Abstract
BackgroundHighly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment.ObjectiveThe aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment.MethodsGame development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form.ResultsA number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors’ visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were “satisfied with the game activities,” and 9 out of 11 “would recommend it to a friend.” On the session evaluation form, 9 out of 11 agreed that they “learned a lot from the game.”ConclusionsWe utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment.Trial RegistrationClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1)
Highlights
BackgroundAccording to the Centers for Disease Control and Prevention, young persons aged 13-29 years accounted for 41% of the new HIV infections in the United States in 2015 [1], and an estimated 99,463 adolescents and young adults in the United States are living with HIV/AIDS [1]
Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors’ visits, and general health information
There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment
Summary
BackgroundAccording to the Centers for Disease Control and Prevention, young persons aged 13-29 years accounted for 41% of the new HIV infections in the United States in 2015 [1], and an estimated 99,463 adolescents and young adults in the United States are living with HIV/AIDS (acquired immunodeficiency syndrome) [1]. Advances in treatments for HIV can allow those infected to manage their HIV infection as a chronic, rather than imminently life-threatening, disease [2] These achievements can only be made when persons living with HIV take their medications as prescribed and maintain consistent medical care [3,4,5,6]. Adolescents and young adults do not have fully developed risk assessment skills, impulse control, or organizational abilities These characteristics are believed to contribute to lower rates of adherence to care among this age group [13,14,15]. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations These clinical achievements can only occur when young persons with HIV are adherent to care. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment
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