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远程医疗是否会影响 HIV 患者对 ART 的依从性?一项系统评价和荟萃分析。

Does telehealth affect the adherence to ART among patients with HIV? A systematic review and meta-analysis.

机构信息

Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

ٌWomen's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

BMC Infect Dis. 2023 Mar 17;23(1):169. doi: 10.1186/s12879-023-08119-w.

Abstract

BACKGROUND

Several studies have shown different effects of telehealth interventions on adherence to Antiretroviral therapy (ART) among people living with HIV. This study conducted a meta-analysis of Randomized Controlled Trials (RCTs) to estimate the pooled effect of telehealth interventions on the treatment adherence of HIV patients.

METHODS

The researchers conducted literature searches in Scopus, PubMed, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials databases. In addition, open grey was systematically searched until January 2022 for RCTs around the effects of telehealth on adherence to treatment ART among patients with HIV. Each study's methodological quality was assessed using the Cochrane Collaboration tool. Pooled Standard Mean Differences (SMD) and Risk Ratio (RR) with 95% CI were calculated using the random effects model.

RESULTS

In total, 12 eligible articles were considered in the present systematic review. A random-effects meta-analysis using 5 RCTs yielded the pooled RR estimate of 1.18 (95% CI: 1.03 to 1.35, p < 0.05); I2 = 0, suggesting the adherence to treatment among patients with HIV who received telehealth intervention was significantly 18% upper than control groups. Moreover, the random effects analysis of SMD showed a positive effect for telehealth with SMR = 0.36 (95% CI: 0.22 to 0.49, p < 0.05); I2 = 91.9%, indicating that telehealth intervention increased ART adherence to the treatment group compared to the control group.

CONCLUSION

Telehealth intervention as a new modality of health care service delivery could be a valuable strategy to improve ART adherence among patients with HIV. It can strengthen the capacity of HIV care services. On a large scale, telehealth can be utilized as a supplementary component for ART delivery and retention toward successful adherence to the therapy.

摘要

背景

多项研究表明,远程医疗干预对艾滋病毒感染者抗逆转录病毒治疗(ART)的依从性有不同的影响。本研究对随机对照试验(RCT)进行了荟萃分析,以估计远程医疗干预对艾滋病毒患者治疗依从性的综合影响。

方法

研究人员在 Scopus、PubMed、Web of Science、Google Scholar 和 Cochrane 对照试验中心注册数据库中进行了文献检索。此外,还系统地搜索了开放灰色文献,以寻找截至 2022 年 1 月关于远程医疗对艾滋病毒患者接受抗逆转录病毒治疗的依从性影响的 RCT。使用 Cochrane 协作工具评估每个研究的方法学质量。使用随机效应模型计算汇总标准均数差(SMD)和风险比(RR)及其 95%置信区间。

结果

本系统评价共纳入 12 篇合格文章。使用 5 项 RCT 的随机效应荟萃分析得出,接受远程医疗干预的艾滋病毒患者的依从性的汇总 RR 估计值为 1.18(95%CI:1.03 至 1.35,p<0.05);I2=0,表明接受远程医疗干预的患者的治疗依从性比对照组高 18%。此外,SMD 的随机效应分析显示,远程医疗具有积极的效果,SMR=0.36(95%CI:0.22 至 0.49,p<0.05);I2=91.9%,表明与对照组相比,远程医疗干预增加了治疗组对 ART 的依从性。

结论

远程医疗干预作为一种新的医疗服务提供模式,可能是提高艾滋病毒患者抗逆转录病毒治疗依从性的一种有价值的策略。它可以增强艾滋病毒护理服务的能力。在较大范围内,远程医疗可以作为抗逆转录病毒治疗的补充手段,促进成功的治疗依从性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/51c6/10024428/23066441ef94/12879_2023_8119_Fig1_HTML.jpg

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