The HIV epidemic in Nigeria for youth aged 15–24 is disproportionately high among young men who have sex with men (YMSM) and young transgender women (YTW). With their first “Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria)” research grant, Babafemi Taiwo, MBBS, at Northwestern University, and his multiple principal investigator, Robert Garofalo, MD, MPH, at Lurie Children’s, worked with a multidisciplinary research team to locally adapt, pilot test, and then conduct a large stepped-wedge trial of two evidence-based interventions combining mHealth strategies and peer navigation. These combination interventions aimed at improving HIV testing and linkage to care, and increasing ART adherence and viral suppression among Nigerian youth.
With their new iCARE Plus grant, this research team aims to scale up and evaluate the effectiveness and implementation outcomes of enhanced versions of the iCARE interventions across Nigeria’s six geopolitical zones.
The iCARE research grants and associated supplemental awards total $10.9 million in direct funding. Other iCARE Plus leaders include Lisa Kuhns, PhD; MPH; Lisa Hirschhorn, MD, MPH; Aima Ahonkhai, MD, MPH; and Amy Johnson, PhD. Baiba Berzins, MPH, is the iCARE program administrator and Ogo Okonkwor, MPH, is a consultant for all the iCARE projects.
“There is evidence to suggest that interventions to reach youth, including hard-to-reach MSM, and improve HIV care outcomes across the HIV care continuum should involve combination interventions as these may have additive benefits compared to single interventions,” said Taiwo. “The development of effective and scalable combination intervention strategies that will accelerate the UNAIDS 95-95-95 goals to end this epidemic among Nigerian youth, including MSM, is critical to improve health outcomes and reduce disease burden due to HIV infection.”
iCARE Nigeria is a NICHD-funded PATC3H research partnership which included a two-year pilot phase, followed by a three-year UH3 phase.
In the iCARE HIV testing intervention, trained peer navigators interacted with youth on three social media platforms popular among Nigeria’s YMSM: WhatsApp, Facebook, and Grindr. This created a sense of community related to iCARE Nigeria and focused on generating interest in HIV testing among young men. Peer navigation enabled community-based testing of YMSM at high-risk of HIV infection and subsequent linkage to care for those who tested positive for HIV. The iCARE Nigeria testing intervention has so far reached over 4,000 YMSM and has been shown to be associated with increased HIV testing and linkage to care in this high-risk, difficult-to-reach population, making it a promising combination intervention for YMSM.
In the iCARE Nigeria treatment intervention, 558 youth who were on ART for at least three months were enrolled in a stepped-wedge trial. The core of this intervention was TXTXT, which is a CDC-endorsed intervention developed by Garofalo, Kuhns, and the Lurie Children’s team. TXTXT involves automated daily text message ART reminders sent to enrolled youth to encourage adherence to ART. The treatment intervention was conducted in tertiary and secondary health care facilities. In addition to TXTXT, young people who were trained to provide practical support to other youth on ART helped enrolled participants with drug pick-up, accompanied them on health care visits, and performed other supportive activities.
Building on the success of iCARE Nigeria, the research team received the iCARE Plus grant. iCARE Plus is a five-year study that aims to scale up and test the effectiveness and implementation outcomes of enhanced versions of the iCARE interventions as part of the newly formed PATC3H-IN research consortium. The goal of this study is to conduct HIV testing in 6,000 YMSM through new Clinical Research Performance Sites (CRPSs) in HIV “hotspots” across Nigeria’s six geopolitical zones. These HIV “hotspots” include Lagos, Taraba, Benue, Aiwa Ibom, Enugu, and Kano States. Each clinical research performance site includes two community clinics where the study will be implemented. For the treatment intervention, while iCARE enrolled youth who were on ART for at least three months, iCARE Plus plans to enroll a new population of 600 ART naive youth (youth who are newly diagnosed with HIV and who are not on treatment yet). The study aims to have 40% of the 600 ART naive youth as YMSM. In addition, iCARE Plus will include a PrEP uptake intervention among YMSM youth who test negative for HIV.
In Nigeria, HIV prevalence among YTW and YMSM ages 15-24 is over six-fold of the general population of youth.
“When we started iCARE, viral suppression among Nigerian youth in the iCARE sites was below 40%. Our goal is to help meet the UNAIDS target of 95% suppression, including MSM,” said Taiwo.
Northwestern researchers Gregory Phillips, II, PhD, and Ramon Lorenzo-Redondo, PhD, also received an iCARE supplement that examined the phylodynamics of HIV among youth including the iCARE population in Ibadan, Nigeria. The iCARE supplement is entitled “A Network and Viral Phylodynamics Substudy of the Intensive Combination Approach to Rollback the Epidemic (iCARE) in Nigerian Adolescents.”
The Third Coast Center for AIDS Research (TC CFAR) supports the statistical work of the iCARE projects through its Biostatistics and Computational Resources Team (BCRT). Pat Janulis, PhD, co-leader of the BCRT, provides services for iCARE and is a co-investigator on the projects.
The success of the iCARE grant was instrumental in renewing the NIH’s Fogarty International Center-funded D43 Multidisciplinary NeuroAIDS Research and Training Program in Nigeria in 2024. This training grant has a new focus on the mental health of sexual and gender minority persons and stroke in persons with HIV in Nigeria and has been refunded through 2028. It also includes new collaborators Michael Newcomb, PhD, director of the TC CFAR’s BSIS Core, and Brian Mustanski, PhD, director of the TC CFAR, and ISGMH faculty members Lauren Beach; JD, PhD; Dennis Li; PhD; Kathryn Macapagal; PhD; Gregory Phillips; PhD; and Janulis.
Taiwo was the founding director of the TC CFAR’s Clinical Sciences Core and currently serves on the TC CFAR’s internal advisory board with oversight of the CS Core.