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Nov 03, 2017;7 (11): e017604.

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

Jana Daher, Rohit Vijh, Blake Linthwaite, Sailly Dave, John Kim, Keertan Dheda, Trevor Peter, Nitika Pant Pai
Author Information
  1. Jana Daher: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
  2. Rohit Vijh: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
  3. Blake Linthwaite: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
  4. Sailly Dave: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
  5. John Kim: National HIV/AIDS Labs, National Labs, Winnipeg, Manitoba, Canada.
  6. Keertan Dheda: Department of Pulmonology, UCT Lung Institute, University of Cape Town, Cape Town, South Africa.
  7. Trevor Peter: Clinton Health Access Initiative (CHAI), Boston, USA.
  8. Nitika Pant Pai: Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
PMID: 29101138 DOI: 10.1136/bmjopen-2017-017604

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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MeSH Term

Antiretroviral Therapy, Highly Active
Cell Phone
HIV Infections
Humans
Medication Adherence
Randomized Controlled Trials as Topic
Self Care
Sexually Transmitted Diseases
Telemedicine
Text Messaging
Journal Article Meta-Analysis Review Systematic Review
Article has an altmetric score of 31

Word Cloud

Created with Highcharts 10.0.0innovationsimpactdigitalmobileinternet-basedsexuallytransmittedinfections1combinedstudiesARTadherenceclinicattendanceDigitalhealthhighserviceHIV/STIinitiativesevaluatedreviewSMScalls23clinicaltrials84%based:internetfeasibleimprovedpooled95%CI:self-carebiassystematicOBJECTIVE:internet/mobilephonesofferpotentialcost-savingsolutionoverburdenedsystemsdeliverycostsimproveefficiencycontrolHoweveroverallevidenceyetappraisedfeasibilityHIV/STIsDESIGN:SystematicSETTING/PARTICIPANTS:settings/allparticipantsINTERVENTION:classifiedhealth-basedmHealth:shortmessage/phoneand/orelectronicmHealth/eHealth:socialmediaavatar-guidedcomputerprogramswebsitesapplicationsstreamedsoapoperavideosincludedSMS/phonemHealth/eHealthPRIMARYANDSECONDARYOUTCOMEMEASURES:FeasibilityacceptabilityMETHODS:searcheddatabasesMEDLINEviaPubMedEmbaseCochraneCENTRALWebScienceabstracteddataexploredheterogeneityperformedrandomeffectssubgroupanalysisRESULTS:reviewed996364%America/Europe3636%Africa/Asia79%79/9983/99mHealth70%69/9921%21/99combined:9%9/99Allhighlyaccepted26/3120/3165%RegardingimpactedmeasuresmHealth-basedsignificantlyantiretroviraltherapyOR=2151891ratesOR=17628426/64/41/1reducingrisk5/5increasedpartnernotificationsConfounding68%selection66%observedobservationalattrition31%CONCLUSION:acceptablegeneratedtrendtowardsusenotedLargescale-upqualitynewintegratedmetricscost-effectivenessneededFindingswillappealstakeholdersglobalspaceHIVwork?Results1996-2017hivmhealth/ehealthreviews

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