A Gamified Smartphone App to Support Engagement in Care and Medication Adherence for HIV-Positive Young Men Who Have Sex With Men (AllyQuest): Development and Pilot Study.
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BACKGROUND HIV disproportionately impacts young men who have sex with men YMSM who experience disparities across the HIV care continuum Addressing antiretroviral therapy ART adherence among YMSM is an urgent public health priority Technology based interventions particularly mobile health platforms can provide tailored adherence interventions and allow YMSM to engage and connect with others OBJECTIVE The objective of this study was to describe the development of AllyQuest a novel theoretically based smartphone app designed to improve engagement in care and ART adherence and social support among HIV positive YMSM METHODS AllyQuest was built on an established platform for patient engagement that embeds social networking and fundamental game mechanics such as challenges points and rewards A medication tracker provides reminders to promote ART adherence via personalized adherence strategies that are user and context specific a calendar allows for reflection on adherence over time After iterative development with input from two youth advisory boards usability testing was conducted to assess app functionality comprehension of the educational content use of intervention features and overall impressions of app relevance and appeal A 28 day pilot trial was conducted with 20 HIV YMSM to evaluate intervention feasibility and acceptability RESULTS Mean age of participants was 21 8 years range 19 24 and 95 19 20 of the participants were nonwhite The mean time of app use was 158 4 min SD 114 1 with a range of 13 to 441 min There was a mean of 21 2 days of use out of a total possible 28 days There were 222 posts to the daily discussion social wall Feasibility and acceptability ratings were high Overall participants found the app easy to use and navigate not intrusive and had few reported technical issues Higher levels of app usage were positively correlated with HIV self management outcomes and there was a statistically significant PUnder 05 positive association between the number of days logged into the app and knowledge and confidence in ability to reliably take HIV medications CONCLUSIONS AllyQuest represents a new highly scalable solution that is well suited to meet the specific prevention and care needs of HIV YMSM The development of this intervention is both timely and vital given the urgency of the ongoing HIV epidemic among YMSM