HIV G.E.T (Gaming, Engaging and Testing) Project

HIV is a significant health issue in the Philippines. In May 2015 the Philippines Department of Health (PDOH) Aids Registry reported 22,684 people living with HIV/AIDS. 86% of the HIV+ population are men who have sex with men (MSM) of which 36% engage in heterosexual activities with women. There are two major issues with the current diagnosis system. According to observations by the PDOH, high risk groups, tend not to come forward for testing, and the two week time period between testing and diagnosis in the current system leads to few returns for treatment and care. This and several other factors are leading to the Philippines having the fastest growing HIV epidemic in the world. There is a clear need to address the current diagnosis system and run targeted interventions.
As adolescents make up a high proportion of the hard to reach high risk group, this project seeks to: improve treatment seeking behaviour and compliance through a digital gaming intervention; and improve access to testing and speed of diagnosis through rapid diagnostic tests (RDTs).
The study will be undertaken in Metro Manila which has HIV prevalence of 5.3-6.7%. Two intervention clinics in the Metro Manila area and 4 control clinics will be included. A step wedge study design will be followed for game evaluation. The current laboratory-based ELISA and western blot testing algorithm for HIV testing and counselling (HTC), will be replaced by a Rapid Diagnostic Algorithm (RDA) intervention. This will be rolled out for 24 months in 2 intervention clinics and the game introduced after 12 months in a stepped process to provide three arms of evaluation for the two interventions: current practices, RDA only and RDA in combination with gaming intervention.
The pilot study will indicate whether the numbers of people seeking HIV services at intervention clinics, compared to control facilities have increased. It will also generate a better understanding of motivational factors for seeking diagnosis, especially from the at risk groups. This will provide valuable information for possible expansion of interventions nationally.
The UK-based research team will provide expertise and guidance, ensuring the transfer of skills and knowledge to the Philippines to plan, strengthen capacity within the HIV health system, roll out, monitor and evaluate the value of the two proposed interventions.

According to PDOH (2015), 748 individuals were newly diagnosed, since last years report, to be HIV Ab seropositive, a 51% increase in cases compared to May 2014. Among the newly diagnosed cases, 96% were male with a median age of 28 years old (range: 16-69 yrs. old), 28% were youth (15-24 years old), and 37% came from National Capital Region (Metro Manila area). In addition, 86% of the sexually transmitted HIV cases were MSM, 7% were Overseas Filipino Workers, and 11% were engaging in transactional sex.
HIV rapid tests are simple to perform with two or more tests providing confirmed results in 30 minutes or less in a serial or a parallel algorithm. A parallel algorithm will be used for the study. The WHO pre-qualifies rapid test kits with a diverse and standardized set of specimens collected globally, requiring test kits to have a minimum sensitivity >99% and specificity >98%. Quality-assured rapid testing has facilitated the movement from laboratory-based testing to other settings, and it has been highlighted that with good training, performance of non-laboratory workers is similar to laboratory staff. HIV testing strategies that rely on rapid testing are widely used in outreach settings with MSM in concentrated epidemic settings. They have been shown to improve the uptake of testing, increase dramatically the proportion of those receiving their results, and improve linkage rates to care and treatment programmes.
The approach to game development and analysis will be conducted trough customised tried and tested frameworks for evaluating games for health. Development of the digital game will be completed in the Unity3d version 4.x engine, or an equally standard, industry-grade middleware package to allow for customisation by other software developers and alleviate concerns over the longevity of development partners.

The study will generate an evidence-base to support the roll out of an RDA in the Philippines. The advantage of rapid diagnostics and counselling at clinics and the introduction of a targeted advocacy game will be communicated. Peer reviewed papers will provide a case study to support further dissemination of the game and use of an RDA in health facilities across the Philippines.
Dr. Jose Gerard B. Belimac (Philippines, PDOH) is the designated National Program Manager for HIV and AIDS, STI in PDOH and is a Co-Investigator on the project. Dr Belimac is responsible for technical coordination of partners, direction setting, evidence-based policies/guidelines and standards development for the health sector response to HIV spanning from prevention, health promotion, diagnosis, treatment and the key populations for HIV and AIDS. This will allow for a direct line of communication between project team members and the PDOH to ensure national processes are addressed and by-in from the PDOH is gained at project inception.
Mid-term workshops with PDOH and University of the Philippines (UP) stakeholders, will be held to demonstrate the game and to discuss and plan future collaborations.
During the project the roll out and marketing of the game will be controlled to avoid contamination between the control and intervention groups. Upon completion of the study the online gaming market will be utilised to provide free country-wide access to the game. Monitoring of use, after general game release will be possible.
If this initial game is successful we will develop capacity in the UP and PDOH, to enable them to undertake simple customisation to make the gaming platform applicable to a variety of public health challenges.
The game will be jointly-owned, through the legal transfer of the software source code, to the PDOH and UP.
Workshops will be held with the PDOH, HIV stakeholders and the wider public health community to communicate the results of the pilot and how the results should be taken forward to improve health within the Philippines. Social networking sites and local media deemed appropriate will be utilised to disseminate project information and results.