Abstract
Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. One of the key strategies to improve adherence is believed to be the use of digital adherence tools. However, evidence is limited in this area. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents. The preferred reporting item for systematic review and meta-analysis guideline was followed. A literature search was done in five databases (PubMed, Web of Science, Embase, Global Health and Cochrane) in August 2020. Additional searches for studies and grey literature were performed manually. We included studies with quantitative design exploring the effectiveness of text message reminders, targeting adolescents aged 10-19 years. Studies were excluded if the intervention involved phone calls, phone-based applications, or other complex tech services. Mean differences between intervention and standard of care were computed using a random effects model. Subgroup analyses were performed to identify sources of heterogeneity between one-way and two-way text messages. Of 2517 study titles screened, seven eligible studies were included in the systematic review. The total number of participants in the included studies was 987, and the study sample varied from 14 to 332. Five studies showed a positive impact of text messaging in improving adherence, while no significant difference was found between the intervention and the control (standard of care) group in the remaining two studies. The pooled mean difference between the intervention and the control group was 0.05 (95% CI: -0.08 to 0.17). There was considerable heterogeneity among the studies (I2 = 78%). The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of ART adherence among adolescents living with HIV. The included studies were heterogeneous in the reported clinical outcomes, where the effectiveness of the intervention was identified in small studies which had a short follow-up period. Studies with bigger sample size and a longer follow-up period are needed.
Highlights
Human Immunodeficiency Virus (HIV), which causes Acquired Immunodeficiency Syndrome (AIDS), is one of the world’s most serious health and development challenges
Effectiveness of mobile phone text message reminder interventions for adolescents living with HIV
The meta-analysis of text message reminder interventions did not show a statistically significant difference in the improvement of antiretroviral therapy (ART) adherence among adolescents living with HIV
Summary
Human Immunodeficiency Virus (HIV), which causes Acquired Immunodeficiency Syndrome (AIDS), is one of the world’s most serious health and development challenges. More than half of the disease burden for HIV is in East and Southern Africa, with an estimated 730,000 new cases in 2019. The latest estimates suggest that approximately 1.7 million adolescents have HIV, accounting for about 5% of all people living with HIV (PLHIV) [3, 4]. The definition of an adolescent used in this study is a person aged 10–19 years [5]. Poor adherence to antiretroviral therapy in adolescents living with HIV is a global challenge. Our objective was to investigate the effectiveness of mobile phone text message reminders in improving ART adherence for adolescents
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