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

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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.