Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Harvard Medical School, Boston, Massachusetts, United States.
Appl Clin Inform. 2018 Apr;9(2):450-466. doi: 10.1055/s-0038-1660516. Epub 2018 Jun 20.
Adherence to antiretroviral therapy (ART) is paramount to successful long-term suppression of human immunodeficiency virus (HIV). For poorly adherent patients with HIV, barriers to remaining adherent may be overcome by the implementation of targeted interventions delivered via mobile devices. This systematic review is focused specifically on mobile phone technologies to deliver adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS) populations.
This review (PROSPERO #CRD42017065131) systematically extracted data from published literature from five databases on mobile phone interventions to improve adherence to ART for HIV. The reported studies had been conducted between 2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each criterion as low, high, or unclear risk of bias.
Of the 835 articles returned, we identified 26 randomized controlled trials (RCTs), retrospective and prospective cohort trials, or mixed method studies with a comparison group that fit criteria for inclusion. No standard measure of adherence was consistent throughout the examined studies, and assessments by self-report, pill counting, and medication event monitoring system (MEMS) were utilized. The studies reported mixed results, with 17 reporting significant improvements to adherence, 3 reporting improvements without supplying -values, and 6 reporting no significant change or a reduction in adherence.
The mixed nature of the results exemplifies the need for more comprehensive approaches and larger scale trials to confirm results observed in limited cohort sizes. To better retain satisfactory adherence within the HIV population, and especially in low-resource settings, we recommend that future interventions incorporate multiple strategies: mobile-based reminders, social support structures, and personalized content.
抗逆转录病毒疗法（ART）的依从性对于成功长期抑制人类免疫缺陷病毒（HIV）至关重要。对于HIV 依从性差的患者，通过实施通过移动设备提供的针对性干预措施，可以克服保持依从性的障碍。本系统评价专门针对通过移动电话技术向 HIV/获得性免疫缺陷综合征（AIDS）人群提供依从性干预措施。
本综述（PROSPERO #CRD42017065131）系统地从五个数据库中提取了关于通过移动电话干预提高 HIV 患者 ART 依从性的已发表文献中的数据。报道的研究是在 2007 年至 2017 年间进行的。使用 Cochrane 方法评估偏倚风险，将每个标准评为低、高或偏倚风险不明确。
在 835 篇文章中，我们确定了 26 项随机对照试验（RCT）、回顾性和前瞻性队列研究或混合方法研究，这些研究具有符合纳入标准的比较组。在被检查的研究中，没有一个标准的依从性测量方法是一致的，自我报告、药片计数和药物事件监测系统（MEMS）的评估都得到了应用。研究报告的结果喜忧参半，17 项研究报告了依从性显著提高，3 项研究报告了改善但没有提供 -值，6 项研究报告了依从性没有显著变化或降低。
结果的混合性质说明了需要更全面的方法和更大规模的试验来证实在有限的队列规模中观察到的结果。为了更好地保持 HIV 人群的满意依从性，特别是在资源匮乏的环境中，我们建议未来的干预措施应结合多种策略：基于移动的提醒、社会支持结构和个性化内容。
