April 27, 2021

Gaming features that can drive airline loyalty and inspire people to take more steps during the day have now been integrated into a mobile phone application to enhance HIV care.

Gamification may do the trick when a doctor’s advice or a patient’s good intentions are not enough to change behavior. In this case, the goal is to motivate people living with HIV to stick to the antiretroviral therapy (ART) that can keep them healthy by suppressing the HIV virus. As described in a new paper published online by the journal AIDS and Behavior, users of the Epic Allies app achieved viral suppression — the study’s primary goal — over 26 weeks.  

Dr. Kate Muessig

Dr. Kate Muessig

Dr. Lisa Hightow-Weidman

Dr. Lisa Hightow-Weidman

Study authors include Lisa Hightow-Weidman, MD, and Kate Muessig, PhD, health behavior specialists at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health; Alyssa Vecchio, MD, of the UNC Institute for Global Health and Infectious Diseases; and Alyssa Platt, MA, and Joseph R. Egger, PhD, of the Duke Global Health Institute.

Researchers teamed up with the web application development company Caktus Group to create a mobile phone app that could help patients to better adhere to medication plans. Specifically, the app was designed with the goal of improving medication adherence among young men who have sex with men who are living with HIV. It’s the population most affected by HIV in the United States.

The app made use of game mechanics and social networking features to improve adherence to HIV medications. In addition to medication reminders and adherence tracking, Epic Allies used gaming elements to create a compelling and engaging experience that could motivate and support behavior change.

Gamers were awarded points and badges for their own successes and for providing support and encouragement to others.

“The app delivered daily health messages in a digestible form that was more fun than sitting in a class and more consistent than a clinic visit scheduled every three to six months,” said lead study author Hightow-Weidman, a professor of medicine and health behavior who researches mHealth and directs the UNC Behavior and Technology Lab.

Rates of viral suppression and ART adherence increased over the course of the study among its 146 participants, even among those who were randomized to receive the control app weekly text-based information about adherence. At 26 weeks, viral suppression among app users was 62.9%, while viral suppression in the control group was 73.5%. When use of the Epic Allies app, which is no longer available, ended, viral suppression leveled out to about 64% for all study participants, who were all 16-24 years old.

Notably, the app appeared to provide a head start to controlling the HIV virus. 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. Regular app users were more than twice as likely to report near perfect ART adherence at both 13 weeks and 26 weeks compared to non-app users.

Study limitations include the small sample size, and the authors note that issues with app use metrics limit the ability to say that the app was effective in causing behavior changes that improved health 

But Hightow-Weidman said technology is emerging to support highrisk patients who may have life circumstances — such as homelessness, mental health issues and substance abuse issues — that may make it harder for them to focus on long-term outcomes. For young people, it can be especially difficult to connect today’s decisions to future health, she said.

And, as telehealth and virtual visits gained momentum during COVID-19 shutdowns, lessons were learned about providing needed care for everyone.

“Apps and digital tools are a bridge to care,” she said. “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 project was supported by a grant from the National Institutes of Health.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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