Epic Allies: A Gamified Mobile App to Improve Engagement in HIV Care and Antiretroviral Adherence among Young Men Who have Sex with Men

Abstract

HIV incidence among young men who have sex with men (YMSM) is disproportionally high. Youth living with HIV demonstrate low rates of sustained virologic suppression (VS). Epic Allies, a theory-based behavioral intervention mobile app, utilizes self-management tools, gamification, and social support to improve engagement in care and antiretroviral adherence among YMSM living with HIV. A two-arm individually randomized-controlled trial enrolled 146 participants aged 16 to 24 years old to test the efficacy of Epic Allies to achieve VS. Both study arms showed improved VS at 26-weeks (62.9% intervention; 73.5% control; ARR = 0.93 (95% CI 0.73, 1.18)) and antiretroviral adherence; intervention effects were amplified in regular app users. Issues with recruitment and app usage metrics limit the ability to definitively say that the app was effective in causing behavior changes resulting in improved health outcomes. (ClinicalTrials.gov Identifier: NCT02782130).

Keywords: ART adherence; Adolescents; HIV; Linkage to care; Smartphone technology.

Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1

Stratified study sample enrollment, randomization and follow-up diagram. LLD lower limit of detection, VL viral load

Fig. 2

Epic Allies daily proportion of participants with any app usage (95% CI shaded in grey) a All intervention participants b New-to-care intervention participants c ART-non-adherence intervention participants with lowess curve fit to smooth daily proportion. Mean (St. Dev), median (IQR) of total self-reported active days by stratum included in companion table. Drops in observations can occur through data loss (described in text) or uninstallation of the Epic Allies app

Fig. 3

Categorical study outcomes (% of sample): a viral load, b adherence category, c engagement in care by arm, wave