Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 4, 2025
Date Accepted: May 5, 2026
Effectiveness of digital health interventions for improving antiretroviral therapy outcomes in people with HIV: a meta-analysis and trial sequential analysis of randomized controlled trials
ABSTRACT
Background:
There had been ongoing controversy regarding the role of digital health interventions in HIV antiretroviral therapy, and there was a lack of comprehensive meta-analyses exploring the role of digital health interventions in this context. This study aimed to evaluate the effectiveness of digital health interventions in enhancing the efficacy of HIV antiretroviral therapy.
Objective:
To assess the effectiveness of digital health interventions (DHIs) in enhancing antiretroviral therapy outcomes in individuals with HIV.
Methods:
PubMed, Cochrane Library, Embase and Web of Science for randomized controlled trails that examined the efficacy of DHIs for HIV treatment up to 1 May 2024. The main outcome included virus suppression (<400 copies/ml) and CD4+ cell levels. Stata (version 17) and RevMan software (version 5.4) were used for the data analysis.
Results:
From 17,504 publications, we included 56 randomized controlled trials involving 22.124 participants for quantitative analysis. DHIs included 6 strategies: SMS (short message service), adherence monitor, app (application), phone call, multimedia education, multiple interventions. Overall, DHIs were associated with significantly improved viral suppression (RR 1·05; 95% CI 1·01 to 1·09) and enhancing CD4+ cell levels (MD 21·35; 95% CI 4·97 to 37·72). DHIs also led to improvements in both objective and subjective adherence, as well as patient retention. In the network meta-analysis, multiple digital interventions and short message services showed significant efficacy in viral suppression.
Conclusions:
DHIs had significant efficacy in improving patient adherence and antiviral outcomes in antiretroviral therapy. Additionally, among these measures, multiple digital interventions and short message services appeared to be particularly effective. Clinical Trial: PROSPERO (CRD42024567903)
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