JMIR Publications

ABSTRACT

Background:

Past few years has witnessed a burgeoning interest in applying gamification to promote desired health behaviors. However, little is known about the effectiveness of such applications in Human Immunodeficiency Virus (HIV) prevention and care continuum among men who have sex with men (MSM).

Objective:

To summarize and evaluate research on the effectiveness of gamification on HIV prevention and care continuum, including HIV testing promotion, risky sexual behavior reduction, uptake and adherence in pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and antiretroviral therapy (ART).

Methods:

We comprehensively searched PubMed, Embase, the Cochrane Library, Web of Science, the Journal of Medical Internet Research and its sister journals for studies published in English and Chinese from inception to March 2023. Eligible studies were included when they used gamified interventions with an active or inactive control group and assessed at least one of the following outcomes: HIV testing, unprotected anal intercourse, uptake and adherence of PrEP, PEP, and ART. During the meta-analysis, a random-effects model was applied. Two reviewers independently assessed the quality and risk of bias of each included study.

Results:

The systematic review identified 22 studies, of which five randomized controlled trials were included in the meta-analysis. The results indicated that gamified digital interventions had been applied to various HIV outcomes, such as risky sexual behaviors, HIV testing, PrEP uptake and adherence, nPEP uptake, and ART adherence. Most of the studies enrolled MSM (16/22) and were conducted in the USA (15/22). The most frequently used game components were gaining points and social connectivity, followed by challenges. The meta-analysis showed gamification interventions could improve PrEP adherence at the 6-month follow-up (three RCTs, RR=1.40, 95%CI: 1.01-1.93) and reduced the number of anal condomless sex (ACS) acts at the 3-month follow-up (Two RCTs, IRR=0.62, 95%CI: 0.44-0.88).

Conclusions:

Our findings suggest the short-term effect of gamified digital interventions on improving PrEP adherence and lowering the number of ACS in MSM. More studies in this field should aim to determine the long-term effect of gamification in HIV prevention and care continuum. Clinical Trial: The study was registered in the international prospective register of systematic reviews on January 27, 2023 (PROSPERO registration number: CRD42023392193).