JMIR Publications

ABSTRACT

Background:

There remain unmet HIV prevention needs in China, particularly among gay, bisexual, and other men who have sex with men (MSM). Technology-based interventions are increasingly used in HIV prevention globally.

Objective:

To perform a systematic review and meta-analysis of studies to assess the effectiveness of technology-based HIV prevention interventions to improve HIV testing and consistent condom use in China.

Methods:

We searched in English (PubMed/MEDLINE, Embase, and Web of Science) and Chinese (Wanfang, WEIPU, and CNKI) databases for technology-based HIV prevention studies published between January 1, 2004 to September 30, 2021. Eligible studies were technology-based HIV prevention intervention studies with outcomes of HIV testing and/or condom use among MSM and/or transgender women using randomized controlled or non-randomized pretest-posttest designs in China. Intervention technologies identified apps, web pages, and other types of electronic communications (e.g., email, short message services, and video messages). Two researchers screened and extracted data independently for each study. Bayesian meta-analysis was conducted to estimate the pooled effect size and 95% credible interval (Crl). We added study and intervention features as covariates to explore their associations with the study effects. Study quality was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs. Publication bias was assessed by funnel plots and Robust Bayesian Meta-Analyses.

Results:

We identified 1214 and 1691 records from English and Chinese databases, respectively. A total of 141 records entered the full-text screening and, 24 studies were eligible for the review. About half of the interventions (n=14) were delivered through social media platforms, predominantly using message-based communication. The remaining studies used email and web-based platforms. The pooled effect sizes estimated were an absolute increase of 20% (95%Crl: 0.10-0.30) in HIV testing uptake and an absolute increase of 15% (95%CrI: 0.05-0.26) in consistent condom use. The pooled point estimate of effect from RCT studies was smaller than non-randomized studies for HIV testing uptake (16% vs. 23%) and consistent condom use (10% vs. 19%), but their CrIs were largely overlapping. Interventions lasting more than six months were associated with a 35% greater uptake of HIV testing (95%CrI: 0.19, 0.51) compared to those lasting six months.

Conclusions:

Technology-based HIV prevention interventions are promising strategies to improve HIV testing uptake and consistent condom use among MSM in China, with significant effects found across a broad array of studies and study designs. However, many studies in the review did not include randomized designs or include a control group. More rigorous study designs, such as RCT, are needed for this evidence base, with outcome measurements that address the limitation of self-report outcomes, to inform the development and implementation of future intervention programs.