Effectiveness of digital health interventions on antiretroviral therapy adherence among people living with HIV in India: A systematic review with an RCT-only meta-analysis

INTRODUCTION: Antiretroviral therapy (ART) coverage has improved in the past few years in India. However, substantial non-adherence to ART has been reported among the people living with human immunodeficiency virus (PLHIV) in India. Digital health solutions can be potentially used as cost-effective interventions to address the problem of non-adherence. This study presents a systematic review followed with randomized clinical trial (RCT) only meta-analysis of existing literature conducted to assess the effectiveness of digital health interventions on ART adherence among the PLHIV in India. METHODOLOGY: A comprehensive systematic review was done on articles examining digital health interventions on ART adherence among PLHIV in India, published till December 2024. Final search strategy was developed based on experiences from a preliminary search and was used to explore electronic databases- PubMed, EMBASE, ProQuest, Web of Science, SciELO, Grants, Google Scholar, and the grey literature. All the articles were reviewed independently by the authors. Bias and quality of the included studies were assessed by two independent authors using Cochrane collaboration tool. RCT only meta-analysis was done to synthesize results using fixed effect model due to low heterogeneity. RESULTS: In total, 441 articles were obtained using the final search strategy. A total of 415 articles were screened after removing duplicate articles. After abstract and full-text screening, only 04 studies met the inclusion criteria. Among the four included studies, three were conducted in southern India and one in eastern India. One of the four studies was quasi-experimental, and the rest were RCTs. Meta-analysis performed on three RCTs showed statistically significant positive effect on ART adherence with relative ratio of 1.18 (95% confidence interval (CI): 1.06 to 1.31, pƒ_%=ƒ_%0.002). As per Cochrane risk of bias assessment tool 2, three RCTs exhibited low risk of bias. CONCLUSION: Meta-analysis result showed that digital health interventions led to improvement in ART adherence among the PLHIV in India. However, the generalizability of the findings is constrained by the limited number of studies included in the review

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Health services
  • Other
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Health Systems
  • Governance arrangements
  • Financial arrangements
  • Delivery arrangements