PMID- 35237765 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220731 IS - 2673-3153 (Electronic) IS - 2673-3153 (Print) IS - 2673-3153 (Linking) VI - 3 DP - 2021 TI - PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria. LID - 656507 [pii] LID - 10.3389/frph.2021.656507 [doi] AB - BACKGROUND: HIV is the leading cause of death for youth in Sub-Saharan Africa (SSA). The rapid proliferation of smart phones in SSA provides an opportunity to leverage novel approaches to promote adherence to life-saving antiretroviral therapy (ART) for adolescents and young adults living with HIV (AYA-HIV) that go beyond simple medication reminders. METHODS: Guided by the Integrate, Design, Assess and Share (IDEAS) framework, our multidisciplinary team developed a peer-based mHealth ART adherence intervention-PEERNaija. Grounded in Social Cognitive Theory, and principles of contingency management and supportive accountability, PEERNaija delivers a multi-faceted behavioral intervention within a smartphone application to address important obstacles to adherence. RESULTS: PEERNaija was developed as a gamified Android-based mHealth application to support the behavioral change goal of improving ART adherence among AYA-HIV within Nigeria, a low- and middle- income country (LMIC). Identified via foundational interviews with the target population and review of the literature, key individual (forgetfulness and poor executive functioning), environmental (poor social support) and structural (indirect cost of clinic-based interventions) barriers to ART adherence for AYA-HIV informed application features. Further informed by established behavioral theories and principles, the intervention aimed to improve self-efficacy and self-regulation of AYA-HIV, leverage peer relationships among AYA to incentivize medication adherence (via contingency management, social accountability), provide peer social support through an app-based chat group, and allow for outreach of the provider team through the incorporation of a provider application. Gamification mechanics incorporated within PEERNaija include: points, progress bar, leaderboard with levels, achievements, badges, avatars and targeted behavior change messages. PEERNaija was designed as a tethered mobile personal health record application, sharing data to the widely deployed OpenMRS electronic health record application. It also uses the secure opensource Nakama gamification platform, in line with Principles of Digital Development that emphasize use of opensource systems within LMICs. CONCLUSIONS: Theory-based gamified mHealth applications that incorporate social incentives have the potential to improve adherence to AYA-HIV. Ongoing evaluations of PEERNaija will provide important data for the potential role for a gamified, smartphones application to deliver multifaceted adherence interventions for vulnerable AYA-HIV in SSA. FAU - Ahonkhai, Aima A AU - Ahonkhai AA AD - Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States. AD - Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States. AD - Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States. FAU - Pierce, Leslie J AU - Pierce LJ AD - Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States. FAU - Mbugua, Samuel AU - Mbugua S AD - Institute of Biomedical Informatics, Moi University, Kesses, Kenya. FAU - Wasula, Benjamin AU - Wasula B AD - Institute of Biomedical Informatics, Moi University, Kesses, Kenya. FAU - Owino, Samuel AU - Owino S AD - Institute of Biomedical Informatics, Moi University, Kesses, Kenya. FAU - Nmoh, Ashley AU - Nmoh A AD - Department of Medicine Health and Society, Vanderbilt University, Nashville, TN, United States. FAU - Idigbe, Ifeoma AU - Idigbe I AD - Nigerian Institute of Medical Research, Lagos, Nigeria. FAU - Ezechi, Oliver AU - Ezechi O AD - Nigerian Institute of Medical Research, Lagos, Nigeria. FAU - Amaral, Sandra AU - Amaral S AD - Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States. AD - Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States. FAU - David, Agatha AU - David A AD - Nigerian Institute of Medical Research, Lagos, Nigeria. FAU - Okonkwo, Prosper AU - Okonkwo P AD - APIN Public Health Initiatives (APIN), Abuja, Nigeria. FAU - Dowshen, Nadia AU - Dowshen N AD - Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States. AD - Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. FAU - Were, Martin C AU - Were MC AD - Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States. AD - Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States. LA - eng GR - R21 TW011327/TW/FIC NIH HHS/United States GR - R25 MH080665/MH/NIMH NIH HHS/United States PT - Journal Article DEP - 20210730 PL - Switzerland TA - Front Reprod Health JT - Frontiers in reproductive health JID - 9918230899006676 PMC - PMC8887881 MID - NIHMS1760282 OTO - NOTNLM OT - HIV OT - adolescents and young adult OT - gamification OT - low- and middle-income countries OT - medication adherence OT - mobile health OT - social support COIS- Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2021/01/01 00:00 MHDA- 2021/01/01 00:01 PMCR- 2021/07/30 CRDT- 2022/03/03 05:37 PHST- 2022/03/03 05:37 [entrez] PHST- 2021/01/01 00:00 [pubmed] PHST- 2021/01/01 00:01 [medline] PHST- 2021/07/30 00:00 [pmc-release] AID - 656507 [pii] AID - 10.3389/frph.2021.656507 [doi] PST - ppublish SO - Front Reprod Health. 2021;3:656507. doi: 10.3389/frph.2021.656507. Epub 2021 Jul 30.