Search

Youth living with HIV (YLWH) have high rates of virologic failure due to medication non-adherence. PEERNaija is a novel, gamified mobile health (mHealth) application designed with user-centered principles to improve medication adherence by integrating medication reminders with social and financial incentives, virtual peer social support and early clinic outreach for non-adherent YLWH in Nigeria. Focus Group Discussions (FGDs) were conducted to identify reactions to key prototype features (user interface, medication reminders, incentives, and peer support), facilitators and barriers to app use, and how well the app would meet adherence needs. FGDs were analyzed using thematic analysis. Fifty-one Nigerian YLWH 15-27 years (29 females, 22 males), 14 parents of YLWH (11 mothers, 3 fathers), and 5 adolescent public health experts participated in FGDs. All groups expressed enthusiasm about PEERNaija and thought it would improve medication adherence. YLWH expressed excitement about gamified and incentive components. All participants highlighted the importance of maintaining privacy. The app was refined in response to feedback, prioritizing desired features of YLWH and addressing barriers across groups. Findings suggest that PEERNaija will be acceptable (to YLWH, parents of YLWH, and adolescent public health experts) and highlight the importance of user-centered design principles to adapt and refine mHealth interventions.

Nigeria has more HIV-infected women who do not receive needed services for the prevention of mother-to-child transmission of HIV (PMTCT) than any other nation in the world. To meet the UNAIDS/WHO goal of eliminating mother-to-child HIV transmission by 2015, multiple interventions will be required to scale up PMTCT services, especially to lower-level, rural health facilities. To address this, we are conducting a cluster-randomized controlled study to evaluate the impact and cost-effectiveness of a novel, family-focused integrated package of PMTCT services. A systematic re-assignment of patient care responsibilities coupled with the adoption of point-of-care CD4 + cell count testing could facilitate the ability of lower-cadre health providers to manage PMTCT care, including the provision and scale-up of antiretroviral therapy (ART) to pregnant women in rural settings. Additionally, as influential community members, male partners could support their partners' uptake of and adherence to PMTCT care. We describe an innovative approach to scaling up PMTCT service provision that incorporates considerations of where and from whom women can access services (task-shifting), ease of obtaining a CD4 + cell count result (point-of-care testing), the degree of HIV service integration for HIV-infected women and their infants, and the level of family and community involvement (specifically male partner involvement). This systematic approach, if proven feasible and effective, could be scaled up in Nigeria and similar resource-limited settings as a means to accelerate progress toward eliminating mother-to-child transmission of HIV and help women with HIV infection take ART and live long, healthy lives (Trial registration: NCT01805752)., (© 2013 Elsevier Inc. All rights reserved.)