User-centered adaption of PEERNaija, A novel mhealth application integrating medication reminders with virtual peer support and social/financial incentives to improve medication adherence.

Youth living with HIV (YLWH) have high rates of virologic failure due to medication non-adherence. PEERNaija is a novel, gamified mobile health (mHealth) application designed with user-centered principles to improve medication adherence by integrating medication reminders with social and financial incentives, virtual peer social support and early clinic outreach for non-adherent YLWH in Nigeria. Focus Group Discussions (FGDs) were conducted to identify reactions to key prototype features (user interface, medication reminders, incentives, and peer support), facilitators and barriers to app use, and how well the app would meet adherence needs. FGDs were analyzed using thematic analysis. Fifty-one Nigerian YLWH 15-27 years (29 females, 22 males), 14 parents of YLWH (11 mothers, 3 fathers), and 5 adolescent public health experts participated in FGDs. All groups expressed enthusiasm about PEERNaija and thought it would improve medication adherence. YLWH expressed excitement about gamified and incentive components. All participants highlighted the importance of maintaining privacy. The app was refined in response to feedback, prioritizing desired features of YLWH and addressing barriers across groups. Findings suggest that PEERNaija will be acceptable (to YLWH, parents of YLWH, and adolescent public health experts) and highlight the importance of user-centered design principles to adapt and refine mHealth interventions.