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Appl Clin Inform 2018; 09(02): 450-466
DOI: 10.1055/s-0038-1660516
Review Article
Schattauer GmbH Stuttgart

A Systematic Review on Promoting Adherence to Antiretroviral Therapy in HIV-infected Patients Using Mobile Phone Technology

Yuri Quintana
1   Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
,
Eduardo A. Gonzalez Martorell
2   Harvard Medical School, Boston, Massachusetts, United States
,
Darren Fahy
1   Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
,
Charles Safran
1   Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
2   Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding None.
Further Information

Publication History

08 January 2018

02 May 2018

Publication Date:
20 June 2018 (online)

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Abstract

Objective Adherence to antiretroviral therapy (ART) is paramount to successful long-term suppression of human immunodeficiency virus (HIV). For poorly adherent patients with HIV, barriers to remaining adherent may be overcome by the implementation of targeted interventions delivered via mobile devices. This systematic review is focused specifically on mobile phone technologies to deliver adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS) populations.

Methods This review (PROSPERO #CRD42017065131) systematically extracted data from published literature from five databases on mobile phone interventions to improve adherence to ART for HIV. The reported studies had been conducted between 2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each criterion as low, high, or unclear risk of bias.

Results Of the 835 articles returned, we identified 26 randomized controlled trials (RCTs), retrospective and prospective cohort trials, or mixed method studies with a comparison group that fit criteria for inclusion. No standard measure of adherence was consistent throughout the examined studies, and assessments by self-report, pill counting, and medication event monitoring system (MEMS) were utilized. The studies reported mixed results, with 17 reporting significant improvements to adherence, 3 reporting improvements without supplying p-values, and 6 reporting no significant change or a reduction in adherence.

Conclusion The mixed nature of the results exemplifies the need for more comprehensive approaches and larger scale trials to confirm results observed in limited cohort sizes. To better retain satisfactory adherence within the HIV population, and especially in low-resource settings, we recommend that future interventions incorporate multiple strategies: mobile-based reminders, social support structures, and personalized content.

Keywords

HIV - acquired immunodeficiency syndrome - medication adherence - antiretroviral therapy - highly active - mHealth

Protection of Human and Animal Subjects

Human or animal subjects were not included in this project.


 

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