JMIR Publications

ABSTRACT

Background:

Hepatitis C virus (HCV) remains an important concern for men who have sex with men (MSM) living with HIV because reinfection can occur after curative treatment. Knowledge and prevention needs vary within this population, and few HCV educational interventions have been designed specifically for MSM living with HIV.

Objective:

This study compared a population-tailored serious game (SG) and a web browsing intervention (WB) with verbal instruction/pamphlet (VP) for improving HCV prevention knowledge and self-efficacy among MSM living with HIV. The principal follow-up assessment was conducted 12 weeks after randomization.

Methods:

The study was conducted in the infectious disease department of a medical center in Taipei, Taiwan. A REDCap sequence with fixed blocks of six and a 1:1:1 allocation ratio assigned participants to a SG, WB, or VP. HCV knowledge and prevention self-efficacy were measured at the preintervention baseline (O1), 1 week (O2), and 12 weeks (O3). The primary analysis used generalized estimating equations (GEE) to estimate population-average group, time, and group-by-time effects; O3-versus-O1 interaction contrasts addressed 12-week differential change. A secondary change-score analysis compared O3-to-O2 maintenance among groups.

Results:

Of 210 randomized participants (SG, n=71; WB, n=69; VP, n=70), 3 did not complete O1 because they missed the visit and could not be contacted (WB, n=2; VP, n=1). The remaining 207 participants (SG, n=71; WB, n=67; VP, n=69) completed O1, O2, and O3 and were analyzed in their assigned groups. For HCV knowledge, the adjusted SG-versus-VP difference in change from O1 to O3 was 1.16 points (95% CI 0.18-2.14; P=0.02), whereas the WB-versus-VP contrast was 0.51 points (95% CI -0.35 to 1.37; P=0.27). For self-efficacy, neither SG (0.19, 95% CI -1.74 to 2.12; P=0.84) nor WB (0.71, 95% CI -1.46 to 2.88; P=.51) differed from VP in O1-to-O3 change.

Conclusions:

A single brief SG session produced a greater 12-week increase in HCV knowledge than VP, whereas WB did not differ from VP. Neither digital format showed a between-group advantage for prevention self-efficacy. These findings support the SG as a potential adjunct to clinic-based HCV education. Clinical Trial: This study was a 3-arm, parallel-group randomized controlled trial comparing a serious game (SG), web browsing intervention (WB), and verbal instruction/pamphlet (VP). The trial was registered on ClinicalTrials.gov on July 28, 2022, before the first participant was enrolled on February 23, 2023 (NCT05497388).