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Meta-Analysis
. 2017 Nov 3;7(11):e017604.
doi: 10.1136/bmjopen-2017-017604.

Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)

Jana Daher  1 , Rohit Vijh  1 , Blake Linthwaite  1 , Sailly Dave  1 , John Kim  2 , Keertan Dheda  3 , Trevor Peter  4 , Nitika Pant Pai  1   5
Affiliations
Meta-Analysis

Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)

Jana Daher et al. BMJ Open. .

Abstract

Objective: Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs.

Design: Systematic review.

Setting/participants: All settings/all participants.

Intervention: We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth).

Primary and secondary outcome measures: Feasibility, acceptability, impact.

Methods: We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.

Results: We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials.

Conclusion: Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

Keywords: hiv; innovations; mhealth/ehealth; sexually transmitted infections; systematic reviews.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2
Figure 2
All innovations by outcome type (font size enlarged). ART, antiretroviral therapy; SMS, short message service
Figure 3
Figure 3
Subgroup analyses.
See this image and copyright information in PMC

References

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