Can games improve the delivery of health services? We think so ‚ thats why our team has set out to explore whether gamification, the use of game elements in non-game contexts, can enhance services to prevent HIV and other sexually transmitted infections. We hypothesize that the foundational elements of games' competition, collaboration, skill acquisition, and fun can motivate young men to engage in positive health behaviors to protect themselves and their communities. We are a team of epidemioogists, economists, clinicians, and game experts working together to understand whether games can be useful additions to the clinical setting. Come hear about our approach and share your thoughts and ideas on how to add fun to health.

1. Creating rePLAY: Development process
of a gamified health intervention for
young gay and bisexual men in California
Sandi McCoy, PhD MPH
YTH Live
April 25, 2016

2. Lifetime Risk of HIV by Transmission Group

3. Estimated New HIV DiagnosesAmong Men Who Have Sex With
Men, by Race/Ethnicity andAge at Diagnosis, 2014 — U.S.

4. rePLAY
A gamified intervention to encourage young
gay/bisexual/queer men aged 18-26 to:
• recruit members of their social network
• adopt safer sexual behaviors
• regularly screen for HIV/STIs, and
• stay free of HIV and other STIs.

5. Project Outcomes
Primary Outcomes:
1. Repeat HIV testing: ≥1 HIV tests over 6 months of follow-up
2. Changes in HIV-related risk behavior at 6 months: Number of
sex partners, unprotected anal intercourse
Mixed-Methods Process Evaluation:
1. Ability to recruit the study population
2. Individual and group engagement with the intervention, including
among African American and Latino MSM
3. Retention in the intervention and comparison groups
4. Cost
5. Adverse events
6. Intervention fidelity, cultural competence

6. • Limited access or
perceived access to
services
• Few youth-friendly
services
• Stigma, homophobia,
discrimination
• Prevention fatigue and
complacency
(lack of motivation)
• Knowledge gaps
• Poor self-efficacy for
safer sex behaviors
• Limited social support
• Racial/ethnic barriers
(e.g., young MSM of
color)
Game Principles
Incremental & challenging skill
development, competition,
collaboration, autonomy
Game Elements
Points system linked to rewards,
creative use of material
incentives
Social Support
Peer recruiting
Social Recognition
Leaderboard, badges
Elements of Chance
Lotteries, surprises
Initial and repeat
HIV/STI screening
• HIV and STI incidence in
young MSM
• Access to treatment and
care
• Late diagnoses of HIV
infection
• Timely linkage to
treatment and care
• Reduction in community
transmission
Safer
sexual behaviors
RePLAY Intervention
Barriers that reduce
demand for HIV/STI
services among young
MSM
Mediating
Outcomes
Health Outcomes,
Public health benefits
Intervention Impact Pathway

7. How can we gamify the HIV/STI testing
experience?
• Review of gamification programs, in health (e.g., quitting
smoking) and for consumer goods (e.g., Starbucks
Rewards)
• In-depth interviews with clinic staff
• Focus group discussions with 18-26 year old men
• ‘Rapid’ pilot studies in the clinic
• Engagement with Gamification experts

8. rePLAY Game Mechanics
Mechanic Description / Purpose
Testing Timer
Online countdown to encourage quarterly
HIV/STI screening
Clinic Activity
Game of chance at the clinic (e.g., prize
wheel, scratchers) with small and large
prizes to reward HIV/STI screening
Weekly activities via SMS
Points earned through periodic online
mini-games, which drives traffic to website
with testing timer
Points, Badges, Leaderboard
Earn points for HIV/STI screening, peer
recruitment, and mini-games; points can
only be redeemed at the clinic for more
opportunities at play the clinic-based game
Peer Recruitment Recruit friends, earn points and rewards

9. In Clinic-Activity
• Fun game of chance
• Colors tied to prizes
• Redeem points for additional
gumballs
• Test counselors enjoy the process
as well

10. Examples of timer designs tested

11. Poll Questions Tested
• TRUE or FALSE: Koalas can get chlamydia too.
• Jacob just started taking PrEP last Friday. Over the weekend
he hooked up with a hot bottom from Grindr but he used a
condom during anal sex only. Today is Tuesday and he’s
meeting some friends for Happy Hour after work-he can’t wait
to tell everyone about his weekend. Based upon his sexual
actions last weekend, does Jacob need to get tested?
• Yes, since he used a condom during anal sex.
• No, he’s taking PreP.
• Maybe, he could get an STI from oral sex.
• Choose the statements that are correct. Once you are on
PrEP:
• You should stop using condoms.
• You have to take it for the rest of your life.
• It is recommended that you take it everyday.

12. Next steps
• Pilot test the project in Oakland and Los Angeles
• Evaluate for potential effectiveness
• Solicit feedback about what went well and areas we can
improve
• Consider alternate versions of the intervention for:
• Transgender men and women
• Heterosexual men and women
• People on PrEP

13. Questions?