Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, & TB Prevention, the Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329-4027.
Community Guide Program, Office of Science, CDC, Atlanta, GA 30329-4027.
Am J Prev Med. 2024 Aug;67(2):303-310. doi: 10.1016/j.amepre.2024.02.009. Epub 2024 Feb 16.
HIV preexposure prophylaxis (PrEP) is highly effective when taken as prescribed. Digital health adherence interventions have been identified as effective for improving antiretroviral therapy adherence among people with HIV, but limited evidence exists for PrEP adherence interventions among people without HIV. The purpose of this Community Guide systematic review was to present the characteristics and effectiveness of digital PrEP adherence interventions.
The author searched the CDC HIV Prevention Research Synthesis cumulative database for digital health interventions with PrEP adherence outcomes published in peer-reviewed journals from 2000 to 2022. Studies with comparison arms or pre-post data evaluating interventions in high-income countries were included. Two reviewers independently screened citations, extracted data, conducted risk of bias assessment, and resolved discrepancies through discussion. Summary effect estimates were calculated using median and interquartile interval.
Nine studies were included and all focused on gay, bisexual, and other men who have sex with men. Eight studies were U.S.-based while the other was conducted in the Netherlands. Five were randomized control trials and four were pre-/post studies. All studies showed improved adherence in the intervention arms compared with comparison groups or preintervention data. One study also reported improvement in PrEP care retention.
Digital health adherence interventions with different strategies to improve PrEP and HIV-related outcomes were identified. The small number of studies identified is a limitation. Findings from this review served as the basis for the Community Preventive Services Task Force recommendation to use these interventions to increase PrEP adherence to prevent HIV infection.
如果按照规定服用，HIV 暴露前预防（PrEP）非常有效。数字健康依从性干预措施已被确定为提高 HIV 感染者抗逆转录病毒治疗依从性的有效方法，但针对未感染 HIV 的人群的 PrEP 依从性干预措施的证据有限。本次社区指南系统评价的目的是介绍数字 PrEP 依从性干预措施的特点和效果。
作者在 CDC HIV 预防研究综合数据库中搜索了 2000 年至 2022 年期间在同行评议期刊上发表的关于数字健康干预措施和 PrEP 依从性结果的文章。纳入了具有对照臂或评估干预措施在高收入国家的前后数据的研究。两名审查员独立筛选引文、提取数据、进行偏倚风险评估，并通过讨论解决分歧。使用中位数和四分位距计算汇总效应估计值。
共纳入 9 项研究，均聚焦于男同性恋、双性恋和其他与男性发生性关系的男性。8 项研究在美国进行，另一项在荷兰进行。其中 5 项为随机对照试验，4 项为前后研究。与对照组或干预前数据相比，所有研究均显示干预组的依从性得到改善。其中一项研究还报告了 PrEP 护理保留率的提高。
已确定了具有不同策略的数字健康依从性干预措施，以改善 PrEP 和与 HIV 相关的结果。确定的研究数量较少是一个限制。本综述的研究结果为社区预防服务工作队使用这些干预措施提高 PrEP 依从性以预防 HIV 感染的建议提供了依据。
