Mobile Phone Access, Usage Patterns, and Perceptions of Adolescents Living With HIV on the Use of Gamified Interventions to Improve Antiretroviral Therapy Adherence in Eswatini: Qualitative Study.

Background: Adolescents living with HIV often experience poor antiretroviral therapy (ART) outcomes due to multiple barriers affecting medication adherence. Effective self-care interventions are needed to address these challenges. Mobile phones are widely used by the adolescent population and therefore present an opportunity to enhance ART adherence using mobile phone-based interventions. However, research on mobile phone access among adolescents living with HIV, usage patterns, and perceptions of mobile phone-based interventions is limited in Eswatini. Objective: This study aimed to explore these aspects to inform effective mobile health strategies for enhancing ART adherence among adolescents living with HIV. Methods: We conducted a qualitative study using in-depth interviews in December 2023. A total of 29 adolescents living with HIV aged 10 to 19 years and enrolled on ART were purposively sampled and interviewed from 5 Teen Clubs in the Hhohho region of Eswatini. Interviews were audio-recorded and transcribed verbatim. Topic areas covered were mobile phone accessibility, usage patterns, and perceptions on the use of mobile phones to facilitate ART adherence. The data were analyzed using the deductive-inductive coding approach. Results: Of the 29 participants, 15 (52%) were female, and 19 (65.5%) were aged between 15 and 19 years. The study findings indicated high mobile phone access among participants, with primary usage focused on making and receiving calls, as well as engaging with social media. Three themes emerged regarding the use of gamified interventions to support ART adherence. First, the use of gamified interventions aimed at ART adherence among adolescents living with HIV was deemed feasible based on mobile phone access and past experiences with mobile games. Second, 3 main qualities of successful gamified interventions were identified as being supportive, being educational, and ensuring secure and confidential connections with other players. Finally, confidentiality and mobile phone access factors were highlighted as potential concerns when designing gamified ART adherence interventions. Conclusions: The findings suggest potentially high access and usage of mobile phones among adolescents living with HIV on ART in Eswatini. This provides an opportunity to leverage mobile technology to enhance ART adherence through gamified interventions. However, it is essential to carefully consider the specific needs and concerns of adolescents living with HIV in the design of these interventions to ensure their successful uptake and sustainability.