A Smartphone Game to Increase Engagement in Care among African Adolescents Living with HIV

项目概述：这项研究的目标是为改善青少年的健康状况做出贡献 撒哈拉以南非洲的艾滋病毒携带者，这是一个人口、临床和流行病学都很高的人群 重要性。我们的目标是通过在肯尼亚基苏木开发和测试智能手机游戏来推进这一目标 对15-18岁ALHIV的干预(MyLife)。它将专注于提高对抗逆转录病毒治疗(ART)的依从性。 以及处理性健康和生殖健康需求。它将通过社会行为、沟通 以及教学理论、循证实践，以及对非洲年轻人关于艾滋病毒的叙述的独特研究。 它将旨在增加ALHIV知识、动机、技能和资源，以促进：(1)增加 治疗管理和自我护理的自主性；(2)心理健康和消除污名的战略；(3) 社会支持，包括通过与照顾者对话和向他人披露；以及(4)避开性风险和 还原。非洲智能手机的日益普及提供了前所未有的机遇 与文化相关的ALHIV基于叙事的行为干预，将数字资源整合到 支持坚持服药和补药追踪器和提醒。这样的干预几乎不需要什么 人员实施，具有很高的娱乐性和动力吸引力，并纳入自动化数据 收藏以支持理论建设。通过让玩家在虚拟和安全的环境中体验真实的代理 环境，精心设计的游戏提供了大多数其他干预措施无法比拟的体验式学习水平。 拟议的项目有以下目标：(1)(R21)设计、开发和实施可用性， 针对15-18岁ALHIV患者的一款基于理论的智能手机游戏的可接受性和安全性测试的重点是提高 以及持续参与艾滋病毒护理以及避免和减少性风险，并得到来自 目标人群；(2)(R33)通过整群随机对照试验，样本为120名15-18岁的ALHIV Kisumu进行全面的可行性测试，并确定游戏是否影响行为 参与护理、避免和减少性风险(包括知识、态度、 行为意向和自我效能)；和(3)(R21/R33)，以加强已建立的能力 多学科团队进行mHealth，特别是针对健康的严肃游戏，在SSA进行研究。我们的中学 目标是：(1)提供游戏对病毒载量、护理参与度和性行为的影响的初步数据 规避风险，降低风险。(2)通过分析结果数据和游戏ParaData，识别游戏 调节干预效果的组成部分和理论结构。 提议的干预措施承诺高度可扩展、经济高效，并在文化上适应 其他设置。通过推进证据和理论基础，通过激励来应对理解的挑战 教育学，评估弱势群体的安全，关注潜在的未来传播，以及建立 在撒哈拉以南非洲的移动健康研究能力方面，这项研究显示了推动全球移动健康的前景。

Project Summary: The goal of the study is to contribute to efforts to improve health outcomes for adolescents living with HIV (ALHIV) in sub-Saharan Africa, a population of high demographic, clinical and epidemiological importance. We aim to advance this goal by creating and testing in Kisumu, Kenya, a smartphone game-based intervention for ALHIV aged 15-18 (MyLife). It will focus on increasing adherence to antiretroviral therapy (ART) and addressing sexual and reproductive health needs. It will be informed by socio-behavioral, communication and pedagogical theories, evidence-based practice, and unique research on young Africans’ narratives about HIV. It will be designed to increase ALHIV knowledge, motivation, skills, and resources to facilitate: (1) increased autonomy in treatment management and self-care; (2) mental health and strategies for addressing stigma; (3) social support including via dialogue with caregivers and disclosure to others; and (4) sexual risk avoidance and reduction. The increasing availability of smartphones in Africa provides unprecedented opportunities to deliver culturally relevant narrative-based behavioral interventions for ALHIV that incorporate digital resources to support adherence such as medication and refill trackers and reminders. Such interventions require little personnel to implement, have high entertainment and motivation appeal, and incorporate automated data collection to support theory-building. By allowing players to experience real agency in a virtual and safe environment, well-designed games offer a level of experiential learning unparalleled by most other interventions. The proposed project has the following aims: (1) (R21) To design, develop, and conduct usability, acceptability, and safety testing of a theory-based smartphone game for ALHIV ages 15-18 focused on increasing and sustaining engagement in HIV care and sexual risk avoidance and reduction, with iterative input from the target population; (2) (R33) Via a cluster-randomized controlled trial with a sample of 120 ALHIV ages 15-18 in Kisumu to conduct comprehensive feasibility testing and determine whether the game influences behavioral mediators of engagement in care and sexual risk avoidance and reduction (including knowledge, attitudes, behavioral intentions, and self-efficacy); and (3) (R21/R33) To strengthen the capacity of the established multidisciplinary team to conduct mHealth, specifically serious games for health, research in sSA. Our Secondary Aims are: (1) To provide preliminary data on the game’s impact on viral load, engagement in care, and sexual risk avoidance and reduction. (2) Through analysis of outcome data and game paradata, to identify the game components and theoretical constructs that mediated intervention effects. The proposed intervention holds promise to be highly scalable, cost-effective, and culturally adaptable to other settings. By advancing the evidence and theory base, addressing challenges to uptake through motivating pedagogy, assessing safety for a vulnerable population, attending to potential future dissemination, and building capacity for mHealth research in sub-Saharan Africa, the study shows promise to advance global mHealth.