Duthely Lunthita M, Sanchez-Covarrubias Alex P
Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States.
Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States.
Front Commun (Lausanne). 2020 Nov;5. doi: 10.3389/fcomm.2020.530164. Epub 2020 Nov 10.
Mobile health technologies (mHealth) are efficacious along the continuum of HIV/AIDS-from prevention of HIV transmission to those at the highest risk of acquiring infection, to adherence to HIV medical care, for those living with the disease-decreasing the public health burden of the disease. HIV/AIDS is a complex condition, as certain population subgroups are disproportionately affected. Furthermore, barriers experienced at the individual level (e.g., HIV stigma) and at the systems level (i.e., access to care) contribute to these disparities. Low cost, high penetration rates and ease of use mean mHealth SMS/texting solutions hold the biggest promise for curbing the global HIV/AIDS epidemic; yet these technologies have their own challenges. Our primary objective was to assess interventions that promote adherence, which are delivered via SMS/texting, and important design and ethical considerations of these technologies. Specifically, we evaluated the underlying frameworks underpinning intervention design, strategies to safeguard privacy and confidentiality, and measures taken to ensure equity and equitable access across different subgroups of persons living with HIV (PLWH). We also synthesized study outcomes, barriers/facilitators to adherence, and barriers/facilitators of technology to support HIV adherence.
A scoping review methodology was utilized, searching the Medline database for recently published articles (January 2017 to June 2019). Two reviewers independently screened titles and abstracts for relevancy using the following eligibility criteria: (a) original research or protocol; (b) inclusion of persons living with HIV; (c) intervention delivery via SMS/text messaging; and, (d) intervention included HIV care adherence.
Seven (7) of the 134 articles met full criteria. The great majority (n = 6) did not report whether the interventions were developed under established behavioral change models or frameworks. Strategies to address privacy, confidentiality and equity/equitable access were taken in four ( = 4) studies.
Our mixed methods review determined that privacy and confidentiality remain a concern for PLWH. Provisions to accommodate literacy, infrastructure, technology and other challenges (e.g., access to smartphones and Wifi) are important ethical considerations that guarantee equity and equitable access. Further investigation will determine the contexts within which theoretical models and frameworks remain relevant in the rapidly evolving field of digitized interventions that support adherence.
移动健康技术（mHealth）在艾滋病毒/艾滋病的整个连续过程中都具有效力——从预防艾滋病毒传播到针对感染风险最高的人群，再到艾滋病毒感染者坚持接受医疗护理，可减轻该疾病的公共卫生负担。艾滋病毒/艾滋病是一种复杂的病症，某些人群亚组受到的影响尤为严重。此外，个人层面（例如，艾滋病毒污名化）和系统层面（即获得护理的机会）所面临的障碍导致了这些差异。低成本、高普及率和易用性意味着移动健康短信/文本解决方案在遏制全球艾滋病毒/艾滋病流行方面最具前景；然而，这些技术也有自身的挑战。我们的主要目标是评估通过短信/文本发送实施的促进坚持治疗的干预措施，以及这些技术在设计和伦理方面的重要考量因素。具体而言，我们评估了干预措施设计的基础框架、保护隐私和保密的策略，以及为确保艾滋病毒感染者（PLWH）不同亚组之间的公平及公平获得治疗所采取的措施。我们还综合了研究结果、坚持治疗的障碍/促进因素以及支持艾滋病毒治疗坚持的技术障碍/促进因素。
采用范围综述方法，在Medline数据库中搜索最近发表的文章（2017年1月至2019年6月）。两名评审员使用以下纳入标准独立筛选标题和摘要的相关性：（a）原创研究或方案；（b）纳入艾滋病毒感染者；（c）通过短信/文本消息传递进行干预；以及（d）干预措施包括艾滋病毒护理坚持治疗。
134篇文章中有7篇符合全部标准。绝大多数（n = 6）未报告干预措施是否在既定的行为改变模型或框架下制定。四项研究采取了应对隐私、保密和公平/公平获得治疗的策略。
我们的混合方法综述确定，隐私和保密仍然是艾滋病毒感染者关注的问题。考虑识字能力、基础设施、技术和其他挑战（例如，获得智能手机和无线网络的机会）的规定是保证公平及公平获得治疗的重要伦理考量因素。进一步的调查将确定在支持治疗坚持的数字化干预措施快速发展的领域中，理论模型和框架仍然适用的背景情况。
