JMIR Publications

ABSTRACT

Background:

Youth aged 15–24 shoulder a disproportionate HIV burden, Digital health interventions (DHIs) have shown potential to promote safer sex behaviors, yet evidence on their relative effectiveness remains inconsistent.

Objective:

To compare the effectiveness of major DHI modalities in improving HIV-preventive sexual behaviors among youth and to establish an evidence-based ranking to inform digital prevention strategies.

Methods:

A network meta-analysis of randomized controlled trials was conducted across PubMed, EMBASE, Web of Science, and Cochrane Library (inception–April 2025). Four DHI categories—mobile app-based (MAI), telecommunication-based (TCI), static web-based (SWI), and interactive online (IOI)—were compared with non-digital interventions (NDI). Primary outcomes included condom use at last sexual contact, consistent condom use, and overall proportion of condom use; secondary outcomes were condom use self-efficacy, number of sexual partners, and STI incidence. Evidence certainty was assessed using the GRADE/CINeMA framework.

Results:

Twenty-four RCTs (20,134 participants) were included. TCI improved condom use at last sex versus NDI (OR 1.13, 95% CrI 1.02–1.26). For consistent condom use, SWI and IOI outperformed TCI (SWI vs TCI: OR 1.77, 1.03–3.06; IOI vs TCI: OR 1.68, 1.02–2.76), with SWI most likely to rank best. For the proportion of condom-protected acts, IOI exceeded SWI (OR 1.34, 1.01–1.80); MAI often ranked highest, but estimates were imprecise. For STI incidence, NDI and TCI strategies were favored (NDI vs IOI: OR 0.78, 0.65–0.93; NDI vs SWI: OR 0.61, 0.46–0.82). Certainty for several contrasts was limited by risk of bias and imprecision; heterogeneity and incoherence were generally low to moderate.

Conclusions:

DHI effectiveness is modality and behavior-specific: brief TCI contacts can prompt immediate protection (last-sex condom use); SWI formats better support sustained consistency; IOI platforms enhance situational condom use; and MAI shows promise but with wide uncertainty. To reduce infections, DHIs should be integrated with offline services (eg, testing, linkage to care, and condom distribution). These modality-specific rankings can guide youth-centered, scalable HIV prevention programs. Clinical Trial: Protocol registered in PROSPERO (CRD42024527317).