Background: Mental health problems are a barrier to the well-being of youth living with HIV. Many youth living with HIV in
Nigeria face peculiar biopsychosocial vulnerabilities that predispose them to mental health problems including depression and
substance use. In addition to improving treatment outcomes like medication adherence and linkage to care, peer engagement
has shown some promise in improving the social and emotional well-being of this population. Mobile health (mHealth)
interventions like SMS text messaging medication reminders may also contribute to better outcomes in youth living with HIV.
Emerging evidence suggests that combination interventions may be more effective than single interventions in improving key
HIV testing and treatment outcomes among youth in Nigeria.
Objective: This study aims to explore the impact of Intensive Combination Approach to Rollback the Epidemic in Nigerian
Adolescents (iCARE Nigeria) study—an mHealth and peer navigation intervention primarily aimed at medication adherence
and viral suppression—on depressive symptoms and substance use among youth living with HIV in Nigeria.
Methods: A single-arm clinical trial was conducted at the Infectious Disease Institute, College of Medicine, University of
Ibadan, Nigeria— primarily to improve medication adherence and viral suppression among youth living with HIV attending its
HIV clinic. The intervention combined peer navigation and daily, 2-way, text message medication reminders delivered over a
period of 48 weeks. Participants were screened at baseline and follow-up visits (24 and 48 weeks) for depression and substance
use using standardized measures. Paired t tests and McNemar tests were used to investigate the change in depressive symptoms
and the change in the proportion of participants reporting substance use over time, respectively.
Results: All 40 enrolled participants (n=20, 50% male; mean age 19.9 y, SD 2.5 y) completed baseline and follow-up visits at
week 24, while 37 (92.5%) participants completed the week 48 visit. Compared with baseline, there were significantly fewer
self-reported depressive symptoms observed at 48 weeks (mean 2.89 vs 2.08; t36=2.04, 95% CI 0.006‐1.615) but not at 24
weeks (mean 2.89 vs 2.62; t36=0.47, 95% CI –0.74 to 1.44). There were fewer self-reports of substance use at weeks 24 and 48
Exploratory Impact of iCARE Nigeria, a Combined mHealth and Peer Navigation Intervention, on Depressive Symptoms and Substance Use Among Youth Living With HIV in Nigeria: Single-Arm Trial
Olusegun Ayomikun Ogunmola1 , MSc; Rita Frinue Tamambang1 , MSc, MD; Kehinde Kuti2 , MBBS, MSCI; Lisa M Kuhns3,4, MPH, PhD; Olutosin Awolude2 , MBBS, MSc; Adedotun Adetunji5 , MBChB, MSCI; Bibilola Oladeji6 , MBBS, PhD; Oladayo Olaleye2 , MPH; Adeola Mary Oyerinde2 , MEd; Robert Garofalo3,4, MPH, MD; Babafemi Taiwo7 , MBBS; Olayinka Olusola Omigbodun1,6, MPH, MD·
Journal: JMIR Formative Research (2025)