体的思维使这一人群的日常用药依从性更具挑战性。此外该 青年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 被视为对所需行为的强大激励。大部分文献都集中在财政激励上， 它们在促进健康行为方面取得了成功。很少有数据探索移动的健康 （mHealth）技术利用社会和财政激励措施，但mHealth平台允许提供 新的行为干预。随着年撒哈拉以南非洲地区移动的电话拥有量的激增， 在一般情况下，特别是在尼日利亚，可以在最需要的地方采取这种干预措施。更 75%以上的艾滋病毒感染者居住在撒哈拉以南非洲，10%居住在尼日利亚。在本提案中，我们 将调整移动健康应用程序PEERNaija，以利用社会和财政激励措施来改善 尼日利亚艾滋病毒感染者中的药物依从性。我们还将与APIN的合作伙伴合作， 尼日利亚的公共卫生，以提高开展独立移动健康研究的能力。 PEERNaija应用程序将具有常规药物提醒功能，沿着个人依从性 用依从性分数、匿名同伴依从性分数（来自参加同一诊所的同伴; 社会激励），以及每月为坚持分数最高的青年提供彩票奖励（财务 激励）。为了实现这些目标，我们将建立在范德比尔特和APIN之前的合作基础上， 这是一个由PEPFAR支持的多地点项目，为尼日利亚的25万多名艾滋病毒感染者提供服务。我们将 通过焦点小组和主要知情人访谈，让社区中的主要利益相关者参与， 我们将招募50名艾滋病毒感染者AYA来试用该应用程序， 重要临床指标（包括依从性）的可行性、可接受性、采用性和初步疗效 和病毒学抑制）。这项拟议中的研究将为mHealth的作用提供重要的初步数据 利用和提供社会和财政激励措施的平台，以促进遵守努力，特别是 脆弱的年轻人，并在尼日利亚的艾滋病毒感染者中进行更大规模的干预试验，评估这款应用程序。

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.