JMIR Publications

ABSTRACT

Background:

Adolescents and young adults (AYA) make up a disproportionate number of new HIV diagnoses in the United States due to missed opportunities for HIV education and testing leading to early diagnosis and prevention.

Objective:

We sought to test the efficacy of an interactive life-simulation gaming intervention to provide HIV education and facilitate access to HIV testing and preventive services among AYA ages 13 to 24 years of age residing in the Washington, DC metropolitan area.

Methods:

We conducted a parallel randomized controlled trial to test the efficacy of an HIV-focused gaming intervention app compared to a control app among AYA. We hypothesized that the intervention app would be more efficacious in increasing HIV testing uptake. Participants were recruited via social media and peer-referral. Eligible participants had to be living in the DC metropolitan area and were randomized 1:1 stratified by age (13-17 vs. 18-24 years and sexual orientation (lesbian, gay, bisexual, or “other” vs. heterosexual). Participants had access to either the game or control app for 3 months and completed baseline, 1-, 3- and 6-month surveys. The primary outcome was self-reported HIV testing within 6 months post enrollment; secondary outcomes included intent to test for HIV, HIV and pre-exposure prophylaxis (PrEP) knowledge and intention to start PrEP. Analyses were also stratified by sexual orientation. Analyses were conducted as intent-to-treat.

Results:

From November 2023-May 2024, we randomized 309 AYA (156 intervention; 153 control) with 80% and 88% retention at 6-months, respectively. Among 150 and 149 participants in the intervention and control arms, respectively, participants were a mean of 20.7 years, 51% female, 34% Non-Hispanic White, 19% Non-Hispanic Black and 19% Hispanic. Fifty-three percent self-reported as gay, lesbian, bisexual, or “other” sexual orientation. Almost half (48%) had previously tested for HIV, with 17% reporting being tested within the prior 3 months. Compared to the control app, game participants were 32% less likely to test for HIV within 6 months (RR 0.68; 95%CI: 0.47-0.98). However, there were no statistically significant differences between the two groups regarding their intention to get tested for HIV in the next 6 months or to start PrEP. A significantly higher difference in mean HIV knowledge scores at 3 months (0.99; 95% CI: 0.33-1.65; p<0.01) and 6 months (0.81; 95% CI: 0.14-1.48; p=0.02), was observed in the game arm compared to the control arm. Additionally, heterosexual participants in the game arm had statistically significant increases in PrEP intention (0.53; 95% CI: 0.05-1.00; p=0.03) across all time points compared to the control arm.

Conclusions:

We found that an interactive life-simulation game-based intervention to deliver HIV testing and prevention information was less effective than an information control app in increasing HIV testing and changing HIV testing and prevention intentions among a group of AYA mostly compromised of young adults. However, the intervention was able to increase HIV knowledge in the game arm and increase PrEP intention among heterosexual AYA. To our knowledge, very few life-simulation apps focused on HIV testing among AYA with integration of testing and prevention features have been rigorously tested for efficacy to date. Our novel and early findings suggest that while digital interactive game-based technology interventions are feasible and acceptable, they require additional tailoring to improve their reach, utilization and potential effectiveness in real-world settings to improve HIV outcomes among AYA. Clinical Trial: This trial was registered initially registered on June 4, 2021 at ClinicalTrials.gov NCT04917575; https://clinicaltrials.gov/ct2/show/NCT04917575.