Effect of mobile health interventions on adherence of anti-retroviral therapy in HIV infected Asian patients: A systematic review and meta-analysis

Abstract

Background: Antiretroviral therapy (ART) is an effective approach to prevent progression of HIV to AIDS, however adherence to HIV medication is still inconclusive. Currently, mobile health intervention (mHealth) is a novel way of delivering healthcare and improving health outcomes. Mobile phone using voice calls and text messages has been shown to be useful to improve adherence rates. Therefore, this study design to investigate effect of mHealth interventions on ART adherence in HIV infected Asian patients. Methods and materials: A systematic search in Embase and Medline was conducted to identify randomized controlled trials (RCTs) comparing mHealth interventions (voice calls and text messages) with control (standard care) in HIV infected patients. We calculated odd ratio (OR) with 95% confidence interval (CI) with random effect model to compare mHealth interventions with control group. Meta-analysis was performed by using RevMan 5.3 software. Results: Out of 1235 retrieved articles, 14 RCTs with 2861 patients from Asia region. From the included studies, patient's age were >14 y and mHealth interventions reported as voice call in 5 studies and text messages in 9 studies. Results from meta-analysis of overall mHealth interventions showed significant improvement (OR: 1.51, 95%CI: 1.19, 1.93; p = 0.0008) in adherence to ART in HIV patients when compared to control group. From subgroup analysis, voice calls showed non-significant association (OR: 1.63, 95%CI: 0.91, 2.92; p = 0.10) and text messages showed significant association (OR: 1.44, 95%CI: 1.12, 1.86; p = 0.004) when compared to control group. However subgroup meta-analysis of text messages, scheduled text messages showed significant improvement (OR: 1.69, 95%CI: 1.24, 2.29; p = 0.0008) and triggered messages showed non-significant association (OR: 1.09, 95%CI: 0.81, 1.46; p = 0.58) in adherence to ART. Conclusion: Overall mHealth interventions have significant impact on ART adherence in HIV infected patients. However, from subgroup data, text messages (scheduled text messages) showed significant improvement in ART adherence, and voice calls and triggered text messages do not have promising impact. Due to preference of voice calls over text messages, further research required to explore voice functions in combination with text messages.