Ndumiso Madubela, a PhD candidate with the Desmond Tutu HIV Foundation and the University of Cape Town, presented his findings at the DTHF research meeting. Madubela’s current research focuses on identifying interventions that not only meet the needs of young people, specifically men, but tailored services needed in lower socio-economic communities.
More than 30 years have passed since the world witnessed the onset of the AIDS epidemic and today, South Africa still accounts for the highest number of people living with HIV in the world (approximately 7,1 million), with a prevalence of 18.9%. In South Africa, which has a generalised epidemic dominated by heterosexual transmission, young men are less likely to know their status or initiate treatment than their female counterparts. Moreover, as in the rest of the world, young men who have sex with men (MSM) are a key population that are 19 times more likely to be infected with the virus than heterosexual males. Together, this makes both heterosexual men and MSM populations that stand to benefit from novel HIV prevention interventions.
Amongst young men, who are understudied in comparison to young women in South Africa, there is a strong need for research to identify the most effective ways to carry out prevention and treatment strategies.
Currently, the most effective way to treat HIV is by suppressing the virus using antiretroviral therapy (ART). When taken daily this medication suppresses the virus and can provide a life expectancy as long as someone who doesn’t have HIV.
The South African government, which hosts the largest HIV treatment programme globally, has put substantial funding towards making access to ARVs straightforward and easy, and organisations such as the Desmond Tutu HIV Foundation (DTHF) are doing their best to provide alternative and innovative means of providing healthcare services to people living with HIV that are accessible and friendly.
Even though treatment is now as simple as taking a single pill each day, studies show that adherence to ART among young men and particularly MSM is low, and this can lead to poor health outcomes and significantly decreased life expectancy.
This is because there remains multiple challenges to daily treatment adherence, including ongoing stigma and competing life priorities that make it difficult to remember or prioritise pill taking.
The fact that young South Africans, similar to youth around the world, conduct most of their social interactions online suggests that new health interventions that meet young people in this online space, are needed and have the potential to be both acceptable and effective. Nearly 75% of all young men under the age of 25 have smart phones in South Africa. Mobile phones represent an appealing opportunity to first access men and then to support the daily use of ARTs.
Public health interventions are increasingly moving to use emerging technologies to improve the use of ART-based interventions.
In particular, app-based interventions using gamification approaches have shown a greater chance of adoption and sustained use. Gamification refers to the technique of using game-like elements and processes in non-game contexts. For example, using the competitive and fun elements of a mobile phone game to deliver educational content, and in this case, heath interventions.
It is within this context that Madubela presented the findings of a study that evaluated the use of a mobile gamification app as a tool to support adherence among young men.
The study assessed the acceptability of a mobile-gamification app called CHArGE, which uses social networking and game-based methods to improve adherence to Pre-Exposure Prophylaxis (PrEP) and ART for young men living in high disease burden areas of Cape Town. PrEP is a daily pill that creates a barrier around cells that stop HIV, meaning that HIV-negative people can take the pill and prevent HIV infection.
The app used game features that included health-related challenges and rewards, the ability to progress through the intervention and “unlock” hidden features, “brain games”, a medication tracker and social connections to support interest, commitment, motivation, and education.
Madubela reported that participants gave positive feedback on interest, uptake and feasibility of gamification-based approaches to ART adherence, meaning that the app was used frequently and rated positively by participants. This preliminary feedback is promising as it provides evidence that adherence to HIV prevention and treatment routines could be improved through the use of mobile applications.
However, there is still a need to adapt the content of these applications to the specific needs and daily realities of young men at risk of and living with HIV in South Africa. Addressing the needs of young men is fundamental in achieving HIV control, especially in South Africa where HIV incidence among youth has been sustained.
Hopefully, innovative solutions like these will continue to improve the way researchers are able to implement HIV treatments and prevention methods in the future.
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