JMIR Publications

ABSTRACT

Background:

Despite the growth of online interventions for HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) for key populations, the evidence for the effectiveness of these interventions has not been synthesized.

Objective:

To inform World Health Organization (WHO) guidelines for HIV/VH/STI prevention, diagnosis, and treatment services for key populations, we systematically reviewed the effectiveness, values and preferences, and costs of online outreach, online case management, and targeted online health information for key populations (men who have sex with men, sex workers, people who inject drugs, trans and gender diverse people and people living in prisons.

Methods:

We searched CINAHL, PsycINFO, PubMed, and EMBASE for peer-reviewed studies; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) and observational studies. We assessed risk of bias using the Cochrane Collaboration tool for RCTs and the Evidence Project and ROBINS-I tools for non-RCTs. Values and preferences and cost data were summarized descriptively.

Results:

Of 2,711 records identified, we included 13 articles in the effectiveness review (3 for online outreach, 7 for online case management, and 3 for targeted online health information), 15 articles in the values and preferences review, and one article in the costs review. Nearly all studies were conducted among men who have sex with men in the United States. These articles provided evidence that online approaches are as effective as face-to-face services in terms of reaching new people, use of HIV/VH/STI prevention services, and linkage to and retention in HIV care. Among men who have sex with men in the United States, such interventions were considered feasible and acceptable. One cost study among Canadian men who have sex with men found that syphilis testing campaign advertisements had the lowest cost-per-click ratio on “hook-up” platforms compared to more traditional social media platforms.

Conclusions:

Online services for HIV/VH/STIs may be a feasible and acceptable approach to expanding services to key populations with similar outcomes as standard of care, but more research is needed in low-resource settings, among key populations other than men who have sex with men, and with infection focuses other than HIV.