A Text-Based Adherence Game for Young People Living With HIV in Ghana
Condition: HIV/AIDS; Medication Adherence
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      This study will develop and evaluate a game-based, text message intervention to promote
      adherence to HIV care among young people living with HIV (YPLH) in Ghana. Intervention
      development will be guided by feedback from YPLH, their treatment supporters, and clinic
      staff, consultation with a mobile health services team, and Social Action Theory. Patient
      participants will be recruited from an urban HIV clinic in Accra, Ghana to complete a
      randomized pilot of the intervention. All participants will receive a brief adherence
      counseling session and complete three assessments over the course of 12 months following
      enrollment. During this time, intervention participants will receive text messages and phone
      calls from a semi-automated text message system, clinic staff, and other individuals in their
      life (e.g., family, friends, and partners) who they have identified as supportive of their
      treatment. The study will provide a wealth of knowledge about YPLH in Ghana, a group
      vulnerable to poor treatment outcomes, and provide preliminary data on a novel adherence
      promotion intervention.
    

Detailed description: 
      Maintaining lifelong adherence to HIV care is a major challenge for older adolescents and
      young adults (young people) living with HIV in sub-Saharan Africa where HIV infection is
      globally most prevalent. Innovative, low cost, and easily scaled strategies are urgently
      needed to improve young people's engagement to HIV treatment and reduce the public health
      consequences associated with nonadherence including secondary transmission of HIV infection.
      Modern mobile health (mHealth) interventions improve adherence to care among young people but
      are currently not feasible for many low-resource areas of sub-Saharan Africa. This includes
      theory-driven applications that use gamification, where real-life adherence behaviors are
      combined with interesting story-lines in a mobile game to promote HIV treatment engagement.
      Whereas web and smartphone access can be limited, traditional cellphones and text messaging
      are near universal and have been used previously to promote adherence through simple
      reminders and linkage to staff support in sub-Saharan Africa. However, to date, no text
      message adherence intervention has been enhanced through the use of gamification. To increase
      access to this potentially powerful intervention approach, the current study will test a
      novel mHealth intervention that uses text messages to gamify adherence behavior among YPLH in
      Ghana. Piloting this intervention will provide information on its feasibility and signs of
      preliminary efficacy. The ultimate goal following is further evaluation and refinement will
      be to disseminate the intervention on a large scale across Ghana and other areas of
      sub-Saharan Africa.
    

Intervention name(s): Text-Based Adherence Game; Standard of Care (SOC)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A mobile health intervention facilitated by a cloud-hosted web application and designed to promote adherence to HIV care through text message-delivered gamification strategies including peer comparison, point reinforcement, feedback on adherence outcomes, facilitation of social support, and use of an engaging and culturally-relevant story-line.; A 10- to 20-minute in-person intervention led by a trained HIV treatment adherence counselor focused on providing basic knowledge of HIV and HIV treatment, motivating participants to engage in HIV treatment, and problem-solving barriers to adherence.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: adherence; young adult; Africa; mhealth; adolescent; viral load