Supplementary file 2_Impact of mHealth on enhancing pre-exposure prophylaxis adherence and strengthening the HIV prevention cascade among key populations: a systematic review and meta-analysis.pdf

BackgroundGood adherence to pre-exposure prophylaxis (PrEP) is critical for effective HIV prevention. Despite the growing awareness of PrEP, many individuals remain at a preliminary understanding stage and struggle to achieve sustained adherence. mHealth (mobile Health) technology is emerging as one of the promising tools in the HIV prevention cascade. While research on mHealth applications for HIV prevention is rapidly advancing, their effectiveness in promoting robust PrEP adherence and optimizing cascade outcomes remains inconclusive, with fragmented evidence limiting scalable implementation.
ObjectiveTo evaluate the efficacy of mHealth tools in optimizing the HIV prevention cascade (from risk identification to PrEP adherence) among key populations (including men who have sex with men, bisexual individuals, sex workers, transgender populations and some other groups who at elevated risk of HIV acquisition).
MethodsWe searched in PubMed, Cochrane Library, Web of Science, Embase, Ovid and CINAHL (EBSCO) from the inception to February 3, 2025. Our inclusion criteria focused on randomized controlled trials (RCTs). Literature screening and data extraction were performed independently by two authors. Methodological quality was assessed using Cochrane’s Risk of Bias in Randomized Controlled Trials tool. The primary outcome was adherence to PrEP and secondary outcomes included PrEP use, HIV testing and number of condomless sex events. Analyses were performed using standardized mean difference (SMD) and 95% confidence interval (CI) for continuous variables and using odds ratios (OR) and 95% CI for categorical variables. Data analysis and forest plotting were carried out using R Statistical Software version 4.4.0.
Results16 RCT studies met the inclusion criteria. The results of the meta-analysis showed that mHealth interventions significantly promoted PrEP adherence (OR = 1.60, 95% CI [1.09, 2.35], ρ = 0.016) and HIV testing (OR = 1.63, 95% CI [1.39, 1.90], ρ < 0.01). It had also shown some effectiveness in promoting the use of PrEP. However, there were no significant effects on reducing the number of condomless sex events during the entire follow-up period.
ConclusionmHealth effectively enhances specific stages of the prevention cascade. However, further optimization of technology design and intervention is needed to address complex difficulties.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=533772, identifier PROSPERO CRD42024533772.

背景：良好的暴露前预防（Pre-Exposure Prophylaxis, PrEP）依从性对于高效的艾滋病病毒（HIV）预防至关重要。尽管大众对PrEP的认知度不断提升，但仍有许多人群仅处于初步认知阶段，且难以实现持续的依从性。移动健康（mobile Health, mHealth）技术正逐渐成为HIV预防链中的极具潜力的工具之一。尽管针对HIV预防的mHealth应用研究正快速推进，但其在促进稳固的PrEP依从性、优化预防链结局方面的有效性仍未明确，且证据碎片化限制了其规模化推广应用。
研究目的：本研究旨在评估移动健康工具在优化关键人群（包括男男性行为者、双性恋者、性工作者、跨性别群体及其他HIV感染风险升高的人群）的HIV预防链（从风险识别到PrEP依从性）方面的有效性。
研究方法：本研究检索了PubMed、考克兰图书馆（Cochrane Library）、Web of Science、Embase、Ovid及CINAHL（EBSCO平台）数据库，检索时限为建库至2025年2月3日。纳入标准聚焦于随机对照试验（Randomized Controlled Trials, RCTs）。文献筛选与数据提取由两名研究者独立完成。研究方法学质量采用考克兰随机对照试验偏倚风险工具进行评估。本研究的主要结局指标为PrEP依从性，次要结局指标包括PrEP使用情况、HIV检测情况及无保护性行为次数。针对连续变量采用标准化均数差（Standardized Mean Difference, SMD）与95%置信区间（Confidence Interval, CI）进行分析，针对分类变量采用比值比（Odds Ratio, OR）与95% CI进行分析。数据分析与森林图绘制采用R统计软件版本4.4.0完成。
研究结果：共有16项随机对照试验符合纳入标准。荟萃分析结果显示，移动健康干预可显著提升PrEP依从性（比值比=1.60，95%置信区间[1.09, 2.35]，ρ=0.016）与HIV检测率（比值比=1.63，95%置信区间[1.39, 1.90]，ρ<0.01），且在促进PrEP使用方面也展现出一定效果。但在整个随访周期内，该干预对减少无保护性行为次数未产生显著影响。
研究结论：移动健康可有效提升HIV预防链的特定环节效果，但仍需进一步优化技术设计与干预方案，以应对复杂挑战。
系统评价注册信息：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=533772，注册号为PROSPERO CRD42024533772。