{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T19:13:12Z","timestamp":1770405192403,"version":"3.49.0"},"reference-count":83,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Eswatini, adolescents living with HIV (ALHIV) face disproportionate challenges in achieving optimal anti-retroviral therapy (ART) adherence, as evidenced by a viral load suppression (VLS) of 77.8% among those aged 15\u201319 years, compared to the 96.2% VLS observed among adults on ART. While mobile phone ownership has surged globally, facilitating the use of mobile phone-based interventions in healthcare, there remains limited evidence on the development and testing of such interventions for improving ART adherence among ALHIV. This study aimed to design a mobile gaming application (app) to promote ART adherence among ALHIV in Eswatini.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic, iterative approach involving a multidisciplinary team of researchers, ALHIV, and app developers was adopted in designing, developing, and testing the prototype of \u201c\n                      <jats:italic>The Conqueror\u201d game<\/jats:italic>\n                      . A total of seven focus group discussion sessions, each comprising 12 participants conveniently sampled from five Teen Clubs in the Hhohho region of Eswatini, were conducted between 27 April and 20 July 2024 to inform the design and development of the mobile game. The usability and acceptability of the game were assessed using self-administered questionnaires among 35 ALHIV, who were not involved in the game development process and were conveniently selected from the Teen Clubs. The qualitative data were analysed thematically, while the quantitative data were analysed descriptively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants desired mobile games aimed at enhancing social support through reminders, acceptance, encouragement, and knowledge. Social support was integrated into a storyline that informed the development of\n                      <jats:italic>The Conqueror<\/jats:italic>\n                      , which centres on a hero who conquers opposition and collects an artefact daily to maintain viral suppression. The game features gamification elements such as a life bar, progressive difficulty, daily cycles, three stages with five-day challenges, and power-ups for health boosts and speed increases. The feasibility of\n                      <jats:italic>The Conqueror<\/jats:italic>\n                      were rated relatively high, at 86.2% and 82.8%, for usability and acceptability respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Gamified mHealth interventions co-developed with potential end-users demonstrate high usability and acceptability. However, further piloting of\n                      <jats:italic>The Conqueror<\/jats:italic>\n                      game through randomized trials is essential to evaluate the feasibility and effectiveness of this approach in improving ART adherence among adolescents before broader implementation and scaling to a wider adolescent population.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0321907","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:22:07Z","timestamp":1770315727000},"page":"e0321907","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A mobile game to promote ART adherence among adolescents living with HIV in Eswatini: Development and prototype testing of \u201cThe Conqueror\u201d"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6595-4436","authenticated-orcid":true,"given":"Londiwe D.","family":"Hlophe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S.","family":"Nyasulu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance S.","family":"Shumba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"pone.0321907.ref001","unstructured":"UNAIDS. Fact Sheet 2022. 2022. https:\/\/www.unaids.org\/en\/resources\/documents\/2024\/UNAIDS_FactSheet"},{"key":"pone.0321907.ref002","unstructured":"UNICEF. Adolescent HIV prevention - UNICEF DATA. https:\/\/data.unicef.org\/topic\/hivaids\/adolescents-young-people\/ 2024."},{"key":"pone.0321907.ref003","unstructured":"UNICEF. HIV Statistics - Global and Regional Trends - UNICEF DATA. https:\/\/data.unicef.org\/topic\/hivaids\/global-regional-trends\/ 2024."},{"key":"pone.0321907.ref004","unstructured":"HIV.gov. Global Statistics: The Global HIV and AIDS Epidemic. https:\/\/www.hiv.gov\/hiv-basics\/overview\/data-and-trends\/global-statistics 2024."},{"issue":"5","key":"pone.0321907.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0276411","article-title":"Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis","volume":"18","author":"LD Hlophe","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0321907.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0279479","article-title":"The association between low-level viraemia and subsequent viral non-suppression among people living with HIV\/AIDS on antiretroviral therapy in Uganda","volume":"18","author":"N Nanyeenya","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0321907.ref007","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1186\/s12879-021-06162-z","article-title":"Predictive factors of viral load high-risk events for virological failure in HIV\/AIDS patients receiving long-term antiviral therapy","volume":"21","author":"S Qin","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0321907.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246140","article-title":"Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda","volume":"16","author":"S Nabukeera","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0321907.ref009","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1186\/s12889-019-7768-z","article-title":"Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi","volume":"19","author":"L Chirambo","year":"2019","journal-title":"BMC Public Health"},{"key":"pone.0321907.ref010","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.puhe.2017.12.010","article-title":"Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review","volume":"157","author":"N Ammon","year":"2018","journal-title":"Public Health"},{"key":"pone.0321907.ref011","unstructured":"Eswatini Ministry of Health. Eswatini Population-based HIV Impact Assessment 3 2021 (SHIMS3 2021): Final Report. 2023. https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2023\/12\/241123_SHIMS_ENG_RR3_Final-1.pdf"},{"key":"#cr-split#-pone.0321907.ref012.1","unstructured":"WHO. Eswatini achieves the 95-95-95 HIV treatment target: a decade ahead of 2030 goal"},{"key":"#cr-split#-pone.0321907.ref012.2","doi-asserted-by":"crossref","unstructured":"WHO Regional Office for Africa. 2023. Available from: https:\/\/www.afro.who.int\/countries\/eswatini\/news\/eswatini-achieves-95-95-95-hiv-treatment-target-decade-ahead-2030-goal","DOI":"10.18356\/9789210025225c096"},{"key":"pone.0321907.ref013","unstructured":"Eswatini Ministry of Health. Guidelines for Differentiated Service Delivery. Mbabane: Eswatini Ministry of Health. 2022. https:\/\/cquin.icap.columbia.edu\/wp-content\/uploads\/2022\/07\/Final_Policy-Guidelines-for-Eswatini-Differentiated-Service-Delivery.pdf"},{"key":"pone.0321907.ref014","doi-asserted-by":"crossref","first-page":"106309","DOI":"10.1016\/j.childyouth.2021.106309","article-title":"Expert client service delivery practices among adolescents living with HIV in Eswatini: A thematic analysis","volume":"132","author":"CV Ahmed","year":"2022","journal-title":"Child Youth Serv Rev"},{"issue":"9","key":"pone.0321907.ref015","doi-asserted-by":"crossref","DOI":"10.2196\/34159","article-title":"The Use of Smartphone Serious Gaming Apps in the Treatment of Substance Use Disorders: Observational Study on Feasibility and Acceptability","volume":"6","author":"T Schilt","year":"2022","journal-title":"JMIR Form Res"},{"key":"pone.0321907.ref016","first-page":"9886306","article-title":"A Systematic Review of Digital Interventions to Improve ART Adherence among Youth Living with HIV in sub-Saharan Africa","volume":"2022","author":"K Griffee","year":"2022","journal-title":"AIDS Res Treat"},{"key":"pone.0321907.ref017","unstructured":"The World Bank. World Development Report 2016: Digital Dividends. 2016. https:\/\/www.worldbank.org\/en\/publication\/wdr2016"},{"issue":"11","key":"pone.0321907.ref018","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017604","article-title":"Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)","volume":"7","author":"J Daher","year":"2017","journal-title":"BMJ Open"},{"key":"pone.0321907.ref019","unstructured":"ITU. Measuring digital development: Facts and Figures 2024. 2025. https:\/\/www.itu.int\/en\/ITU-D\/Statistics\/Pages\/facts\/default.aspx"},{"issue":"4","key":"pone.0321907.ref020","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1007\/s11904-018-0407-y","article-title":"eHealth to enhance treatment adherence among youth living with HIV","volume":"15","author":"MI Mulawa","year":"2018","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"5","key":"pone.0321907.ref021","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/COH.0000000000000399","article-title":"The future of digital games for HIV prevention and care","volume":"12","author":"LB Hightow-Weidman","year":"2017","journal-title":"Curr Opin HIV AIDS"},{"key":"pone.0321907.ref022","doi-asserted-by":"crossref","DOI":"10.2196\/39915","article-title":"The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review","volume":"11","author":"W Jitmun","year":"2023","journal-title":"JMIR Serious Games"},{"key":"pone.0321907.ref023","article-title":"Digital 2024: Eswatini \u2014 DataReportal \u2013 Global Digital Insights","author":"S Kemp","year":"2024"},{"issue":"4","key":"pone.0321907.ref024","doi-asserted-by":"crossref","DOI":"10.2196\/resprot.6543","article-title":"Efficacy of mobile serious games in increasing hiv risk perception in swaziland: a randomized control trial (SGprev Trial) research protocol","volume":"5","author":"BW Lukhele","year":"2016","journal-title":"JMIR Res Protoc"},{"key":"pone.0321907.ref025","unstructured":"Eswatini Ministry of Sports Culture and Youth. Tune Me Program | Eswatini National Youth Council. https:\/\/snyc.org.sz\/enyc-tuneme.php. 2021."},{"key":"pone.0321907.ref026","doi-asserted-by":"crossref","unstructured":"Hlophe LD, Nyasulu PS, Shumba CS. Mobile phone access, usage patterns and perceptions of adolescents living with HIV on the use of gamified interventions to improve ART adherence in Eswatini. 2024.","DOI":"10.21203\/rs.3.rs-4770966\/v1"},{"issue":"4","key":"pone.0321907.ref027","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s11904-008-0028-y","article-title":"The information-motivation-behavioral skills model of antiretroviral adherence and its applications","volume":"5","author":"JD Fisher","year":"2008","journal-title":"Curr HIV\/AIDS Rep"},{"key":"pone.0321907.ref028","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1017\/pds.2021.513","article-title":"Re-defining the system boundaries of human-centred design","volume":"1","author":"T Gall","year":"2021","journal-title":"Proc Des Soc"},{"issue":"4","key":"pone.0321907.ref029","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1037\/0278-6133.25.4.462","article-title":"An information-motivation-behavioral skills model of adherence to antiretroviral therapy","volume":"25","author":"JD Fisher","year":"2006","journal-title":"Health Psychol"},{"issue":"4","key":"pone.0321907.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e14889","article-title":"Social cognitive theory-based health promotion in primary care practice: A scoping review","volume":"9","author":"KF Islam","year":"2023","journal-title":"Heliyon"},{"key":"pone.0321907.ref031","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/1471-2458-7-104","article-title":"A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV\/AIDS?","volume":"7","author":"S Munro","year":"2007","journal-title":"BMC Public Health"},{"key":"pone.0321907.ref032","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1146\/annurev-publhealth-040218-044008","article-title":"Interventions to Support Behavioral Self-Management of Chronic Diseases","volume":"40","author":"JP Allegrante","year":"2019","journal-title":"Annu Rev Public Health"},{"key":"pone.0321907.ref033","doi-asserted-by":"crossref","first-page":"101832","DOI":"10.1016\/j.cedpsych.2019.101832","article-title":"Motivation and social cognitive theory","volume":"60","author":"DH Schunk","year":"2020","journal-title":"Contemp Educ Psychol"},{"issue":"7","key":"pone.0321907.ref034","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.3390\/pharmaceutics13071100","article-title":"Factors contributing to medication adherence in patients with a chronic condition: a scoping review of qualitative research","volume":"13","author":"K Kvarnstr\u00f6m","year":"2021","journal-title":"Pharmaceutics"},{"issue":"1","key":"pone.0321907.ref035","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/ANS.0000000000000469","article-title":"An analysis and evaluation of the information-motivation-behavioral skills (IMB) model for antiretroviral therapy","volume":"47","author":"S Prakot","year":"2024","journal-title":"Adv Nurs Sci"},{"issue":"7","key":"pone.0321907.ref036","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1080\/09540121.2021.2019667","article-title":"The information-motivation-behavioral skills (IMB) model of antiretroviral therapy (ART) adherence among people living with HIV in Shanghai","volume":"35","author":"Z Peng","year":"2023","journal-title":"AIDS Care"},{"issue":"7","key":"pone.0321907.ref037","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1007\/s10461-022-03588-7","article-title":"Assessing the information-motivation-behavioral skills model to predict pre-exposure prophylaxis adherence among black men who have sex with men and transgender women in a community setting in New York City","volume":"26","author":"J Knox","year":"2022","journal-title":"AIDS Behavior"},{"key":"pone.0321907.ref038","first-page":"347","article-title":"Persuasive e-Health design for behavior change","author":"H Baumeister","year":"2022","journal-title":"Stud Neuroscience Psychol Behavioral Economics. Springer International Publishing"},{"issue":"5","key":"pone.0321907.ref039","article-title":"A Persuasive mHealth behavioral change intervention for promoting physical activity in the workplace: feasibility randomized controlled trial","volume":"4","author":"MS Haque","year":"2020","journal-title":"JMIR Form Res"},{"issue":"12","key":"pone.0321907.ref040","doi-asserted-by":"crossref","DOI":"10.2196\/25129","article-title":"Behavioral theories and motivational features underlying ehealth interventions for adolescent antiretroviral adherence: systematic review","volume":"9","author":"AM Bezabih","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"issue":"6","key":"pone.0321907.ref041","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1007\/s10461-020-03118-3","article-title":"The Impact of a Mobile Gaming Intervention to Increase Adherence to Pre-exposure Prophylaxis","volume":"25","author":"L Whiteley","year":"2021","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0321907.ref042","doi-asserted-by":"crossref","first-page":"150","DOI":"10.3390\/adolescents2020014","article-title":"Highlighting a digital platform to assess young people needs: reaching and engaging adolescents and young adults for care continuum in health project (REACH)","volume":"2","author":"P Memiah","year":"2022","journal-title":"Adolesc"},{"key":"pone.0321907.ref043","article-title":"Scaling up peer-led community-based differentiated support for adolescents living with HIV: keeping the needs of youth peer supporters in mind to sustain success","author":"S Bernays","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"6","key":"pone.0321907.ref044","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1177\/1403494819863514","article-title":"Patients participating as co-researchers in health research: a systematic review of outcomes and experiences","volume":"48","author":"K Malterud","year":"2020","journal-title":"Scand J Public Heal"},{"issue":"1","key":"pone.0321907.ref045","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s40271-022-00592-w","article-title":"Conducting Patient-Oriented Research in Low-Income and Middle-Income Countries: A Scoping Review","volume":"16","author":"BM Ibitoye","year":"2023","journal-title":"Patient"},{"key":"pone.0321907.ref046","unstructured":"Ministry of Health Kingdom of Swaziland. Swaziland Integrated HIV Management Guidelines. 2018. http:\/\/swaziaidsprogram.org\/wp-content\/uploads\/2021\/07\/2018-Integrated-HIV-Management-Guidelines_final-1.pdf"},{"key":"pone.0321907.ref047","unstructured":"Swaziland National AIDS Programme. National facility teen clubs. Eswatini Ministry of Health. 2023."},{"key":"pone.0321907.ref048","article-title":"Research design: qualitative, quantitative, and mixed methods approaches","author":"JW Creswell","journal-title":"Los Angeles: SAGE Publications Inc"},{"key":"pone.0321907.ref049","volume-title":"Burns & Grove\u2019s the Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence","author":"JR Gray","year":"2017","edition":"8"},{"key":"pone.0321907.ref050","doi-asserted-by":"crossref","first-page":"656507","DOI":"10.3389\/frph.2021.656507","article-title":"PEERNaija: a gamified mhealth behavioral intervention to improve adherence to antiretroviral treatment among adolescents and young adults in Nigeria","volume":"3","author":"AA Ahonkhai","year":"2021","journal-title":"Front Reprod Health"},{"key":"pone.0321907.ref051","doi-asserted-by":"crossref","DOI":"10.2196\/47575","article-title":"Supporting adolescents with HIV in South Africa through an adherence-supporting app: mixed methods beta-testing study","volume":"7","author":"MI Mulawa","year":"2023","journal-title":"JMIR Form Res"},{"key":"pone.0321907.ref052","unstructured":"The Sandbox Game Maker. Available from: https:\/\/register.sandbox.game\/gamemaker\/?wpsrc=Google+AdWords&wpcid=20256365973&wpscid=15529190993"},{"issue":"1","key":"pone.0321907.ref053","article-title":"Effect of information, motivation, and behavioral skills model on adherence to medication, diet, and physical activity in HIV\/ADIS patients: A health promotion strategy","volume":"9","author":"M Ameri","year":"2020","journal-title":"J Educ Health Promot"},{"issue":"1","key":"pone.0321907.ref054","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1080\/17441692.2020.1851743","article-title":"The end of AIDS? 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Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study","volume":"2019","author":"S Madiba","year":"2019","journal-title":"Biomed Res Int"},{"issue":"2","key":"pone.0321907.ref058","doi-asserted-by":"crossref","DOI":"10.2196\/publichealth.8923","article-title":"A gamified smartphone app to support engagement in care and medication adherence for hiv-positive young men who have sex with men (AllyQuest): development and pilot study","volume":"4","author":"L Hightow-Weidman","year":"2018","journal-title":"JMIR Public Health Surveill"},{"issue":"4","key":"pone.0321907.ref059","doi-asserted-by":"crossref","DOI":"10.2196\/resprot.8811","article-title":"Epic allies, a gamified mobile phone app to improve engagement in care, antiretroviral uptake, and adherence among young men who have sex with men and young transgender women who have sex with men: protocol for a randomized controlled trial","volume":"7","author":"S LeGrand","year":"2018","journal-title":"JMIR Res Protoc"},{"issue":"1","key":"pone.0321907.ref060","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s12889-020-8361-1","article-title":"The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda","volume":"20","author":"P Nabunya","year":"2020","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0321907.ref061","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1186\/s13643-020-01524-1","article-title":"Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis","author":"Y Lailulo","year":"2020","journal-title":"Syst Rev"},{"issue":"4","key":"pone.0321907.ref062","doi-asserted-by":"crossref","first-page":"52","DOI":"10.3390\/tropicalmed7040052","article-title":"Adherence to Antiretroviral Therapy by Medication 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