JMIR Publications

ABSTRACT

Background:

Two strategies of the U.S. Ending the HIV Epidemic (EHE) 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 (AYA) who are disproportionately impacted by HIV, particularly if they identify as Black and/or 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 AYA ages 13-24 in Washington, DC.

Objective:

The goals of this mixed-methods study are to (1) determine the acceptability of an interactive enhanced life-simulation game prototype among AYA, (2) conduct a pilot test of the gaming intervention among a small cohort of AYA to ensure game usability and acceptability, and (3) evaluate the efficacy of an interactive life-simulation game in a randomized controlled study (RCT) with AYA at risk for HIV in Washington, DC.

Methods:

This research protocol will be conducted in three phases. A formative phase will involve surveys and focus groups (n=64) with AYA living in the DC area. These focus groups will allow researchers to understand youth preferences for game enhancements. 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 RCT among 300 AYA 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 electronic surveys. At 6 months, a subset of intervention participants (n=25) will participate 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 AYA in the DC area. This intervention uses social interactions in which 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 AYA, 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.