Enhancing health among youth living with HIV using an iPhone game

Figures & data

Figure 1. BattleViro and sample adherence guided text message.

Figure 2. (a) Examples of BattleViro levels and activities (b) Example of a quiz question from a clinician with a correction to a wrong answer displayed.

Figure 3. Consort sheet.

Table 1. Characteristics at baseline of 61 youth living with HIV by intervention condition.

Variable	Total sample (n = 61)	Intervention (n = 32)	Control (n = 29)	Test statistic (t, F or χ^2)	p-value
Age (years, M(SD))	22.4 (2.5)	22.5 (2.5)	22.3 (2.5)	0.34	0.73
Gender (%, n)				0.01	0.91
Male	78.7 (48)	78.1 (25)	79.3 (23)
Female	21.3 (13)	21.9 (7)	20.7 (6)
Race (%, n)				2.28	0.32
Black, African American, or Haitian	96.7 (59)	96.9 (31)	93.1 (28)
Other	1.6 (1)	0 (0)	3.4 (1)
Multiple	1.6 (1)	0 (0)	3.4 (1)
Ethnicity
Non-Hispanic/Latino	100 (61)	100 (32)	100 (29)	-	-
Hispanic/Latino	0 (0)	0 (0)	0 (0)
Most recent grade completed (%, n)				2.99	0.57
10th	3.3 (2)	3.1 (1)	3.4 (1)
11th	6.6 (4)	6.3 (2)	6.9 (2)
12th	36.1 (22)	40.6 (13)	31.0 (9)
Some college	45.9 (28)	37.5 (12)	55.2 (16)
Graduated college	8.2 (5)	12.5 (4)	3.4 (1)
Started ARV in past 3 months (%, n)				0.08	0.77
No	63.9 (39)	65.6 (21)	62.1 (18)
Yes	36.1 (22)	34.4 (11)	37.9 (11)
Gaming status (%, n)				0.68	0.41
Daily or almost daily	36.1 (22)	31.3 (10)	41.4 (12)
Not everyday	63.9 (39)	68.8 (21)	58.6 (17)
Health literacy (Need help with materials from doctor or pharmacy)* (%, n)				1.09	0.30
Never/rarely	98.3 (59)	100.0 (31)	96.6 (28)
Sometimes or more	1.7 (1)	0 (0)	3.4 (1)
Current living situation (%, n)				0.14	0.93
Own house or apartment	26.2 (16)	25.0 (8)	27.6 (8)
Parent’s house or apartment	47.5 (29)	46.9 (15)	48.3 (14)
Other	26.2 (16)	28.1 (9)	24.1 (7)
Stable of living situation (%, n)				0.83	0.36
No	13.1 (8)	9.4 (3)	17.2 (5)
Yes	86.9 (53)	90.6 (29)	82.8 (24)
Sexual orientation (%, n)				1.75	0.63
Heterosexual	26.2 (16)	28.1 (9)	24.1 (7)
Homosexual	57.4 (35)	53.1 (17)	62.1 (18)
Bisexual	11.5 (7)	15.6 (5)	6.9 (2)
Undecided	4.9 (3)	3.1 (1)	6.9 (2)
Global symptom index (M(SD))	0.9 (0.9)	1.0 (1.1)	0.9 (0.8)	0.04	0.97

*n < 61.

Table 2. Intervention outcomes at 16-weeks post baseline among 61 youth living with HIV.

	Battle Viro intervention		di ^b	Control		dc ^b	Effect size difference (di − dc) ^c	F ^d	p
	Pretest	Post ^a		Pretest	Post ^a
Log viral load (M (SD))	3.62 (1.20)	1.48 (2.06)	−0.99	3.96 (1.18)	1.82 (2.14)	−1.21	0.22	0.97	0.62
Wisepill 7–day Adherence^e (M (SD))	0.62 (0.36)	0.43 (0.38)	−0.51	0.63 (0.35)	0.32 (0.36)	−0.65	0.14	0.23	0.63
Self-reported 7-day adherence (M (SD))	0.86 (0.25)	0.88 (0.23)	0.08	0.93 (0.20)	0.91 (0.23)	−0.09	0.17	0.56	0.46
HIV knowledge (M (SD))	2.44 (1.16)	3.09 (1.42)	0.50	3.00 (1.04)	3.00 (1.28)	0	0.50	1.59	0.33
ARV treatment knowledge (M (SD))	11.36 (3.85)	12.34 (3.03)	0.28	12.11 (2.06)	11.65 (4.26)	−0.14	0.42	0.73	0.40
IMB-motivation (M (SD))	12.81 (3.81)	13.10 (4.00)	−0.01	10.82 (4.29)	12.38 (4.45)	0.40	−0.41	0.06	0.81
Self-efficacy for ARV use (M (SD))	17.94 (4.02)	19.83(4.68)	0.43	18.21 (5.53)	19.48 (5.12)	0.24	0.19	0.21	0.65
Social support (M (SD))	26.13 (3.96)	26.97 (5.39)	0.18	26.38 (2.72)	24.45 (5.52)	−0.44	0.62	3.34	0.07

^a16 weeks post-baseline.

^bCohen’s d.

^cCohen’s d effect size difference (Battle Viro – Control).

^dFisher’s exact statistic for ANCOVA analyses, controlling for baseline.

^eWisepill adherence assessed in week prior to receiving game/phone and 12 weeks later at the end of BattleViro adherence texts.

Figure 4. Wisepill adherence (past 7-day) by intervention condition by starting ARV in past 3 months.

Figure 5. Log viral load by intervention condition by newly starting ARV.

Table 3. Outcomes by intervention condition among those starting ART in past 3 months

	Battle Viro intervention		d ^b	Control		d ^b	Effect size difference (di − dc)^c	F ^d	p
	Pretest	Post ^a		Pretest	Post^a
Log viral load (M (SD))	3.63 (1.11)	0.93 (1.63)	−2.74	3.94 (0.90)	1.53 (2.49)	−0.53	−2.21	4.33	0.04
Wisepill 7-day adherence (M (SD))	0.70 (0.35)	0.71 (0.32)	0.03	0.86 (0.17)	0.48 (0.44)	−1.12	1.15	3.90	0.05
Self-report 7-day adherence (M (SD))	0.96 (0.09)	0.88 (0.31)	−0.35	0.97 (0.06)	0.91 (0.30)	−0.27	−0.08	0.05	0.82
HIV knowledge (M (SD))	2.27 (0.79)	2.91 (1.45)	0.55	2.90 (0.94)	2.55 (1.13)	−0.35	0.90	0.52	0.47
ART treatment knowledge (M (SD))	11.82 (3.46)	13.18 (1.94)	0.47	12.45 (1.81)	11.63 (4.23)	−0.25	0.72	0.42	0.52
Motivation for ART (M (SD))	13.18 (3.22)	12.00 (4.12)	−0.32	10.70 (4.19)	12.20 (3.52)	0.39	−0.71	0.39	0.53
Self-efficacy for ART skills (M (SD))	19.18 (3.71)	19.09 (5.65)	−0.02	18.36 (5.51)	19.36 (3.64)	0.21	−0.23	0.56	0.46
Social support (M (SD))	27.64 (3.32)	27.64 (5.18)	0	25.45 (2.94)	25.00 (4.02)	−0.13	0.13	0.03	0.87

^a16-weeks post-baseline.

^bCohen’s d.

^cCohen’s d effect size difference (Battle Viro – Control).

^dANCOVA interaction statistic between intervention condition and newly starting ARV in past 3 months in entire sample, controlling for baseline.