Development, Refinement, and Acceptability of Digital Gaming to Improve HIV Testing Among Adolescents and Young Adults at Risk for HIV

Abstract

Objective: Adolescents and young adults (AYAs) account for >20% of new HIV diagnoses in the United States, yet >50% are unaware of their infection. Digital gaming is widespread among youth and has proven efficacious in other disease areas; thus, we sought to determine whether a life-and-dating simulation game to increase HIV testing would be acceptable among AYAs. Materials and Methods: Focus groups and surveys were administered to health care providers and AYAs in Washington, DC. AYAs were shown a life-and-dating simulation game that incorporated the Centers for Disease Control and Prevention Risk Estimator tool to demonstrate the potential HIV risk of selected behaviors and a zipcode-level HIV testing locator. Thematic analysis was used to identify general gaming themes and game acceptance. Descriptive statistics were used to summarize response frequencies and Likert scales were used to evaluate game acceptability. Results: Providers, some of whom (38%, n = 5/13) had significant experience caring for youth living with or at increased risk for HIV, advised against the game forcing youth to disclose sexual identity or labeling youth ''at risk.'' AYAs (n = 46) found the initial and revised versions of the game to be highly acceptable: youth thought the game was interesting [mean (standard deviation, SD) = 4.8/5 (0.4)]; liked playing games about HIV-related behaviors [mean (SD) = 4.8/5 (0.5)]; and would share the game to help friends get tested for HIV [mean = 4.6/5 (0.8)].Conclusions: This study suggests that a digital game to improve HIV testing is acceptable among youth. An efficacy trial is planned to determine the impact of the game on improving HIV testing.

Barriers and Facilitators to HIV Testing Among Adolescents and Young Adults in Washington, District of Columbia: Formative Research to Inform the Development of an mHealth Intervention

“…The study was conducted as part of a larger study to determine the acceptability of using a life-and-dating simulation game to increase HIV testing among AYA; the methods have been described elsewhere [ 43 ]. The game will allow AYA to play characters that are similar to, or different from, their gender identity.…”

“…From February 2017 to December 2017, HIV-negative or status-unknown AYA aged 13-24 years who were living in the DC metro area were recruited from an adolescent health center during routine visits, 2 community-based organizations, and a youth advisory council [ 43 ]. Recruitment was primarily facilitated by CT, a female researcher.…”

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

“…The life-simulation game prototype for smartphones (iOS and Android), tablets, and the web was developed in a phase 1 Small Business Innovation Research study [ 33 ] and shows an AYAs’ HIV risk based on their sexual choices in the game. Several areas for modification were identified in the phase 1 study, including the incorporation of a customizable avatar; the development of additional activities, locations, and dating scenarios; incorporation of data analytics features to collect game and paradata; and access to a PrEP provider locator.…”

“…This credibility is necessary for the consequences of their sexual choices to be meaningful and impactful. When the player’s flirtations succeed, a screen appears with their chosen partner and a range of sexual choices based on the sex of the player and their partner [ 33 ]. For each sexual act selected, the player is prompted to decide whether to use condoms.…”

“…In our pilot study [ 33 ], we found that approximately 10% of sexually active AYAs reported being tested for HIV in the past 4-6 months. A sample of approximately 300 subjects (150 per arm) would achieve >80% power to detect a moderate effect corresponding to a difference of at least 13 percentage points (equivalent to a relative risk of 2.3 assuming a 10% prevalence of HIV testing in the past 4-6 months in the control group) in HIV testing between the intervention and control groups after 6 months using a two-sided test at a 5% significance level and assuming a 16% attrition rate after 6 months.…”