Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 26, 2019
Date Accepted: Feb 1, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
A Meta-Analysis of Effectiveness of eHealth Interventions for Promoting HIV-Preventive Behaviors among Men Who Have Sex with Men: An Integrative Framework of Design and Implementation Features
ABSTRACT
Background:
The disproportionately high HIV/AIDS(Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome) epidemic among men who have sex with men (MSM) remains a global concern.
Objective:
Given the increasing utilization of ehealth technology in the delivery of HIV prevention interventions, the present study aimed to systematically explore the effectiveness and its relationship with diverse intervention characteristics.
Methods:
Eligible studies were identified through the rigorous screening process. Primary meta-analyses were first conducted to estimate the effectiveness of ehealth interventions (d+) in changing three HIV prevention-related behaviors among MSM: unprotected anal intercourse (UAI), HIV testing and multiple sex partnership (MSP). Moderation analyses were then performed to examine a priori effectiveness predictors including behavioral treatment components (theory use, tailoring strategy use, navigation style and treatment duration), ehealth technology components (operation mode and modality type), and intervention adherence.
Results:
A total of 46 pairwise comparisons were finally included. Overall effect sizes at endpoint were small but significant for all outcomes (UAI: d+=-.21, p<.001; HIV testing: d+=.38, p<.001; MSP: d+=-.26, p=.02). Intervention effects on UAI was significantly larger when contrasted against a pre-intervention status than against a concurrent comparison. Interventions with more tailoring strategies or specifically adopting a feedback strategy were significantly more effective in reducing UAI than the concurrent comparison. Self-paced treatments generated more UAI reductions from the pre-intervention level, whereas tunneled ones were more effective than the concurrent comparison. However, such a variation in the moderating effects of navigation style by study design might be attributed to different tunneling strategies used. It was further found that interventions featuring longer treatment durations, operated via computer-mediated communication and applying messaging, social media or a combined modality significantly improved the uptake of HIV testing. Higher intervention adherence consistently predicted larger effects on UAI and HIV testing.
Conclusions:
This study provided empirical evidence for the effectiveness of ehealth interventions in promoting HIV-preventive behaviors among MSM. Features of treatment content and ehealth technology might best predict intervention effects on UAI and HIV testing, respectively. Most importantly, intervention adherence tended to play an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.
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