Text Message Intervention Designs to Promote Adherence to Antiretroviral Therapy (ART): A Meta-Analysis of Randomized Controlled Trials

<div><p>Background</p><p>The efficacy of antiretroviral therapy depends on patient adherence to a daily medication regimen, yet many patients fail to adhere at high enough rates to maintain health and reduce the risk of transmitting HIV. Given the explosive global growth of cellular-mobile phone use, text-messaging interventions to promote adherence are especially appropriate. This meta-analysis synthesized available text messaging interventions to promote antiretroviral therapy adherence in people living with HIV.</p><p>Methods</p><p>We performed Boolean searches of electronic databases, hand searches of recent year conference abstracts and reverse searches. Included studies (1) targeted antiretroviral therapy adherence in a sample of people living with HIV, (2) used a randomized-controlled trial design to examine a text messaging intervention, and (3) reported at least one adherence measurement or clinical outcome.</p><p>Results</p><p>Eight studies, including 9 interventions, met inclusion criteria. Text-messaging interventions yielded significantly higher adherence than control conditions (OR = 1.39; 95% <i>CI</i> = 1.18, 1.64). Sensitivity analyses of intervention characteristics suggested that studies had larger effects when interventions (1) were sent less frequently than daily, (2) supported bidirectional communication, (3) included personalized message content, and (4) were matched to participants’ antiretroviral therapy dosing schedule. Interventions were also associated with improved viral load and/or CD4+ count (<i>k</i> = 3; OR = 1.56; 95% <i>CI</i> = 1.11, 2.20).</p><p>Conclusions</p><p>Text-messaging can support antiretroviral therapy adherence. Researchers should consider the adoption of less frequent messaging interventions with content and timing that is individually tailored and designed to evoke a reply from the recipient. Future research is needed in order to determine how best to optimize efficacy.</p></div

Forest plot of weighted mean effect size by study with aggregate mean effect size.

<p>Forest plot of weighted mean effect size by study with aggregate mean effect size.</p

Mean effect sizes by Intervention Characteristics of Randomized Controlled Trials.

<p><i>Note.</i> Odds ratios (OR) gauge the success of the interventions at increasing adherence as represented by its average across available measures for each study, where larger values indicate better success. Each moderator listed was evaluated individually without controlling for other listed moderators; that is, analyses are bivariate.</p

Characteristics of included studies.

<p><i>Note.</i> SR = self-report questionnaire; PC = pill count; EDM = electronic drug monitoring; PR = pharmacy records; VL = viral load; CD4+ = T-cell count; NR = not reported. ^aAveraged when there is more than one measure of adherence. ^b methodological quality sub-scales (range): RB =  reporting bias (0–11); EV =  external validity (0–3); MB =  measurement bias (0–7); SB =  sampling bias (0–6); PW =  power (0–5). ^c CD4+ at baseline and 3 months only.</p

Mean effect sizes by measurement method.

<p><i>Note.</i> Mean effect sizes (OR) greater than 1 indicate improvement in the outcome of interest relative to the control arm. <i>k</i> = number of interventions.</p

Literature search results.

<p>Literature search results.</p

Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016

<div><p>Background</p><p>Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies.</p><p>Aims</p><p>This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy.</p><p>Methods</p><p>We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11–19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the <i>I</i>^<i>2</i> statistic and its associated 95% confident interval.</p><p>Results</p><p>Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges’<i>g</i> = 1.01), attitudes (<i>g</i> = 0.29), self-efficacy toward condom use (<i>g</i> = 0.22), intention to refuse sex (<i>g</i> = 0.56), condom use intention (<i>g</i> = 0.46), and condom use (<i>g</i> = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (<i>g</i> = 0.47). Moderators of the efficacy are discussed.</p><p>Conclusions</p><p>Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.</p></div

Forest plot from meta-analysis of condom use (medium-time).

<p>Effects are ordered from most successful to least successful. The overall estimate for each is represented at the end of the list of studies.</p

Descriptive features of 63 studies in the sample.

<p>Descriptive features of 63 studies in the sample.</p

Weighted <i>Mean</i> effect sizes and related statistics at short-, medium- and long-term assessments for interventions targeting adolescents.

<p>Weighted <i>Mean</i> effect sizes and related statistics at short-, medium- and long-term assessments for interventions targeting adolescents.</p