Feasibility and Acceptability of Digital Gaming to Improve Adherence among Adolescents and Young Adults Living with HIV (Preprint)

BACKGROUND An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. OBJECTIVE We assessed the feasibility and acceptability of videogaming to improve AYA ART adherence. METHODS Focus group discussions (FGDs) and surveys were administered to healthcare providers and AYA aged 13-24 years living with HIV at a pediatric HIV program in Washington, DC. During FGDs, AYA viewed demonstrations of three game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. RESULTS Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. Six FGDs with 12 AYA identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were "very or somewhat likely" to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually-tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. CONCLUSIONS AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.