- A meta-analysis shows that in persons living with HIV, interventions delivered by text message to improve antiretroviral therapy (ART) adherence, have a moderate effect.
- ART adherence and clinically important outcomes improve after specific mobile phone interventions, such as text messages which include either a link to a health care professional, or imagery, or combined with a phone call.
- Further research is needed to explore the effectiveness of interventions delivered by mobile phone prior to considering implementations.
Currently, 59% of about 36 million people worldwide living with HIV (PLWH) have access to ART. For efficient therapy, high adherence is required, but the World Health Organisation estimates that only one-third of the PLWH adhere appropriately. Factors which contribute to poor adherence include poor knowledge or pill burden. Interventions delivered by mobile phone was shown to increase adherence, but recent trials have reported mixed results.
In this systematic review and meta-analysis, authors provide an up-to-date synthesis of randomised control trials (RCTs) of interventions designed to increase adherence to HIV medication.
Nineteen trials were identified (1990-2017, databases: Cochrane, Medline, CINAHL, EMBASE and Global Health) for a total of 2,650 participants. Interventions were delivered via different mechanisms: text message (n=9), mobile phone call (n=5), mobile phone imagery (n=1) and mixed interventions (n=4).
There was no effect on risk ratios when data from interventions delivered by text message were pooled (1.25; CI 0.97 to 1.61; P=0.08), although a moderate effect on improved adherence was observed from standard mean differences (0.42; 0.03 to 0.81; P=0.04).
It was unclear if the delivery mechanism (daily, weekly, scheduled or triggered times) had an effect since there was mixed evidence.
Messages with link to support, interactivity and the use of more than three behaviour change techniques all improved adherence.
Authors found that one trial, in which intervention was delivered by mobile-phone call, and one trial using mobile-phone imagery, showed a reduction in HIV viral load. A further three trials that delivered interventions by text message and mobile-phone counselling, reported improved biological outcomes.
Results suggest that specific interventions are effective for implementation, rather than mobile-phone-based interventions in general.
Further research, particularly RCTs, is needed to assess the effect, the cost-effectiveness and the clinically important outcomes of interventions, prior to considering implementation.
Limitations: the meta-analysis collected few trials, often with small sample size and short follow-up; there were difficulties in conducting pooled analyses of the same outcomes due to fifteen different adherence measures being used in the trials; intervention effects may have been underestimated due to unlikely particular attention to adherence of control groups during the trials.