PeerNaija: A Mobile Health Platform Incentivizing Medication Adherence Among Youth Living With HIV in Nigeria

NCT04930198 | Completed Results

• 2 other identifiers: 200116R21TW011327
• Study Type: interventional
• Target: 54
• Locations: 1 country
• Sites: 2

Brief Summary

The PEERNaija application will feature routine medication reminders, along with individual adherence monitoring with adherence scores, anonymized peer adherence scores (from peers attending the same clinic; social incentive), and a monthly lottery-based prize for youth with the highest adherence scores (financial incentive). The Investigators will recruit a cohort of 50 HIV-infected adolescents and young adults (AYA) to pilot the app and assess feasibility, acceptability, adoption, and preliminary efficacy of important clinical measures (including adherence and virologic suppression). The proposed study will provide important preliminary data for the role of mobile health (mHealth) platforms to harness and deliver social and financial incentives to promote adherence efforts, especially for vulnerable youth, and for a larger intervention trial evaluating this app among HIV-infected AYA in Nigeria.

Conditions

HIV/AIDS

Keywords

HIV/AIDS; Sub-Saharan Africa

Outcome Measures

Primary Outcomes (6)

• Recruitment Rate

  Recruitment rate is measured by the percentage of participants randomized relative to total trial referrals.

  Baseline

• Retention Rate

  Retention rate is measured by the percentage of participants who completed the 24-week follow-up.

  24 weeks

• Feasibility of Intervention

  Feasibility will be assessed with the Feasibility of Intervention Measure (FIM), a validated, four-item measure to determine the extent to which stakeholders believe an intervention is feasible to implement. The FIM will assess participant's likes/dislikes of the mobile health platform, privacy/security concerns, technology barriers, usage preferences, medication compliance and reasons for non-compliance. The FIM is scored on a scale of 1-5 with higher scores indicating higher perceived feasibility.

  24 weeks

• Acceptability of Intervention

  Acceptability will be assessed with the Acceptability of Intervention Measure (AIM), a validated, four-item measure to determine the extent to which stakeholders believe an intervention is feasible to implement. The AIM will assess participant's likes/dislikes of the mobile health platform, privacy/security concerns, technology barriers, usage preferences, medication compliance and reasons for non-compliance. The AIM is scored on a scale of 1-5 with higher scores indicating higher perceived acceptability.

  24 weeks

• Appropriateness of Intervention

  Appropriateness will be assessed with the Intervention Appropriateness Measure (IAM), a validated, four-item measure to determine the extent to which stakeholders believe an intervention is feasible to implement. The IAM will assess participant's likes/dislikes of the mobile health platform, privacy/security concerns, technology barriers, usage preferences, medication compliance and reasons for non-compliance.

  24 weeks

• Preliminary Efficacy of Intervention on Viral Load

  Preliminary efficacy will be assessed by identifying the number of participants virally suppressed at study end (undetectable \< 1000 m/ml).

  24 weeks

Study Arms (2)

Social Incentive

OTHER

For the social incentive, the mHealth application will track the participant's individual adherence score (% of doses taken), track the top scorers (leaderboard), and provide a figure highlighting the proportion of their peers with poor (\<80%), medium (80-94%), or high (\>94%) adherence scores. The display of the individual's adherence score relative to peer scores is considered a descriptive norm and is meant to portray "what most people are doing," as young people often inaccurately estimate behaviors for their peer groups. Participants will also receive an injunctive norm, or an indication of what they ought to be doing. This will come in the form of an emoji or congratulatory vs. motivating text for those with high or low adherence scores, respectively. When coupled with descriptive norms, injunctive norms have counteracted regression to the mean for individuals who demonstrate desirable behaviors relative to their peers.

Behavioral: PeerNaija

Social Plus Financial Incentive

OTHER

For the financial incentive, the top 5 scorers in the PEER+ arm will be eligible win a lottery prize each month of the 24 week pilot of 1000 Nigerian Naira (NGN) of "data" that can be directly loaded onto the winner's phone. Behavioral economics theory tells us that individuals are more averse to losses than rewarded by gains, so that even incentives/prizes should be framed in terms of losses. Accordingly, participants in the financial incentive arm will receive weekly motivating messages such as "take your dose today or you lose the chance of winning the lottery."

Behavioral: PeerNaija

Interventions

PeerNaija BEHAVIORAL

All participants (anticipated N=50) will receive daily medication reminders and access to the virtual support group on the PEERNaija app. Participants will be randomized to receive a social incentive (anticipated n=25) or a social plus financial incentive (anticipated n=25), PEER+, and be followed for 24 weeks.

Social Incentive; Social Plus Financial Incentive

Eligibility Criteria

• Age: 16 Years - 27 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Own a smartphone (on which they are willing to download PEERNaija),
• years of age,
• on ART, and
• demonstrate the ability read simple text language in English.

Sponsors & Collaborators

• Vanderbilt University Medical Center: lead
• Fogarty International Center of the National Institute of Health: collaborator
• APIN Public Health Initiatives: collaborator
• Nigerian Institute of Medical Research: collaborator
• Children's Hospital of Philadelphia: collaborator

Study Sites (2)

APIN Public Health Initiatives

Abuja, Nigeria

Location

Nigerian Institute of Medical Researd

Lagos, Nigeria

Location

Related Publications (4)

• Were MC, Pierce LJ, Idigbe I, Okonkwo P, Mbugua S, Savai S, Eliazer CL, Ahonkhai AA. Applying Gamification Principles to a Mhealth App to Support Adherence to Hiv Medication in a Resource-Limited Setting. Stud Health Technol Inform. 2025 Aug 7;329:1545-1549. doi: 10.3233/SHTI251098.

  PMID: 40776116 RESULT

• Idigbe I, Were M, Pierce LJ, Ekelem C, Nmoh A, Gbaja-Biamila T, David A, Ejiga Q, Ogunwale J, Adetoye D, Okonkwo P, Musa Z, Downshen N, Ezechi O, Audet C, Ahonkhai AA. User-centered adaption of PEERNaija, A novel mhealth application integrating medication reminders with virtual peer support and social/financial incentives to improve medication adherence. AIDS Care. 2025 Feb;37(2):263-278. doi: 10.1080/09540121.2024.2445789. Epub 2025 Jan 6.

  PMID: 39761419 RESULT

• Ahonkhai AA, Pierce LJ, Mbugua S, Wasula B, Owino S, Nmoh A, Idigbe I, Ezechi O, Amaral S, David A, Okonkwo P, Dowshen N, Were MC. PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria. Front Reprod Health. 2021;3:656507. doi: 10.3389/frph.2021.656507. Epub 2021 Jul 30.

  PMID: 35237765 RESULT

• Pierce LJ, Were MC, Amaral S, Aliyu MH, Ezechi O, David A, Idigbe I, Musa AZ, Okonkwo P, Dowshen N, Ahonkhai AA. PEERNaija-a mobile health platform incentivizing medication adherence among youth living with HIV in Nigeria: study protocol for a randomized controlled trial. Pilot Feasibility Stud. 2023 Oct 27;9(1):179. doi: 10.1186/s40814-023-01404-0.

  PMID: 37891681 RESULT

MeSH Terms

Conditions

Acquired Immunodeficiency Syndrome

Condition Hierarchy (Ancestors)

HIV Infections; Blood-Borne Infections; Communicable Diseases; Infections; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; RNA Virus Infections; Virus Diseases; Slow Virus Diseases; Genital Diseases; Urogenital Diseases; Immunologic Deficiency Syndromes; Immune System Diseases

Limitations and Caveats

As a pilot, the trial recruited a small sample size. Otherwise, we have nothing to report.

Results Point of Contact

• Title: Dr. Martin Were
• Organization: Vanderbilt University Medical Center

martin.c.were@vumc.org

(617) 319-6462

Study Officials

• Aima Ahonkhai, MD, MPH

  Massachusetts General Hospital

  PRINCIPAL INVESTIGATOR

• Martin C Were, MD, MS

  Vanderbilt University Medical Center

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor Biomedical Informatics and Medicine

Study Record Dates

• First Submitted: May 25, 2021
• First Posted: June 18, 2021
• Study Start: August 1, 2021
• Primary Completion: March 13, 2024
• Study Completion: March 31, 2024
• Last Updated: November 25, 2025
• Results First Posted: November 25, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

NG (2)