Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth

Abstract

Background Nigeria has the second highest number of people living with HIV (PLWH) globally, and evidence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods To elicit expert and community perspectives, a local group of advisors from academia, community, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analysis approach. Results Local experts recommended intervention adaptations specific to the status of peer navigators as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator-peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability.

Evaluation of the iCARE Nigeria Pilot Intervention Using Social Media and Peer Navigation to Promote HIV Testing and Linkage to Care Among High-Risk Young Men

“…Community and stakeholder perspectives guided adaptation of evidence-based HIV testing, mHealth (defined by the National Institutes of Health as the use of mobile and wireless devices to improve health outcomes, health care services, and health research), and peer-navigation interventions for Nigerian youths. 18 A manualized intervention specified staffing structure, general content of social media messages, and frequency of posts on 3 social media platforms used and trusted by Nigeria's young MSM: WhatsApp, Facebook, and Grindr.…”

Effect of Text Messaging Plus Peer Navigation on Viral Suppression Among Youth With HIV in the iCARE Nigeria Pilot Study

“…The iCARE Nigeria was adapted for Nigerian youth through broad input from local YWH and other stakeholders. 28 In this study, we report the findings of the first (pilot) phase of the treatment intervention arm of the iCARE study, where we hypothesized that the investigational combination intervention will improve the odds of viral suppression among YWH aged 15-24 years at IDI/CoMUI. We also tested, as secondary outcomes, the effects of the combination intervention on adherence and retention in care, intervention feasibility and acceptability, and participants' satisfaction.…”

Cultivating resilience and hope: A qualitative study of a pilot program using patient navigators to assist men who have sex with men with retention in the HIV care continuum in Uganda

“…These findings shed light on how PN programs could benefit other MSM communities in high discrimination settings. It is important to note that in these settings, it has been documented that HIV prevention and control efforts are often hindered due to inaccuracies and scarcity of MSM and HIV positive population data and difficulties reaching MSM individuals [5,13,32]. Based on our findings, it could be suggested that PN interventions in these settings are well suited to overcome these two challenges as they can use both HIV positive and negative MSM to provide information and services to other individuals in their community.…”

“…In contexts where same-sex sexual behavior is highly stigmatized, PNs have been used to both provide information about HIV and assist with gaining the skills needed for living with HIV. Set in Guatemala, Nigeria, and Kenya, these interventions successfully motivated patients to remain engaged in care, linked newly diagnosed patients to care, addressed antiretroviral therapy (ARV) adherence barriers, and provided emotional support [4,5,13].…”