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Meta-Analysis
. 2013 May 31;2013(5):CD009189.
doi: 10.1002/14651858.CD009189.pub2.

Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection

Sarah Gentry  1 , Michelle H M M T van-Velthoven, Lorainne Tudor Car, Josip Car
Affiliations
Meta-Analysis

Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection

Sarah Gentry et al. Cochrane Database Syst Rev. .

Abstract

Background: This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV.

Objectives: To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection.

Search methods: We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles.

Selection criteria: Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded.

Data collection and analysis: Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the mode of communication, and whether underlying factors for change were altered. Meta-analyses, each of three studies, were performed for medication adherence and depressive symptoms. A narrative synthesis is presented for all other outcomes due to study heterogeneity.

Main results: Out of 14 717 citations, 11 RCTs met the inclusion criteria (1381 participants).Six studies addressed outcomes relating to medication adherence, and there was some evidence from two studies that telephone interventions can improve adherence. A meta-analysis of three studies for which there was sufficient data showed no significant benefit (SMD 0.49, 95% CI -1.12 to 2.11). There was some evidence from a study of young substance abusing HIV positive persons of the efficacy of telephone interventions for reducing risky sexual behaviour, while a trial of older persons found no benefit. Three RCTs addressed virologic outcomes, and there is very little evidence that telephone interventions improved virologic outcomes. Five RCTs addressed outcomes relating to depressive and psychiatric symptoms, and showed some evidence that telephone interventions can be of benefit. Three of these studies which focussed on depressive symptoms were combined in a meta-analysis, which showed no significant benefit (SMD 0.02, 95% CI -0.18 to 0.21 95% CI).

Authors' conclusions: Telephone voice interventions may have a role in improving medication adherence, reducing risky sexual behaviour, and reducing depressive and psychiatric symptoms, but current evidence is sparse, and further research is needed.

PubMed Disclaimer

Conflict of interest statement

None to declare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Effects of the interventions for improving medication adherence, outcome: 1.1 ART adherence.
5
5
Forest plot of comparison: 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, outcome: 2.1 Depressive symptoms (BDI score).
1.1
1.1. Analysis
Comparison 1 Effects of the interventions aimed at improving medication adherence, Outcome 1 ART adherence.
2.1
2.1. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 1 Depressive symptoms (BDI score).
2.2
2.2. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 2 Psychiatric distress (General Severity Index of the Brief Symptom Index).
2.3
2.3. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 3 Psychiatric distress (Outcomes questionnaire score).
2.4
2.4. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 4 Psychological distress (Total SCL‐90‐R score).
2.5
2.5. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 5 Life stressor burden (HIV‐related life‐stressor burden scale).
2.6
2.6. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 6 Support from family (PSRS).
2.7
2.7. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 7 Support from friends (PSRS).
2.8
2.8. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 8 Barriers to care (BACS).
2.9
2.9. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 9 Coping self‐efficacy (Coping self‐efficacy scale).
2.10
2.10. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 10 Social well‐being (Social/family well‐being subscale of the FAHI).
2.11
2.11. Analysis
Comparison 2 Effects of the interventions aimed at improving depressive and psychiatric symptoms, Outcome 11 Emotional well‐being (Emotional well‐being subscale of the FAHI).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Collier 2005 {published data only}
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