Intervention to encourage HIV Testing and Counseling among Adolescents

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 DESCRIPTION (provided by applicant): HIV disproportionately impacts minority adolescents, and most of them have neither undergone HIV testing and counseling (HTC) nor know their status. Adolescence is a "window of opportunity" to intervene with HIV behavior change interventions. Challenges to implementing and disseminating some effective HIV prevention programs in adolescents may limit their impact. To address these challenges, videogames can be used as interventions to improve health-related behaviors. They meet adolescents "where they are at," are engaging, provide more consistent fidelity to the intervention, and are easier to disseminate, leading to potentially greater reach at a lower cost. Therefore, the goal of this proposal is to adapt an existing iPad-based HIV prevention videogame with demonstrated efficacy, Play Forward: Elm City Stories (developed for teens aged 11-14 and focused on sexual risk reduction) to create a new videogame intervention focused on promoting access to and uptake of HTC in adolescents, aged 15-16. In the original Play Forward, players create a virtual character they use to travel through life, facing challenges and making decisions that bring different risks, benefits, and consequences. The players can see how their actions in the game influence their future. The game involves a series of realistic stories representing risky situatios faced by teens in middle or high school, and players successfully resolve each story by playing skill-based mini-games to acquire "senses" and "powers." For the proposed Phase 1 study, we will conduct formative work with focus groups, and our team of game developers and researchers will adapt the game for a focus on HTC in an older adolescent age group. We will evaluate the game in a subsequent pilot study with 30 adolescents, examining its feasibility and acceptability, as well as determining its preliminary efficacy for impacting adolescents' intention to seek HTC, actual obtaining of HTC, and knowledge about HIV/AIDS. They will play the game for 2 hours per week for 3 weeks, and standardized assessment data will be collected at baseline, 3, and 6 weeks. In a subsequent Phase 2 study, we will plan to integrate into the game opportunities and incentives that promote the adolescent connecting with a health clinic program that will help to directly link the participant with one of the clinics for HTC. After successful testing, the participant can enter key data back into the game and be rewarded additional game incentives for completing testing. Given the compelling evidence supporting the efficacy of videogames in health promotion and disease prevention, and their increased access, fidelity, and potential cost-effectiveness, this proposal holds the promise of an effective, engaging, and tailored prevention intervention with the potential for greater sustainable dissemination and considerable impact on this vulnerable population of adolescents.