Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021:3:656507.
doi: 10.3389/frph.2021.656507. Epub 2021 Jul 30.

PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria

Aima A Ahonkhai  1   2   3 , Leslie J Pierce  2 , Samuel Mbugua  4 , Benjamin Wasula  4 , Samuel Owino  4 , Ashley Nmoh  5 , Ifeoma Idigbe  6 , Oliver Ezechi  6 , Sandra Amaral  7   8 , Agatha David  6 , Prosper Okonkwo  9 , Nadia Dowshen  10   11 , Martin C Were  3   12
Affiliations

PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria

Aima A Ahonkhai et al. Front Reprod Health. 2021.

Abstract

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.

Keywords: HIV; adolescents and young adult; gamification; low- and middle-income countries; medication adherence; mobile health; social support.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Seven steps of the IDEAS framework employed in the development of PEERNaija.
Figure 2
Figure 2
PEERNaija architecture.
Figure 3
Figure 3
(3.1–3.8) PEERNaija application user interfaces.
See this image and copyright information in PMC

References

    1. Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. (2014) 66 (Suppl. 2):S144–53. 10.1097/QAI.0000000000000176 - DOI - PubMed
    1. WHO . Health for the World's Adolescents: A Second Chance in the Second Decade. World Health Organization (2014). Available online at: https://www.who.int/maternal_child_adolescent/documents/second-decade/en/ (accessed January 13, 2021).
    1. WHO . Adolescents: Health Risks and Solutions (2018). Available online at: https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risk... (accessed January 13, 2021).
    1. Ahonkhai AA, Banigbe B, Adeola J, Adegoke AB, Regan S, Bassett IV, et al. Age matters: increased risk of inconsistent HIV care and viremia among adolescents and young adults on antiretroviral therapy in Nigeria. J Adolesc Health. (2016) 59:298–304. 10.1016/j.jadohealth.2016.05.002 - DOI - PMC - PubMed
    1. Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from Sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. (2014) 14:627–39. 10.1016/S1473-3099(13)70363-3 - DOI - PMC - PubMed