Efficacy trial for a smartphone game to prevent HIV among young Africans

项目概述：这项研究的目标是帮助减少亚洲区青年中艾滋病毒的发病率 撒哈拉非洲。我们的目标是通过评估交互式智能手机的功效来推进这一目标 一种游戏，旨在通过推迟首次性行为和增加 第一次做爱时使用避孕套。基于游戏的干预在NIMH资助的随机调查中显示出了希望 在肯尼亚的可行性研究。干预是由社会行为和教育学理论、证据- 以实践为基础，对撒哈拉以南非洲的青年性文化进行独特的形成性研究。 Tumaini(在斯瓦希里语中的意思是对未来的希望)是一款自己选择冒险游戏的应用程序，价格低廉 Android智能手机，使用互动叙事促进观察性学习、认知和行为 排练、解决问题和沉浸。Tumaini旨在通过以下方式增加第一次性行为的年龄和避孕套的使用量： 增加关于性健康和艾滋病毒的知识；培养风险规避和降低风险的技能及相关知识 自我效能感；挑战艾滋病毒污名和有害的性别规范和态度；培养未来方向、目标-- 设置和规划；以及促进与成人导师的对话。游戏中有六个角色(3个女孩，3个 男孩)有不同的社会人口统计和背景故事，因为他们在三场比赛中经历了青春期 级别。玩家为角色做出决定，并体验这些决定的后果 人物的生活、健康和未来目标。 这项研究将遵循912名肯尼亚青少年的性别平衡样本，他们的年龄在13-14岁之间。 随机分配到干预或控制游戏45个月，并有4个月的行为 评估。它将在基线和终点测试HIV和HSV-2，分析来自手机的游戏日志文件 干预手臂参与者，并与参与者、他们的父母和其他人一起进行定性研究 利益相关者。 建议的项目有以下目标：(1)确定一个基于理论、有经验的移动电话 基于手机游戏的干预推迟了首次性行为，并增加了第一次性行为时避孕套的使用；(2)确定 基于游戏的干预是否影响行为中介(知识、态度、行为 意图和相关的自我效能)；(3)通过分析结果数据和 手机的日志文件，决定了哪些游戏成分和理论建构起到了中介作用。在……里面 此外，我们还有以下次要目标：(SA1)确定游戏是否能减少HSV-2和HIV 感染；(SA2)进行定性研究，以优化试验实施，监测对内部或 外部效度，强化干预的变革理论，通知潜在传播。 如果被证明是有效的，建议的干预措施具有高度可伸缩性、低成本和文化上的潜力 适用于撒哈拉以南地区的个别国家。

Project Summary: The goal of the study is to contribute to reductions in HIV incidence among youth in sub- Saharan Africa. Our objective is to advance that goal by evaluating the efficacy of an interactive smartphone game that is designed to prevent HIV among African adolescents by delaying sexual debut and increasing condom use at first sex. The game-based intervention has shown promise in an NIMH-funded randomized feasibility study in Kenya. The intervention is informed by socio-behavioral and pedagogical theories, evidence- based practice, and unique formative research on youth sexual culture in sub-Saharan Africa. Tumaini (meaning “hope for the future” in Kiswahili) is a choose-your-own-adventure game app for inexpensive Android smartphones that uses interactive narrative to promote observational learning, cognitive and behavioral rehearsal, problem-solving, and immersion. Tumaini is designed to increase age and condom use at first sex by: increasing knowledge about sexual health and HIV; building risk-avoidance and risk-reduction skills and related self-efficacy; challenging HIV stigma and harmful gender norms and attitudes; fostering future orientation, goal- setting, and planning; and promoting dialogue with adult mentors. The game follows six characters (3 girls, 3 boys) with diverse socio-demographics and backstories, as they proceed through adolescence over three game levels. Players make decisions for the characters and experience the consequences of those decisions on characters' lives, health, and future goals. The study will follow a gender-balanced sample of 912 Kenyan adolescents, aged 13-14 at enrolment, and randomly assigned to the intervention or to a control game for 45 months with 4-monthly behavioral assessments. It will test for HIV and HSV-2 at baseline and endline, analyze game log files from the phones of intervention arm participants, and conduct qualitative research with participants, their parents and other stakeholders. The proposed project has the following aims: (1) Determine if a theory-based, empirically grounded mobile phone game-based intervention delays sexual debut and increases condom use at first sex; (2) Determine whether the game-based intervention influences behavioral mediators (knowledge, attitudes, behavioral intentions, and related self-efficacy) of early and unprotected sex; (3) Through analysis of outcome data and the mobile phone log files, determine which game components and theoretical constructs mediated effects. In addition, we have the following secondary aims: (SA1) Determine whether the game reduces HSV-2 and HIV infection; (SA2) Conduct qualitative research to optimize trial implementation, monitor threats to internal or external validity, strengthen the intervention's theory of change, and inform potential dissemination. If proven efficacious, the proposed intervention has the potential to be highly scalable, low cost, and culturally adaptable to individual sub-Saharan countries.