Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands.
Institut du Développement Rural, Université Nazi Boni (Former Université Polytechnique de Bobo-Dioulasso), Bobo-Dioulasso, Burkina Faso.
AIDS Patient Care STDS. 2020 Feb;34(2):59-71. doi: 10.1089/apc.2019.0181.
The use of mobile health technologies (mHealth) to ameliorate HIV care has considerably risen in low- and middle-income countries (LMICs) since 2010. Yet, the discrepancies in the results of accompanying studies warrant an updated and systematic consolidation of all available evidence. We report a systematic review of studies testing whether text/image messages, interactive voice response reminders, or calls promote adherence and retention to antiretroviral therapy (ART) in LMICs. We systematically compiled studies published in English until June 2018 from PubMed/Medline, Web of Science, WHO database, ProQuest Dissertations and Theses, and manual search. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and used frequency analysis to assess reported findings. In total, we compiled 35 published articles: 27 completed studies and 8 protocols. Among the main 27 studies, 17 examine adherence, 5 retention, and 5 both measures. Results indicate that 56% report positive and statistically significantly impacts of mHealth on primary outcomes, the remaining 44% report insignificant results. While 41% of studies found a positive and significant effect for adherence, only 12% improved retention. The evidence shows ambiguous results (with high variability) about the effectiveness of mobile phone-assisted mHealth interventions to boost adherence and retention to ART. The literature also points to short follow-up periods, small samples, and limited geographical coverage. Hence, future research should focus on evaluating longer interventions with more patients spread across wider areas to address whether mHealth can be effectively used in LMICs.
自 2010 年以来，移动医疗技术（mHealth）在中低收入国家（LMICs）改善艾滋病毒护理方面的应用显著增加。然而，伴随研究结果的差异需要对所有现有证据进行更新和系统的整合。我们报告了一项系统评价，评估了文本/图像消息、交互式语音响应提醒或电话是否能促进中低收入国家接受抗逆转录病毒治疗（ART）的依从性和保留率。我们系统地从 PubMed/Medline、Web of Science、世界卫生组织数据库、ProQuest Dissertations and Theses 和手动搜索中编译了截至 2018 年 6 月发表的英文研究。我们使用了系统评价和荟萃分析的首选报告项目（PRISMA）2009，并使用频率分析来评估报告的发现。总共编译了 35 篇已发表的文章：27 项已完成的研究和 8 项方案。在主要的 27 项研究中，有 17 项研究了依从性，5 项研究了保留率，5 项研究了这两个指标。结果表明，56%的研究报告了 mHealth 对主要结局的积极和统计学上显著的影响，其余 44%的研究报告了无显著影响。虽然 41%的研究发现手机辅助 mHealth 干预对提高依从性有积极和显著的效果，但只有 12%的研究提高了保留率。该证据表明，手机辅助 mHealth 干预提高接受抗逆转录病毒治疗的依从性和保留率的有效性存在模棱两可的结果（具有高度可变性）。文献还指出，随访时间短、样本量小、地理覆盖范围有限。因此，未来的研究应侧重于评估更长时间的干预措施，覆盖更多的患者，并在更广泛的地区进行，以确定 mHealth 是否可以在中低收入国家有效使用。
