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Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017)
  1. Jana Daher1,
  2. Rohit Vijh1,
  3. Blake Linthwaite1,
  4. Sailly Dave1,
  5. John Kim2,
  6. Keertan Dheda3,
  7. Trevor Peter4,
  8. Nitika Pant Pai1,5
  1. 1 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
  2. 2 National HIV/AIDS Labs, National Labs, Winnipeg, Manitoba, Canada
  3. 3 Department of Pulmonology, UCT Lung Institute, University of Cape Town, Cape Town, South Africa
  4. 4 Clinton Health Access Initiative (CHAI), Boston, USA
  5. 5 Department of Medicine, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Nitika Pant Pai; Nitika.Pai{at}mcgill.ca

Abstract

Objective Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs.

Design Systematic review.

Setting/participants All settings/all participants.

Intervention We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth).

Primary and secondary outcome measures Feasibility, acceptability, impact.

Methods We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.

Results We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).

All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials.

Conclusion Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

  • mhealth/ehealth
  • innovations
  • hiv
  • sexually transmitted infections
  • systematic reviews

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors NPP, JD: concept, design. NPP: data critiquing, write-up, critique, and overall responsibility of the data. JD: data synthesis, write-up, critiquing. RV, BL and SD: data synthesis, write"up and critique. JK, TP and KD: write"up and critique.

  • Funding Grand Challenges Canada Transition to Scale; Grant number 0710"05.FRSQ Salary Award Chercheur"Boursier Junior 2.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available. This is a systematic review/syntheses of existing studies, therefore all data are reported in the tables.

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