London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
BMC Public Health. 2019 Jul 9;19(1):915. doi: 10.1186/s12889-019-6899-6.
BACKGROUND: Antiretroviral therapy is effective in preventing the progression of HIV to AIDS, but adherence to HIV medication is lower than ideal. A previous Cochrane review concluded that SMS interventions increased adherence to HIV medication, but more recent trials have reported mixed results. Our review aims to provide an up-to-date synthesis of the effects of interventions delivered by mobile phone on adherence. METHODS: We searched Cochrane, Medline, CINAHL, EMBASE and Global Health for randomised control trials (RCTs) of interventions delivered by mobile phones, designed to increase adherence to antiretroviral medication. Risk of bias was assessed using the Cochrane risk of bias tool. We calculated relative risk ratios (RR) or standardised mean difference (SMD) with 95% confidence interval (CI). Trials were analysed depending on delivery mechanism and intervention characteristics. We conducted meta-analysis for primary objective outcome measures. RESULTS: We identified 19 trials. No trials were at low risk of bias. Interventions were delivered as follows; nine via text message, five via mobile phone call, one via mobile phone imagery and four via mixed interventions. There was no effect when interventions delivered by text message were pooled in the RR1.25 (CI 0.97 to 1.61) P = 0.08. The SMD 0.42 (0.03 to 0.81) p = 0.04 showed a moderate effect to improve adherence. There was mixed evidence of the effect of text messages delivered daily, weekly, at scheduled or triggered times, however, messages with link to support, interactivity and three or more behavior change techniques (BCTs) all improved adherence. Of the five trials delivered by mobile phone call, one reported a reduction in HIV viral load. One trial using mobile phone imagery reported a reduction in HIV viral load. Three trials that delivered interventions by text message and mobile phone counselling reported improved biological outcomes. CONCLUSION: Specific interventions, of proven effectiveness should be considered for implementation, rather than mobile phone-based interventions in general. Interventions targeting a wider range of barriers to adherence may be more effective than existing interventions. The effects and cost-effectiveness of such interventions should be evaluated in a randomised controlled trial alongside long term objective and clinically important outcomes.
背景：抗逆转录病毒疗法可有效预防 HIV 发展为艾滋病，但 HIV 药物的依从性并不理想。之前的 Cochrane 综述得出结论，短信干预措施可提高 HIV 药物的依从性，但最近的试验报告结果喜忧参半。我们的综述旨在提供最新的关于通过手机提供的干预措施对依从性影响的综合评估。
方法：我们在 Cochrane、Medline、CINAHL、EMBASE 和 Global Health 中搜索了通过手机提供的干预措施的随机对照试验（RCT），这些措施旨在提高抗逆转录病毒药物的依从性。使用 Cochrane 偏倚风险工具评估偏倚风险。我们计算了相对风险比（RR）或标准化均数差（SMD）及其 95%置信区间（CI）。根据传递机制和干预措施的特点对试验进行了分析。我们对主要的观察指标进行了荟萃分析。
结果：我们共确定了 19 项试验。没有试验的偏倚风险较低。干预措施的传递方式如下：9 项通过短信、5 项通过手机通话、1 项通过手机图像、4 项通过混合干预措施。当将通过短信传递的干预措施汇总为 RR1.25（97%CI 0.97 至 1.61）P=0.08 时，没有效果。SMD 0.42（0.03 至 0.81）p=0.04 表明有适度的效果可提高依从性。有混合证据表明每天、每周、按时或触发时间发送短信的效果，但带有支持链接、互动性和 3 种或更多行为改变技术（BCTs）的短信都可以提高依从性。通过手机通话进行的 5 项试验中有 1 项报告 HIV 病毒载量降低。1 项使用手机图像的试验报告 HIV 病毒载量降低。通过短信和手机咨询进行干预的 3 项试验报告生物结局改善。
结论：应考虑实施经过验证的有效性的具体干预措施，而不是一般的基于手机的干预措施。针对依从性障碍的更广泛范围的干预措施可能比现有的干预措施更有效。应在随机对照试验中评估此类干预措施的效果和成本效益，同时评估长期的客观和临床重要结局。
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