Published in PLOS One on 2026-02-05, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Londiwe D. Hlophe, Peter S. Nyasulu, Constance S. Shumba
Source: PLOS One • DOI 10.1371/journal.pone.0321907
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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 15–19 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.
A systematic, iterative approach involving a multidisciplinary team of researchers, ALHIV, and app developers was adopted in designing, developing, and testing the prototype of “The Conqueror” game. 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.
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 The Conqueror, 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 The Conqueror were rated relatively high, at 86.2% and 82.8%, for usability and acceptability respectively.
Gamified mHealth interventions co-developed with potential end-users demonstrate high usability and acceptability. However, further piloting of The Conqueror 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.
Introduction
The introduction of anti-retroviral therapy (ART) has reduced AIDS related deaths by 69% since the peak in 2004 globally [1]. In sub-Saharan Africa (SSA), home to 70% of all the global population living with HIV, there has been a 60% drop in AIDS related death due to the introduction of ART [1,2]. However, adolescents constitute a disproportionately affected population globally, with only 65% of those living with HIV on ART and an estimated 27,000 AIDS-related deaths reported in 2023 [3]. The situation is particularly pronounced in SSA, which is home to approximately 90% of the world’s adolescents living with HIV (ALHIV) [2,4]. For instance, a systematic review of studies conducted between 2010 and 2022, revealed that viral load suppression (VLS) was 55% among ALHIV in SSA [5]. A non-suppressed viral load is associated with opportunistic infections and AIDS related deaths heightening the need for interventions aimed at ART adherence and a suppressed viral load [6–8].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider technology & industry desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Londiwe D. Hlophe, Peter S. Nyasulu, Constance S. Shumba. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Acceptability of Suubi+Adherence intervention to improve ART adherence in Southern Uganda: A qualitative analysis
