Young people living with HIV (Y-PLWH) have poor adherence to antiretroviral therapy and engagement in HIV care, making HIV the leading cause of death for African adolescents. Depression and psychological distress are much more common among Y-PLWH than in the general population, and are associated with significantly worse adherence to care and treatment when compared to Y-PLWH without these co-morbid conditions. Thus, untreated depression and severe psychological distress are important contributors to poor HIV outcomes in this population. Nigeria is home to the 4th largest HIV population globally and 10% of Y-PLWH, but mental health screening is not routinely conducted in this setting, and less than 10% of those diagnosed have access to evidence-based care. Despite this treatment gap, few interventions have targeted the mental health needs of Y-PLWH in Africa.
The World Health Organization recommends that caregivers of Y-PLWH adopt youth- friendly strategies and incorporate psychosocial services to meet their needs, and that task shifting to non- specialized health workers be used to overcome the dearth of trained professionals in low and middle-income countries. Task-shifted cognitive behavioral therapy-based interventions like Problem Solving Therapy (PST) has been effectively used treat both depression and psychological distress using a task-shifted approach. However, PST is an intensive strategy often delivered in-person with poor completion rates -- a concern further magnified during the current COVID-19 climate. Mobile health technologies may be uniquely suited to surmount some of the obstacles for effective PST delivery in Nigeria and novel digital game-based strategies, can be utilized to promote engagement in mental health interventions on a platform that is compelling for young people.
Aimalohi "Aima" Ahonkhai, MD, MPH, assistant professor of Medicine and core faculty at the Vanderbilt Institute for Global Health has developed, a prototype of a theory-grounded game, Change My Story, in which players navigate difficult experiences based on drivers of psychological distress and interact with a virtual environment to choose a narrative path toward the story's conclusion. In this proposal, she will work with youth living with HIV, investigators at University of Ibadan in Nigeria and game designers at Playmatics, LLC in New York to finalize this game, and integrate it into a PST intervention delivered by trained HIV counselors via mobile telephone. Through this innovative approach, Dr. Ahonkhai’s team hopes to improve engagement in a critical psychological intervention for youth living with HIV in Nigeria to improve both mental health and HIV outcomes.
This project is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the Fogarty International Center of the National Institutes of Health under award number 1R21HD106578.