A Digital Gaming Intervention to Improve HIV Testing for Adolescents and Young Adults: Protocol for Development and a Pilot Randomized Controlled Trial

Abstract

Background Two strategies of the US Ending the HIV Epidemic initiative are early diagnosis of infections via widespread testing and prevention of new infections using pre-exposure prophylaxis (PrEP). These strategies are particularly important for adolescents and young adults (AYAs) who are disproportionately affected by HIV, particularly if they identify as Black and/or lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+). This study will develop and test an interactive life-simulation game in which players can enact real-life behaviors and receive their HIV risk profile to improve HIV testing and PrEP access among AYAs aged 13-24 years in Washington, DC. Objective This mixed methods study aims to determine the acceptability of an interactive, enhanced life-simulation game prototype among AYAs, conduct a pilot test of the gaming intervention among a small cohort of AYAs to ensure game usability and acceptability, and evaluate the efficacy of the game in a randomized controlled study with AYAs at risk for HIV in Washington, DC. Methods This research protocol will be conducted in 3 phases. A formative phase will involve surveys and focus groups (n=64) with AYAs living in the DC area. These focus groups will allow researchers to understand youth preferences for game enhancement. The second phase will consist of a pilot test (n=10) of the gaming intervention. This pilot test will allow researchers to modify the game based on formative results and test the planned recruitment and data collection strategy with intended end users. The third phase will consist of a randomized controlled study among 300 AYAs to examine the efficacy of the life-simulation game compared with app-based HIV educational materials on HIV and PrEP in changing HIV testing, knowledge, risk behaviors, and PrEP access. Participants will have unlimited access to either the life-simulation game or the educational app for 3 months from the time of enrollment. Study assessments will occur at enrollment and at 1, 3, and 6 months post enrollment via e-surveys. At 6 months, a subset of intervention participants (n=25) will participate in in-depth exit interviews regarding their experience being in the study. Results Institutional review board approval was received on February 5, 2020. This project is currently recruiting participants for the formative phase. Conclusions This interactive life-simulation intervention aims to increase HIV testing and PrEP access among AYAs in the DC area. In this intervention, players can enact real-life behaviors and receive their HIV risk profile to promote HIV testing and PrEP seeking. Such an intervention has great potential to improve knowledge of HIV and PrEP among AYAs, increase motivation and self-efficacy related to HIV testing and PrEP use, and decrease individual and structural barriers that often preclude engagement in HIV prevention services. Trial Registration ClinicalTrials.gov NCT04917575; https://clinicaltrials.gov/ct2/show/NCT04917575 International Registered Report Identifier (IRRID) PRR1-10.2196/29792

An integrated online-to-offline model for HIV post-exposure prophylaxis (O2O-PEP) scale-up among men who have sex with men (MSM): Protocol for developing a pilot randomized controlled trial

“…Our model consists of three innovative components. First, the gamification-based PEP education packages provide a more entertaining format in the context of behavioral education, which has been adopted in other HIV interventions, such as HIV testing and shame reduction in MSM ( 28 , 51 ). Second, the online HIV risk assessment tools can improve individual risk awareness and subsequent PEP-seeking actions.…”

Compliance and approach to voluntary HIV testing in a high-risk region for HIV transmission in Europe

“…Finally, the HIV testing is also related to the availability of the testing kits. To increase the testing rate, it is essential to ensure the availability of HIV tests 29 , 30 .…”

“…In less urbanized settings, the efforts to increase the HIV testing rates should focus on the trusted members of the local community, such as local health professionals, athletes, artists, academics or representatives of the religious communities, who may publicly discuss the issues surrounding HIV. The channels of communication with young people have evolved along with the technological advancement [29][30][31] . Previous studies indicated that interventions based on the use of new technologies can lead to an increase in HIV testing among young people 29 .…”

“…Previous studies indicated that interventions based on the use of new technologies can lead to an increase in HIV testing among young people 29 . In this way users are able to estimate individual risks by filling in a simple online test or understand the risks through video materials or computer games [29][30][31] . Also, this approach helps to overcome barriers to HIV testing in young people such as stigma and discrimination, low perception of personal risk, presence and monitoring of parents, lack of privacy and confidentiality [29][30][31][32] .…”

“…In this way users are able to estimate individual risks by filling in a simple online test or understand the risks through video materials or computer games [29][30][31] . Also, this approach helps to overcome barriers to HIV testing in young people such as stigma and discrimination, low perception of personal risk, presence and monitoring of parents, lack of privacy and confidentiality [29][30][31][32] . Use of digital platforms allows for an easier access to counselling.…”