Mayer Jonathan E, Fontelo Paul
a Department of Medicine , Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b National Library of Medicine , Lister Hill National Center for Biomedical Communications, National Institutes of Health , Bethesda , MD , USA.
AIDS Care. 2017 Apr;29(4):409-417. doi: 10.1080/09540121.2016.1214674. Epub 2016 Aug 1.
For the treatment of HIV, compliance in regard to appointment attendance and medication usage is critical. Various methods have been attempted to increased HIV care compliance, and a method that has inspired many published studies is text message reminders. We conducted a meta-analysis of the literature from inception through May 2016 using the following databases: Pubmed, Embase, CINAHL, Web of Science, and Cochrane. Examples of terms used in the search included exploded versions of "HIV, "AIDS", "cell phone", "SMS", "text message", "reminder". After abstract and manuscript review, articles were discussed with co-author and included based on consensus. We excluded qualitative analyses, observational studies without an intervention, and studies without a control or pre-intervention group. We used random-effects models to calculate odds ratios (OR) and standardized mean differences (SMDs) for the text message intervention. Thirty-four unique studies were found and included in the meta-analysis. For the seven articles relating to non-attendance, text message reminders significantly reduced the rates of non-attendance (OR, 0.66; 95% CI, 0.48-0.92; P = .01; I = 52%). For the 20 articles on drug adherence, text message reminders significantly increased adherence (SMD, 0.87; 95% CI, 0.06-1.68; P = .04; I = 99%). For the 11 articles with physiologic measures (CD4 count or viral load), text message reminders led to significant improvement (SMD, 1.53; 95% CI, 0.52-2.55; P = .003; I = 99%). This meta-analysis reveals that text message reminders are a promising intervention that can be used to increase HIV care compliance when logistically feasible. Further study should focus on which populations benefit the most from this intervention, and successful implementers could create an established technological infrastructure for other clinics to adopt when seeking to boost compliance.
对于艾滋病毒的治疗而言，按时就诊和正确用药的依从性至关重要。人们尝试了各种方法来提高艾滋病毒治疗的依从性，其中一种激发了众多已发表研究的方法是短信提醒。我们使用以下数据库对从开始到2016年5月的文献进行了荟萃分析：PubMed、Embase、CINAHL、科学网和Cochrane。搜索中使用的术语示例包括“艾滋病毒”“艾滋病”“手机”“短信服务”“短信”“提醒”的扩展版本。在对摘要和手稿进行审查后，与共同作者讨论了文章，并根据共识纳入研究。我们排除了定性分析、无干预措施的观察性研究以及无对照组或干预前组的研究。我们使用随机效应模型计算短信干预的比值比（OR）和标准化均值差（SMD）。共找到34项独特的研究并纳入荟萃分析。对于7篇与未就诊相关的文章，短信提醒显著降低了未就诊率（OR，0.66；95%置信区间，0.48 - 0.92；P = 0.01；I² = 52%）。对于20篇关于药物依从性的文章，短信提醒显著提高了依从性（SMD，0.87；95%置信区间，0.06 - 1.68；P = 0.04；I² = 99%）。对于11篇涉及生理指标（CD4细胞计数或病毒载量）的文章，短信提醒带来了显著改善（SMD，1.53；95%置信区间，0.52 - 2.55；P = 0.003；I² = 99%）。这项荟萃分析表明，短信提醒是一种很有前景的干预措施，在后勤可行的情况下可用于提高艾滋病毒治疗的依从性。进一步研究应聚焦于哪些人群从这种干预中获益最大，成功的实施者可以创建一个成熟的技术基础设施，供其他诊所寻求提高依从性时采用。
