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Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017).

Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017).
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Daher J, Vijh R, Linthwaite B, Dave S, Kim J, Dheda K, Peter T, Pai NP,


Daher J, Vijh R, Linthwaite B, Dave S, Kim J, Dheda K, Peter T, Pai NP, (click to view)

Daher J, Vijh R, Linthwaite B, Dave S, Kim J, Dheda K, Peter T, Pai NP,

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BMJ open 2017 11 037(11) e017604 doi 10.1136/bmjopen-2017-017604

Abstract
OBJECTIVE
Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs.

DESIGN
Systematic review.

SETTING/PARTICIPANTS
All settings/all participants.

INTERVENTION
We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth).

PRIMARY AND SECONDARY OUTCOME MEASURES
Feasibility, acceptability, impact.

METHODS
We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.

RESULTS
We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials.

CONCLUSION
Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

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