Babafemi O Taiwo1, Kehinde M Kuti2, Lisa M Kuhns3,4, Olayinka Omigbodun5,6, Olutosin Awolude2,7, Adedotun Adetunji8, Baiba Berzins1, Patrick Janulis9, Amy K Johnson3,4, Ogochukwu Okonkwor1, Bibilola D Oladeji9, Abigail Muldoon4, Olubusuyi M Adewumi10, Paul Amoo2, Hannah Atunde2, Bill Kapogiannis11, Robert Garofalo3,4. 1. Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, IL. 2. Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria. 3. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Division of Adolescent Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL. 5. Department of Child and Adolescent Psychiatry, and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria. 6. Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria. 7. Department of Obstetrics and Gynecology, and Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria. 8. Department of Family Medicine, University College Hospital, Ibadan, Nigeria. 9. Department of Medical Social Sciences, Northwestern University, Chicago, IL. 10. Department of Virology, College of Medicine, University of Ibadan, Nigeria; and. 11. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Abstract
BACKGROUND: Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral nonsuppression. Hence, novel interventions are needed. SETTING: Infectious Diseases Institute, College of Medicine, University of Ibadan, Nigeria. METHODS: In a single-arm trial, participants aged 15-24 years received 48 weeks of a combination intervention, comprising daily 2-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression less than 200 copies/mL. The secondary outcome measures included self-reported adherence on a visual analog scale and medication possession ratio, each dichotomized as ≥90% (good) or <90% (poor) adherence. The outcomes were analyzed using McNemar test. Retention in care, intervention feasibility and acceptability, and participants' satisfaction were also assessed. RESULTS: Forty YWH (50% male participants) were enrolled: mean age 19.9 years (SD = 2.5), 55% perinatally infected, and 35% virologically suppressed at baseline. Compared with baseline, the odds of virologic suppression was higher at 24 weeks (odds ratio = 14.00, P < 0.001) and 48 weeks (odds ratio = 6.00, P = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, P = 0.008) and 48 weeks (68%, P = 0.031). Medication possession ratio ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks alone (P = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. CONCLUSION: Daily 2-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
BACKGROUND: Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral nonsuppression. Hence, novel interventions are needed. SETTING: Infectious Diseases Institute, College of Medicine, University of Ibadan, Nigeria. METHODS: In a single-arm trial, participants aged 15-24 years received 48 weeks of a combination intervention, comprising daily 2-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression less than 200 copies/mL. The secondary outcome measures included self-reported adherence on a visual analog scale and medication possession ratio, each dichotomized as ≥90% (good) or <90% (poor) adherence. The outcomes were analyzed using McNemar test. Retention in care, intervention feasibility and acceptability, and participants' satisfaction were also assessed. RESULTS: Forty YWH (50% male participants) were enrolled: mean age 19.9 years (SD = 2.5), 55% perinatally infected, and 35% virologically suppressed at baseline. Compared with baseline, the odds of virologic suppression was higher at 24 weeks (odds ratio = 14.00, P < 0.001) and 48 weeks (odds ratio = 6.00, P = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, P = 0.008) and 48 weeks (68%, P = 0.031). Medication possession ratio ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks alone (P = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. CONCLUSION: Daily 2-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
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