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Accepted for/Published in: JMIR mHealth and uHealth

Date Submitted: Apr 16, 2019
Open Peer Review Period: Apr 23, 2019 - Jun 1, 2019
Date Accepted: Aug 18, 2019
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

Wang Z, Zhu Y, Cui L, Qu B

Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

JMIR Mhealth Uhealth 2019;7(10):e14404

DOI: 10.2196/14404

PMID: 31621641

PMCID: 6913542

EHealth Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: A Systematic Review and Meta-Analysis

  • Ziqi Wang; 
  • Yaxin Zhu; 
  • Liyuan Cui; 
  • Bo Qu

ABSTRACT

Background:

EHealth is increasingly used for self-management and service delivery of human immunodeficiency virus (HIV) related diseases. With the publication of more and more studies focusing on ART adherence, this makes it possible to make quantitative and systematic assessments of the effectiveness and feasibility of eHealth interventions.

Objective:

The purpose of this review was to explore the effectiveness of eHealth interventions on improving antiretroviral therapy (ART) adherence in people living with HIV (PLWH). The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed.

Methods:

Under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Cochrane Collaboration guidelines, we systematically searched MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials and three conference abstract databases using search terms related to HIV, antiretroviral therapy, adherence, and eHealth interventions. Two authors independently screened the studies, extracted the data, and assessed the study quality. Disagreements were settled through discussions with a third author. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of PLWH were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios (OR), Cohen’s d, and their 95% confidence intervals (95%CI) were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity.

Results:

Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle- income countries. Sixteen trials were undertaken in adults, and 5 were in adults and adolescents. The health status at baseline of participants in 14 trials were healthy, and 7 trials were at risk. Of the trials included, 7 of 21 used personality content, 12 of 21 used 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16% (1857 of 3937) females), eHealth interventions significantly improved the ART adherence of PLWH (Pooled Cohen’s d, 0.25; 95% CI, 0.05 to 0.46; P = 0.013). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (Pooled Cohen’s d, 0.25; 95% CI, 0.11 to 0.38; P<0.001). The effect was sensitive to sample size (Q, 5.56; P, 0.02) and study duration (Q, 8.89; P, 0.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the three sensitivity analyses.

Conclusions:

Some of the eHealth interventions may be the effective method to increase the ART adherence of PLWH. Considering that most of the trials was with small sample size and short-term duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence, as well as long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes.


 Citation

Please cite as:

Wang Z, Zhu Y, Cui L, Qu B

Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

JMIR Mhealth Uhealth 2019;7(10):e14404

DOI: 10.2196/14404

PMID: 31621641

PMCID: 6913542

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