Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada.
National HIV/AIDS Labs, National Labs, Winnipeg, Manitoba, Canada.
BMJ Open. 2017 Nov 3;7(11):e017604. doi: 10.1136/bmjopen-2017-017604.
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.
Systematic review.
SETTING/PARTICIPANTS: All settings/all participants.
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).
Feasibility, acceptability, impact.
We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.
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.
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.
互联网/移动电话的数字创新为服务提供成本高昂的卫生系统提供了一种潜在的节省成本的解决方案，以提高艾滋病毒/性传播感染（性传播感染）控制措施的效率。然而，它们的总体证据尚未得到评估。我们评估了所有数字创新在所有艾滋病毒/性传播感染方面的可行性和影响。
系统评价。
设置/参与者：所有设置/所有参与者。
我们将数字创新分为（1）基于移动健康的（移动健康：短信/电话），（2）基于互联网的移动和/或电子健康（移动健康/电子健康：社交媒体、头像引导的计算机程序、网站、移动应用程序、流媒体肥皂剧视频）和（3）联合创新（包括短信/电话和基于互联网的移动健康/电子健康）。
可行性、可接受性、影响。
我们通过 PubMed 的 MEDLINE、Embase、Cochrane CENTRAL 和 Web of Science 数据库进行了搜索，提取了数据，探讨了异质性，并进行了随机效应亚组分析。
我们回顾了 99 项研究，其中 63 项（64%）来自美洲/欧洲，36 项（36%）来自非洲/亚洲；79%（79/99）为临床试验；84%（83/99）评估了影响。在创新方面，基于移动健康的创新占 70%（69/99）；基于互联网的创新占 21%（21/99）；联合创新占 9%（9/99）。所有数字创新都得到了高度认可（26/31；84%），并且是可行的（20/31；65%）。关于受影响的措施，基于移动健康的创新（短信）显著提高了抗逆转录病毒治疗（ART）的依从性（合并 OR=2.15（95%CI：1.18 至 3.91））和就诊率（合并 OR=1.76（95%CI：1.28,2.42））；基于互联网的创新提高了就诊率（6/6）、ART 依从率（4/4）、自我护理（1/1），同时降低了风险（5/5）；联合创新提高了就诊率、ART 依从率、伴侣通知和自我护理。观察性研究中存在混杂（68%）和选择偏倚（66%），临床试验中存在 31%的失访偏倚。
数字创新是可以接受的、可行的，并产生了影响。注意到使用基于互联网和联合（互联网和移动）创新的趋势。需要开展高质量的大规模研究，采用新的综合影响指标和成本效益分析。研究结果将吸引艾滋病毒/性传播感染全球倡议领域的所有利益相关者。
