Mobile phone access, usage patterns and perceptions of adolescents living with HIV on the use of gamified interventions to improve ART adherence in Eswatini

Abstract Background Adolescents living with HIV (ALHIV) often experience poor anti-retroviral 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, thus present an opportunity to be used as a tool to enhance ART adherence through the use of mobile phones as a targeted intervention. However, research on ALHIV's mobile phone access, usage patterns, and perceptions of mobile phone-based interventions has shown to be limited in Eswatini. This study thus explored these aspects to inform effective mobile health (mHealth) strategies for enhancing ART adherence among ALHIV. Methods We conducted a qualitative study using in-depth interviews in the month of December 2023. A total of 29 ALHIV purposively sampled were interviewed from five Teen Clubs in the Hhohho region in Eswatini. These adolescents were aged 10 to 19 years, aware of their HIV status, and were also on ART. Results Nearly 94% of the participants (28/29) had access to a mobile phone. Of these, 25 (89.3%) used their phone daily. Among participants with mobile phone access, all (100%) reported using their phones primarily for calling and receiving calls, while 21 (75%) used their mobile phones for social media. Three themes emerged regarding the use of gamified interventions to support ART adherence. Firstly, the use of gamified interventions aimed at ART adherence among ALHIV was deemed feasible, based on mobile phone access and past experiences with mobile game. Secondly, successful gamified interventions should consist of three qualities: being supportive, educational, and ensuring privacy in the design of the game. Lastly, two potential concerns (confidentiality and mobile phone access factors) should be considered when designing gamified ART adherence interventions. Conclusion There is wide use of mobile phones among adolescent living with HIV infection on ART in Eswatini. This provides an opportunity to leverage mobile technology to enhance ART adherence through use of gamified interventions. However, it is essential to carefully consider ALHIV-specific needs and concerns in the design of these interventions to ensure their successful implementation and sustainability.