Accepted for/Published in: JMIR Serious Games
Date Submitted: Aug 23, 2018
Open Peer Review Period: Sep 11, 2018 - Oct 12, 2018
Date Accepted: Dec 9, 2018
(closed for review but you can still tweet)
The Development of a Mobile Gaming Intervention to Increase Motivation and Adherence to Pre-Exposure Prophylaxis (PrEP) for Young Minority MSM
ABSTRACT
Background:
In the U.S., young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (Pre-exposure Prophylaxis, PrEP) is an efficacious and promising new prevention strategy. There have been significant advances regarding PrEP including the definitive demonstration that PrEP reduces HIV acquisition, the regulatory approval of Truvada (tenofovir/emtricitabine) with an indication for sexual HIV prevention, and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data shows that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence.
Objective:
The purpose of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to pre-exposure prophylaxis (PrEP).
Methods:
Game development was guided by social learning theory, taking into consideration the perspectives of young adult men who have sex with men (MSM) who are taking PrEP. A total of 20 young MSM (18-35 yrs) were recruited from a STI/HIV testing and PrEP care clinic Jackson Mississippi. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all of the participants identified as male. Acceptability of the game was assessed with client service questionnaire (CSQ) and session evaluation form (SEF).
Results:
A number of themes emerged that informed game development. Young MSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. 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 a focus on personal relevance of PrEP related care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care.
Conclusions:
We utilized youth feedback, social learning theory (IMB), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to pre-exposure prophylaxis (PrEP). There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming app intervention to decrease HIV risk and promote adherence to PrEP for young MSM. Clinical Trial: NCT02611362
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.