SBIR-STTR Award

HIV disproportionately impacts minority adolescents and most of them have neither undergone HIV testing and counseling HTC nor know their status Adolescence is a andquot window of opportunityandquot to intervene with HIV behavior change interventions Challenges to implementing and disseminating some effective HIV prevention programs in adolescents may limit their impact To address these challenges videogames can be used as interventions to improve health related behaviors They meet adolescents andquot where they are at andquot are engaging provide more consistent fidelity to the intervention and are easier to disseminate leading to potentially greater reach at a lower cost Therefore the goal of this proposal is to adapt an existing iPad based HIV prevention videogame with demonstrated efficacy Play Forward Elm City Stories developed for teens aged and focused on sexual risk reduction to create a new videogame intervention focused on promoting access to and uptake of HTC in adolescents aged In the original Play Forward players create a virtual character they use to travel through life facing challenges and making decisions that bring different risks benefits and consequences The players can see how their actions in the game influence their future The game involves a series of realistic stories representing risky situatios faced by teens in middle or high school and players successfully resolve each story by playing skill based mini games to acquire andquot sensesandquot and andquot powers andquot For the proposed Phase study we will conduct formative work with focus groups and our team of game developers and researchers will adapt the game for a focus on HTC in an older adolescent age group We will evaluate the game in a subsequent pilot study with adolescents examining its feasibility and acceptability as well as determining its preliminary efficacy for impacting adolescentsandapos intention to seek HTC actual obtaining of HTC and knowledge about HIV AIDS They will play the game for hours per week for weeks and standardized assessment data will be collected at baseline and weeks In a subsequent Phase study we will plan to integrate into the game opportunities and incentives that promote the adolescent connecting with a health clinic program that will help to directly link the participant with one of the clinics for HTC After successful testing the participant can enter key data back into the game and be rewarded additional game incentives for completing testing Given the compelling evidence supporting the efficacy of videogames in health promotion and disease prevention and their increased access fidelity and potential cost effectiveness this proposal holds the promise of an effective engaging and tailored prevention intervention with the potential for greater sustainable dissemination and considerable impact on this vulnerable population of adolescents PUBLIC HEALTH RELEVANCE This project will adapt an evidence based HIV prevention videogame for a population of older minority adolescents and evaluate its efficacy at promoting HIV testing and counseling in this population This Phase study serves as a foundation and has far reaching implications as it builds on the engaging and compelling nature of videogames for behavior change as well as the advantages of technology based interventions for increasing access to and optimizing intervention implementation dissemination and sustainability

HIV disproportionately impacts minority adolescents, and most of them have neither undergone HIV testing and counseling (HTC) nor know their status. Adolescence is a "window of opportunity" to intervene with HIV behavior change interventions. Challenges to implementing and disseminating some effective HIV prevention programs in adolescents may limit their impact. To address these challenges, innovative digital technologies can be used as interventions to improve health-related behaviors. They meet adolescents "where they are at," are engaging, provide more consistent fidelity to the intervention, and are easier to disseminate, leading to potentially greater reach at a lower cost. Therefore, the goal of this proposal is to build on the work completed with a Phase I project to further adapt an existing iPad-based HIV prevention intervention with demonstrated efficacy, PlayForward: Elm City Stories (developed for adolescents aged 11-14 and focused on sexual risk reduction) to create a new intervention focused on promoting access to and uptake of HTC in adolescents, aged 14-16. In the original PlayForward, participants create a virtual character they use to travel through life, facing challenges and making decisions that bring different risks, benefits, and consequences. The participants can see how their actions influence their future. The intervention involves a series of realistic stories representing risky situations faced by adolescents in middle or high school, and participants successfully resolve each story to acquire "senses" and "powers." The subsequent Phase I study adapted the intervention for a greater focus on HTC with enhanced storylines and conducted a pilot study that demonstrated efficacy in increasing actual HTC, intentions, and knowledge. For the proposed Phase II study, we will conduct additional formative work with focus groups, and our team of product developers and researchers will expand on the content and scope of the intervention while translating the intervention to a web-based platform. We will move towards commercialization of the digital intervention by working with implementation and marketing partners. We will evaluate the adapted intervention in a randomized controlled trial with 296 racial/ethnic minority adolescents, determining its efficacy as a web-based intervention for impacting their intention to seek HTC, actual obtaining of HTC, and knowledge about HIV/AIDS and testing. They will interact with the intervention for 2 hours per week for 6 weeks, and standardized assessment data will be collected at baseline, 6 weeks, 3 and 6 months. Given the compelling evidence supporting the efficacy of technology in health promotion and disease prevention, and their increased access, fidelity, and potential cost-effectiveness, this proposal holds the promise of an effective, engaging, tailored, and highly accessible prevention intervention with the potential for greater sustainable dissemination and considerable impact on this vulnerable population of adolescents.

Public Health Relevance Statement:
Project Narrative This Phase II project is designed to further adapt an evidence-based HIV testing and counseling and prevention intervention for a population of adolescent boys and girls and evaluate its efficacy at promoting HIV testing and counseling in this population. The Phase I study, which serves as a foundation for the current proposal, was successfully conducted and demonstrated efficacy of the game in its first round of adaptations. The digital intervention will be translated to a web-based platform and commercialization strategies will be implemented. These projects have far-reaching implications as they build on the engaging and compelling nature of digital interventions for behavior change, as well as the advantages of these interventions in terms of increasing access to and optimizing implementation, dissemination, and sustainability of the intervention.

Project Terms:
14 year old; 16 year old; Accounting; Address; Adolescence; Adolescent; after-school program; Age; age group; aged; AIDS prevention; AIDS/HIV problem; Attitude; base; Behavior; behavior change; Behavior Therapy; Behavioral Mechanisms; boys; Centers for Disease Control and Prevention (U.S.); Cities; Clinical; commercialization; cost; cost effectiveness; Counseling; Data; Decision Making; design; Development; Devices; Diagnosis; digital; disorder prevention; Ensure; ethnic minority population; evidence base; experience; Female Adolescents; Focus Groups; Foundations; Funding; Future; girls; Goals; Grant; handheld mobile device; Health; Health Promotion; high risk; high school; High School Student; HIV; HIV-1; Home environment; Hour; Human immunodeficiency virus test; improved; innovation; Intention; Internet; Intervention; junior high school; Knowledge; Learning; Life; Male Adolescents; Manuals; Marketing; Mechanics; Methods; Minority; Modeling; Motivation; Nature; Online Systems; Outcome; Outcome Measure; Participant; Patient Self-Report; pediatrician; peer; Perception; Performance; Phase; phase 1 study; phase 2 study; Pilot Projects; Planned Parenthood Federation of America; Play; Population; Prevention; Prevention program; Preventive; Preventive Intervention; programs; racial and ethnic; Randomized Controlled Trials; Recommendation; Reporting; Research Personnel; Risk; Risk Reduction; Schools; screening; Self Efficacy; Series; sex; skills; social; Standardization; Students; System; teacher; Technology; Testing; Theoretical model; tool; Translating; Travel; United States; uptake; virtual; Vulnerable Populations; Work; young adult; Youth