Project 375 is mobile phone gaming application designed to increase knowledge on HIV among young adults. It informs players of the dangers of HIV/A.I.D.S whilst regularly presenting them with survey questions to gauge their understanding as they play. The game targets young adults and is based on story lines of two characters that depict the life style of typical young adults at the University.
In 2014 – 2016, we developed and piloted an Android, Windows, and Symbion compatible cell phone-based gaming application (project 375) for HIV prevention that incentivized positive health behavior through a system of tangible rewards. Project 375 is a simple, fast and low cost an educational mobile based game that entertains and informs players of the dangers of HIV/AIDS whilst regularly presenting them with survey questions to gauge their understanding as they play. The game targets young adults and is based on story lines of two characters that depict the life style of typical young adults at the University.
Project 375 has been piloted among 756 students at Makerere University and it showed potential to increase knowledge on HIV prevention and reduction on risky behaviours for HIV acquisition among this target group.
How does your innovation work?
The game is presented in two forms. The first being a story based comic experience that takes the players through the lives of two individuals. As the players progress through the game, they are faced with challenged they have to overcome to finish the game. These challenges manifest themselves inform of HIV infection risk factors like poor decision making as regards to condom use or alcohol use. The characters/individuals in the game are portrayed to be young people between the ages of 15 – 24years who are most at risk of acquiring HIV.
The game is based on story lines of characters that depict the life style of typical students at Makerere University. The test version of the game had two characters and 3 levels at the start. Gamers were free to play any character. Within the game, there was a mini-game intended to help students collect points that unlock subsequent levels. Each level of the game had 3 questions that were presented in question and answer format. HIV messages were embedded in the gaming interface to complement the play i.e., once a player achieved a given playing task (a given number of play points), they would earn the right to answer an HIV knowledge question and move to the next level.
In addition, a dedicated server to monitor downloads, active gamers and rewards was developed to register students’ cumulative points as they played. The rewards system was based on the following rules: the game differentiated between play points and knowledge points. All the statements/questions had one correct answer. In the app interface, a correct or wrong answer to a knowledge question (both) triggered the “explanation” for emphasis purposes after which the player returned to the play part of the game. The correct answers earned points (each point was worth 1 Uganda Shilling of airtime). Knowledge points were given based on the following rules: a correct answer to a given question the 1st time earned 500 points, 400 points on the second trial by the same person, 300 points on the 3rd trial, 200 points on the 4th trial, 100 points on the 5th trial and no points after the 5th trial.
What Evidence do you have that your Innovation works?
A total of 1512 were enrolled into the randomized trial phase of the project. The mean (sd) age was 21.2 (0.04). 773 (51.1%) were males, 790 (52.3%) resided in a hall on the main university campus and 1355 (90.0%) were single. In as treated analyses, students who actually played the game had a mean (sd) HIV KQ 18 score of 12.95 (2.4) and those who did not receive the game had a mean (sd) score of 12.52 (2.5). The difference 0.43 (95% CI: -0.84, -0.01) was marginally significant (p = 0.04). Adjusting for the baseline knowledge score, the difference in knowledge score at the end of the study of 0.41 was not marinally significant (p = 0.05). Students in the treated group were more likely to have never had sex (31.4% vs 23.0%), more likely to have used a condom during sexual intercourse since last interview (55.7% vs 42.5%) and were more likely to have had sex with more partners since last interview (2.7 vs 1.3) while studets in the control groups were more likely to be willing to get circumcized (45% vs 37%) and were more likely to be aware of places where to find condoms (91.1 vs 83.8). Other variables assessed for HIV prevention behaviors showed no significant changes in proportions
Do you have current users or testers?
Makerere University students.
What is your strategy for expanding use of your innovation?
Given wide penetration of mobile phones in this target age group and the success in developing and piloting project 375 , we plan to add commercial advert interfaces that will generate revenue to support the project as well as rewards for the players. Because of this high cell phone coverage & HIV prevalence, we believe that Project 375 has the potential to be deployed widely across the sub-Saharan African counties especially among young adults (15-24 years).
We also paln to partner with Organizations that directly work with young people in sexual and reproduct health like Reproductive Health Uganda (RHU), Marie Stopes Uganda (MU), Straight Talk Foundation Uganda and Plan International Uganda.
In phase II (validation phase), further evidence needed is the acceptability of such an innovation in another University and non-school going young adults, effectiveness, marginal cost of Project 375 in this setting and the cost-effectiveness measured as cost per increased levels of knowledge scores and budget impact of such a program.