JMIR Publications

ABSTRACT

Background:

Eswatini has one of the highest HIV prevalence rates globally (24.8% among people ≥15 years of age). Unprotected heterosexual transmission accounts for more than 90% of new HIV infections in the country. Low HIV risk perception is known to influence risk behavior. Mobile phone technology is growing rapidly, offering opportunities for technology-driven interventions for HIV prevention.

Objective:

We designed and tested a serious game to increase HIV risk perception and intention to engage in protective HIV behaviors among young people in Eswatini

Methods:

Our team developed SwaziYolo, a smartphone, interactive, educational story game that places the player in the role of a young adult looking for love in Eswatini’s capital city. We conducted the Serious Games HIV Prevention Trial (SGPrev-Trial), a 4-week, 2-arm, 1:1 randomized controlled trial of SwaziYolo among people 18-25 years of age in Eswatini. The main outcome was HIV risk perception scores (10-item index and a subscale 8-item index), assessed using intention-to-treat and per-protocol difference-in-difference (DID) analysis. Secondary analyses examined differences in intention to engage in protective behavior and serious game acceptability.

Results:

Of 380 people who agreed to participate in this study, 130 in the control arm and 127 in the intervention arm completed follow-up. Among the 79.5% (101/127) of intervention arm participants who completed at least one game (per-protocol analysis), we observed an increase in the 10-item HIV risk perception index compared to control arm participants (DID mean score of 1.63, P-value 0.048) and a borderline increase for the 8-item HIV risk perception index (DID mean of 1.37, P-value 0.060). In intention to treat analysis, there were no significant differences between arms in both the 10-item and 8-item indices. The intervention was associated with the intention to reduce the number of sexual partners (OR = 2.595 [95% CI: 1.466-4.593]). Nearly all (96.1%) participants strongly agreed or agreed that they would recommend SwaziYolo to their peers.

Conclusions:

in Eswatini and similar settings. Future iterations of SwaziYolo should focus on strategies to increase game completion rates. Our findings also suggest that serious game interventions can be effective at increasing HIV risk perception and should be prioritized for people who report multiple sexual partnerships and condomless sex or others who could benefit from interventions focused on HIV risk perception and prevention. Clinical Trial: University Hospital Medical Information Network Clinical Trial Registry ID number (UMIN-CTR):UMIN000021781