Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 9, 2021
Date Accepted: Nov 30, 2021
E-health interventions to address HIV and other sexually transmitted infections, sexual risk behaviour, substance use and mental ill health in men who have sex with men: systematic review and meta-analysis
ABSTRACT
Background:
Men who have sex with men (MSM) experience disproportionately high levels of HIV and other sexually transmitted infections (STIs), sexual risk behaviour, substance use and mental ill health. E-health interventions could address these issues simultaneously.
Objective:
We systematically reviewed the evidence for the effectiveness of e-health interventions in addressing these outcomes separately or together.
Methods:
We searched 19 databases for randomised trials of interactive or non-interactive e-health interventions delivered via mobile phone apps, internet or other electronic media to populations consisting entirely or principally of MSM to prevent HIV, STIs, sexual risk behaviour, alcohol and drug use or common mental illnesses. We extracted data and appraised each study, estimated meta-analyses where possible using random effects and robust variance estimation and assessed certainty of findings using GRADE.
Results:
We included 14 trials, of which 13 included active vs control comparisons, none reported mental health outcomes, and all drew from 12 months or less of follow-up post-intervention. Findings for drug use, HIV infections and STI infections drew on low numbers of studies and did not suggest consistent short-term (<3 months post-intervention) or mid-term (3 to 12 months post-intervention) evidence of effectiveness. Certainty was graded as low to very low for most analyses. Eight studies considering sexual risk behaviour outcomes suggested a short-term, non-significant reduction (d=-0.14, 95% CI [-0.30, 0.03]) with very low certainty, but six studies reporting mid-term follow-ups suggested a significant impact on reducing sexual risk (d=-0.12, 95% CI [-0.19, -0.05]), with low certainty.
Conclusions:
To create a joined-up e-health intervention that targets multiple outcomes, intervention evaluations should seek to generalise both mechanisms and components that are successfully used to achieve change in one outcome over multiple outcomes. However, additional evaluations of interventions seeking to address outcomes other than sexual risk behaviour are needed.
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