Adapting and testing a combination peer navigation and mHealth intervention to enhance treatment engagement and viral suppression among sexual and gender minority youth in Nigeria

点击翻译按钮获取中文摘要

Project Summary Nigeria is one of the six countries with half of the global burden of youth with HIV. HIV prevalence among young men who have sex with men (YMSM) and young transgender women (YTW), ages 15-24 is over six-fold that of the general population of youth. Furthermore, across risk groups, youth have disproportionately worse HIV care outcomes in comparison to adults. There are challenges to treatment engagement and viral suppression among YMSM and YTW. While adult HIV care routinely begins at age 15, youth-adapted programs to support successful care engagement are rare, particularly for YMSM and YTW, who typically prefer to receive care in multipurpose key population-focused community-based centers, which often lack evidence-driven, youth-specific interventions that include psychosocial and medication adherence support for best outcomes. This preference for key population-focused community centers is rational given the country’s unfavorable social milieu which promotes social stigma, lack of disclosure, and low social support, and in the context of a legal environment which criminalizes same-sex relationships. Evidence-based and scalable approaches, incorporating preferences for community centers, are needed to have the greatest impact on ART outcomes among YMSM and YTW in Nigeria. Thus, we propose to adapt and test the Intensive Combination Approach to Rollback the Epidemic in Nigeria (iCARE Nigeria), to improve HIV treatment engagement, medication adherence, and viral suppression among YMSM and YTW where they receive care. The iCARE Nigeria model uses evidence-based and youth-specific approaches, including peer navigation and daily text message reminders in combination. iCARE Nigeria has demonstrated efficacy in a general population of youth with HIV in a traditional HIV clinic at the University of Ibadan, Nigeria. In this study, we will expand it to YMSM and YTW cared for in community centers using a community and outreach-based delivery approach. Our goal is to develop a practical and scalable enhancement to HIV treatment for YMSM and YTW where they receive care. Our aims are to: 1) adapt the iCARE Nigeria HIV clinic-based intervention to a community-based outreach approach for YMSM and YTW ages 15-24 living with HIV in Ibadan, Nigeria; 2) test the adapted iCARE intervention for initial efficacy, feasibility, satisfaction, and acceptability among YMSM and YTW and 3) evaluate implementation indicators based on RE-AIM (reach, adoption, implementation, maintenance) to inform widespread dissemination and scalability of the adapted iCARE Nigeria intervention.