Stick To It: pilot study results of an intervention using gamification to increase HIV screening among young men who have sex with men in California

Abstract

Background: In the United States, young men who have sex with men (YMSM) experience a disproportionate burden of HIV and sexually transmitted infections (STIs). Mobile health (mHealth) interventions, including those that incorporate elements of games ("gamification"), have the potential to improve YMSM engagement in desirable sexual health services and behaviors. Gamification leverages theory and tools from behavioral science to motivate people to engage in a behavior in a context of fun. The objective of the study was to determine whether an intervention using gamification is acceptable to YMSM in California and potentially increases repeat HIV screening. Methods: Eligible YMSM were: (I) 18-26 years, (II) born as and/or self-identified as male, (III) reported male sexual partners, and (IV) lived in a zip code adjacent to one of the two study clinics in Oakland and Hollywood, California. The gamification intervention, Stick To It, had four components: (I) recruitment (clinic-based and online), (II) online enrollment, (III) online activities, and (IV) 'real-world' activities at the clinic. Participants earned points through online activities that could be redeemed for a chance to win prizes during HIV/STI screening and care visits. The primary outcome was intervention acceptability measured with participant engagement data and in-depth interviews. The secondary outcome was the intervention's preliminary effectiveness on repeat HIV screening within 6 months, restricted to the subset of men who provided consent for review of medical records and who had ≥6 months of follow-up. Outcomes were compared to a historical control group of similar YMSM who attended study clinics in the 12 months prior to intervention implementation. Results: Overall, 166 of 313 (53%) eligible YMSM registered. After registration, 93 (56%) participants completed enrollment and 31 (19%) completed ≥1 online activity in the subsequent 6 months. Points were redeemed in clinic by 11% of the 166 users (27% and 5% of those who enrolled in the clinic and online, respectively). Despite moderate engagement, participants provided a positive assessment of the program in interviews, reporting that the inclusion of game elements was motivating. The analysis of repeat HIV testing was assessed among 31 YMSM who consented to medical record review and who had ≥6 months of followup. During follow-up, 15 (48%) received ≥2 HIV tests compared to 157 (30%) of a historical comparison group of 517 similar YMSM who lived in the same zip codes and who received care at the same clinics before the intervention (OR =2.15, 95% CI: 1.03-4.47, P=0.04). Conclusions: Engagement in the intervention was modest, with YMSM who enrolled in a clinic more actively engaged than YMSM who enrolled online. Among the subset of participants recruited in the clinic, repeat HIV screening was higher than a comparison group of similar YMSM attending the same clinic in the prior year.

Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review

“…Other studies reported retention rates of 70% to 90%. Two other studies reported notably higher rates of attrition than the others [ 65 , 89 ]. These high rates of attrition did not appear linked to acceptability, with both interventions reporting largely positive responses from participants.…”

“…The majority of the interventions identified in this review were targeted toward risk reduction or the management of STIs. Of the 17 interventions identified as having focused on risk reduction and management of STIs, 1 focused on pre-exposure prophylaxis adherence [ 66 ], 2 focused on reducing unprotected sex [ 67 - 71 ], 7 targeted multiple aspects of HIV prevention [ 72 - 83 ], 2 focused on HPV prevention [ 84 , 85 , 101 ], 3 focused on increasing STI testing [ 86 - 89 ], and 2 focused on antiretroviral medication adherence [ 90 , 91 ]. All 17 interventions were targeted toward young men who are attracted to men, 2 of which were specifically for adolescents.…”

“…With regard to the effectiveness of these interventions, there was consistent evidence from a number of interventions that digital health interventions could improve HIV testing rates in young MSM [ 79 , 80 , 88 , 89 ]. Aside from this, STI-focused interventions appeared to effect change more consistently in cognitive or attitudinal outcomes, such as HIV awareness and preparedness to use condoms, than in behavioral outcomes in practice, such as condom use and unprotected anal sex.…”

mHealth for pre-exposure prophylaxis adherence by young adult men who have sex with men

“…Lastly, a strength of the online approach to implementation is that it allowed participants to complete the post-test survey independently, separate from researchers and healthcare providers, potentially limiting the impact of social desirability on our findings. Relatedly, a recent HIV prevention study with YMSM found that levels of study engagement were similar among participants recruited online and those recruited via their clinic (29). Future research using an online approach, yet drawing from a broader geographic range, and from both urban and rural settings, seems warranted.…”

Sandra I. McCoy: leveraging elements of games to improve sexual health

“…Sandra I. McCoy from the University of California, Berkeley School of Public Health and her team recently developed an innovative mHealth intervention using gamification (the use of game elements in non-game setting). The intervention, Stick To It, aims to motivate young men who have sex with men (YMSM) to engage in desirable sexual behaviors in a context of fun and ultimately increasing repeat HIV screening (2). In the following interview with Prof. McCoy, mHealth will invite you to have a closer look at her research in this regard.…”