Gaming App Improves Adherence to Medication Plans for HIV-positive Men

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Sixty percent of men ages 18 to 29 say they play video games often or sometimes, according to a 2017 study by Pew Research Center. While that data is surprising to almost no one, it’s how researchers recently leveraged this love of video games to help young men live healthier lifestyles.  

A team of researchers from the University of North Carolina at Chapel Hill and Duke University recently created an app-based game to encourage young men living with HIV to take their medication and achieve viral suppression. After all, what better way to inspire young men to take action than by relating to them via a platform they already immensely enjoy?

Science and gaming are already well-acquitted—take Foldit, the online puzzle video game about protein folding, for example. Debuting in 2008, a 2010 paper credited the game’s users with finding real-world results that matched or outperformed computed solutions. And there’s tons of games employed in STEM education, regardless of age.

In this case, the timing of the authors’ study boasted an element that has never been a factor before. The study happened to coincide with the rise of telehealth due to the COVID-19 pandemic and stay-at-home orders.

"Apps and digital tools are a bridge to care," said Lisa Hightow-Weidman, professor of medicine and health behavior at the UNC Gillings School of Global Public Health, and lead author of the study. "They cannot replace a network of doctors and nurses and care management, but they can be a bridge to that real world and inspire change."

The research team worked with web app development company Caktus Group to create an app with gaming features that would motivate young men living with HIV to adhere to the antiretroviral therapy (ART) necessary to suppress the virus.  

Study participants, or “gamers,” were awarded points and badges for both their own successes and for providing support and encouragement to others. In addition to game mechanics and social networking features, the app delivered daily health messages in a digestible form that Hightow-Weidman says was “more fun than sitting in a class and more consistent than a clinic visit scheduled every 3 to 6 months.” Adding in the medication reminders and adherence tracking, men who participated in the study doubled their chances of reaching near perfect adherence to medication plans.

The study included 146 participants aged 16 to 24 who were randomized to receive the gaming app or the control app, which featured just weekly text-based information about adherence. According to the the paper published in AIDS and Behavior, at 26 weeks, viral suppression among app users was 63% while viral suppression in the control group was 74%. When use of the app ended, viral suppression leveled out to about 64% for all study participants.

Additionally, participants who used the app regularly—four or more days a week—had a reported 56% higher likelihood of achieving viral suppression at 13 weeks compared to those who didn't use the app. The researchers found that regular app users were also more than twice as likely to report near-perfect ART adherence at both 13 weeks and 26 weeks compared with non-app users.

The team designed the app specifically for young men with HIV who have sex with men as it’s the population most affected by the virus in the United States. For young people, it can be difficult to connect today's decisions to future health consideration; but, these men are not the only ones. Patients who have life circumstances such as homelessness, mental health issues or substance abuse issues also may find it hard to focus on the long-term, which is especially critical for those who must take HIV medication every day. Hightow-Weidman says she is confident technology is emerging to support these high-risk patients, as well.