Abstract
BackgroundRates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed. We conducted a meta-analysis to evaluate text messaging to support STI/HIV prevention and treatment interventions.MethodsWe included articles that reported findings from randomized controlled trials (RTCs) involving adults and youth who were at risk of acquiring (or who currently had) a STI and/or HIV, a text message and comparator intervention, and reported provided outcome data on adherence to STI/HIV treatments. Articles were excluded if they were not published in English. We only included studies that have full-text publications so certainty and risk of bias assessments could be performed. Eight databases were searched to retrieve articles published between 1996 and March 2017. The Cochrane risk of bias tool was used and certainty of the evidence was assessed using GRADE. Effect estimates were pooled using a random effects model.ResultsA total of 35 RCTs were found, 6 of which were considered at low risk of bias. Eight studies found an increased association using text messaging in appointments attended compared to standard care (OR 1.64, 95% CI 1.28 to 2.10). Participants receiving text messages had an increase in HIV testing compared to standard care (n = 6; OR 1.73, 95% CI 1.39 to 2.15). Ten text messaging RCTs measuring adherence using micro-electro-mechanical systems (MEMS) pill counts has a non-significant association (OR 1.17, 95% CI 0.95–1.45) while five studies measuring adherence by self-report was found to be significant (OR 1.64, 95% CI 1.28–2.11).ConclusionsThe effectiveness of text message interventions is equivocal. While text messaging has the potential to enhance the delivery of STI/HIV interventions, program planners are encouraged to evaluate any SMS intervention to ensure it is achieving the desired result.Systematic review registrationPROSPERO CRD42013006503
Highlights
Rates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed
We summarized dichotomous outcomes using odds ratios (OR), with 95% confidence intervals (CI)
A total of 14,850 articles were initially identified through database and manual searches conducted between 1996 and March 2017 (Fig. 1)
Summary
Rates of STIs continue to rise worldwide, and novel evidence-based interventions such as text messaging aimed at improving client services are needed. In many western jurisdictions including Canada, Australia, and the USA, reported rates of genital chlamydia and gonorrhea are increasing. The latest data from Australia shows that gonorrhea has increased by 63% over the past 5 years (between 2012 and 2016; 62 to 101 per 100,000) [3]. These increased rates heighten concerns of sequelae such as pelvic inflammatory disease (PID), infertility, and increased vulnerability to acquiring HIV. Rates of reported cases of infectious syphilis, continue to rapidly increase among men who have sex with men (MSM) in Canada, the USA, and Western Europe [4,5,6]
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