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

项目摘要：这项研究的目标是为改善青少年的健康状况做出贡献 艾滋病毒感染者（ALHIV）在撒哈拉以南非洲，人口，临床和流行病学高 重要性我们的目标是通过在肯尼亚的基苏穆创建和测试一个基于智能手机游戏的 15-18岁的ALHIV干预（MyLife）。它将侧重于提高抗逆转录病毒疗法的坚持率 并满足性和生殖健康需求。它将通过社会行为，沟通 和教学理论，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 治疗管理和自我保健的自主权;（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;（4）性风险规避， 还原智能手机在非洲的普及为交付提供了前所未有的机会 针对ALHIV的文化相关的基于叙事的行为干预，包括数字资源， 支持依从性，例如药物和再填充跟踪器和提醒。这种干预措施几乎不需要 人员实施，具有高娱乐性和激励吸引力，并整合自动化数据 支持理论建设。通过让玩家体验真实的机构在一个虚拟的和安全的 在环境中，精心设计的游戏提供了一个体验式学习的水平，是大多数其他干预措施所无法比拟的。 本项目的目标如下：（1）（R21）设计、开发和实施可用性， 可接受性和安全性测试的理论为基础的智能手机游戏的ALHIV年龄15-18侧重于增加 并持续参与艾滋病毒护理和避免及减少性风险， 目标人群;（2）（R33）通过一项随机分组对照试验，样本为120名15-18岁的ALHIV， 基苏穆进行全面的可行性测试，并确定游戏是否影响行为 参与护理和避免和减少性风险的调解人（包括知识，态度， 行为意向和自我效能）;和（3）（R21/R33）加强既定的能力， 多学科团队进行移动健康，特别是严重的游戏健康，在sSA的研究.我们的次要 目的是：（1）提供关于游戏对病毒载量，参与护理和性行为影响的初步数据。 避免和减少风险。(2)通过分析结果数据和博弈分析，识别博弈 成分和理论结构，介导的干预效果。 拟议的干预措施有望具有高度的可扩展性、成本效益和文化适应性， 其他设置。通过推进证据和理论基础，通过激励解决吸收的挑战 教育学，评估弱势群体的安全，关注未来潜在的传播， 该研究为撒哈拉以南非洲的移动健康研究提供了基础，显示出推进全球移动健康的希望。

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.