Huang Wenting, Stegmueller Daniel, Ong Jason J, Wirtz Susan Schlueter, Ning Kunru, Wang Yuqing, Mi Guodong, Yu Fei, Hong Chenglin, Sales Jessica M, Liu Yufen, Baral Stefan D, Sullivan Patrick S, Siegler Aaron J
Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Department of Political Science, Duke University, Durham, NC, United States.
J Med Internet Res. 2025 Apr 28;27:e63111. doi: 10.2196/63111.
There remain unmet HIV prevention needs in China, particularly among gay, bisexual, and other men who have sex with men. Technology-based interventions are increasingly used in HIV prevention worldwide.
We aimed to conduct a systematic review and meta-analysis of studies to assess the effectiveness of technology-based HIV prevention interventions to improve HIV testing and consistent condom use in China.
We searched English-language (PubMed and MEDLINE, Embase, and Web of Science) and Chinese-language (Wanfang, WEIPU, and China National Knowledge Infrastructure) databases for technology-based HIV prevention intervention studies published between January 1, 2004, and September 30, 2021. Eligible studies were technology-based HIV prevention intervention studies with outcomes of HIV testing or condom use among men who have sex with men or transgender women using randomized controlled or nonrandomized pretest-posttest designs in China. The intervention technologies identified were apps, web pages, and other types of electronic communications (eg, email, SMS text messages, and video messages). A Bayesian meta-analysis was conducted to estimate the pooled effect size and 95% credible interval (CrI). We added study and intervention features as covariates to explore their associations with the study effects. Study quality was assessed using the integrated quality criteria for review of multiple study designs. Publication bias was assessed using funnel plots and robust Bayesian meta-analyses.
We identified 1214 and 1691 records from English-language and Chinese-language databases, respectively. A total of 141 records entered full-text screening, and 24 (17%) studies were eligible for the review. Approximately half (14/24, 58%) of the interventions were delivered through social media platforms, predominantly using message-based communication. The remaining studies used email and web-based platforms. The pooled effect sizes estimated were an absolute increase of 20% (95% CrI 10%-30%) in HIV testing uptake and an absolute increase of 15% (95% CrI 5%-26%) in consistent condom use. The pooled point estimate of the effect of randomized controlled trials was smaller than that of nonrandomized studies for HIV testing uptake (16% vs 23%) and consistent condom use (10% vs 19%), but their CrIs largely overlapped. Interventions lasting >6 months were associated with a 35% greater uptake of HIV testing (95% CrI 19%-51%) compared to those lasting 6 months.
Technology-based HIV prevention interventions are promising strategies to improve HIV testing uptake and consistent condom use among men who have sex with men in China, with significant effects found across a broad array of studies and study designs. However, many studies in this review did not include randomized designs or a control group. More rigorous study designs, such as randomized controlled trials, are needed, with outcome measurements that address the limitation of self-report outcomes to inform the development and implementation of future intervention programs.
PROSPERO CRD42021270856; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021270856.
中国仍存在未满足的艾滋病预防需求，尤其是在男同性恋者、双性恋者以及其他与男性发生性行为的男性群体中。基于技术的干预措施在全球艾滋病预防工作中越来越多地被使用。
我们旨在对相关研究进行系统评价和荟萃分析，以评估基于技术的艾滋病预防干预措施在中国提高艾滋病检测率和持续使用避孕套方面的有效性。
我们检索了英文数据库（PubMed、MEDLINE、Embase和Web of Science）以及中文数据库（万方、维普和中国知网），查找2004年1月1日至2021年9月30日期间发表的基于技术的艾滋病预防干预研究。符合条件的研究是在中国针对男同性恋者或跨性别女性开展的、以艾滋病检测或避孕套使用为结局指标、采用随机对照或非随机前后测设计的基于技术的艾滋病预防干预研究。所确定的干预技术包括应用程序、网页以及其他类型的电子通信方式（如电子邮件、短信和视频信息）。进行贝叶斯荟萃分析以估计合并效应量和95%可信区间（CrI）。我们将研究和干预特征作为协变量纳入，以探讨它们与研究效应之间的关联。使用多种研究设计的综合质量标准评估研究质量。使用漏斗图和稳健贝叶斯荟萃分析评估发表偏倚。
我们分别从英文和中文数据库中识别出1214条和1691条记录。共有141条记录进入全文筛选阶段，24项（17%）研究符合纳入综述的条件。大约一半（14/24，58%）的干预措施是通过社交媒体平台实施的，主要采用基于信息的通信方式。其余研究使用电子邮件和基于网络的平台。估计的合并效应量为艾滋病检测率绝对提高20%（95% CrI 10%-30%），持续使用避孕套的比例绝对提高15%（95% CrI 5%-26%）。对于艾滋病检测率（16%对23%）和持续使用避孕套（10%对19%），随机对照试验的合并点估计值小于非随机研究，但它们的可信区间有很大重叠。与持续6个月的干预措施相比，持续时间超过6个月的干预措施使艾滋病检测率提高了35%（95% CrI 19%-51%）。
基于技术的艾滋病预防干预措施是提高中国男同性恋者艾滋病检测率和持续使用避孕套的有前景的策略，在广泛的研究和研究设计中均发现了显著效果。然而，本综述中的许多研究未包括随机设计或对照组。需要更严格的研究设计，如随机对照试验，并采用能够解决自我报告结局局限性的结局测量方法，以为未来干预项目的开发和实施提供参考。
PROSPERO CRD42021270856；https://www.crd.york.ac.uk/PROSPERO/view/CRD42021270856
