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Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials
  1. Sima Berendes1,
  2. Anasztazia Gubijev1,
  3. Ona L McCarthy1,
  4. Melissa J Palmer1,
  5. Emma Wilson2,
  6. Caroline Free1
  1. 1 Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Population, Policy & Practice Department, Faculty of Population Health Sciences, University College London GOS Institute of Child Health, London, UK
  1. Correspondence to Dr Sima Berendes, Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; sima.berendes{at}lshtm.ac.uk

Abstract

Background The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed.

Objective To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour.

Methods We searched seven databases and reference lists of 49 related reviews (January 1990–February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance.

Results After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI −0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence.

Conclusions Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.

  • sexual health
  • sexual behaviour
  • infection
  • telemedicine
  • preventive health services

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Footnotes

  • Handling editor Jason J Ong

  • Twitter @BerendesSima

  • Contributors SB and CF wrote the protocol with support from all authors; SB developed and implemented the search strategy with support from AG, MJP, OLM and CF; SB retrieved full papers with support from EW; all authors agreed on the eligibility criteria and selection process. AG, SB and EW screened titles/abstracts, and AG, SB and OLM assessed full-text articles for eligibility. SB designed the data extraction tool with support from CF, MJP, OLM and AG; SB extracted data and completed risk of bias (ROB) assessments and AG and OLM cross-checked these; SB conducted the meta-analysis with support from CF and MJP; SB completed GRADE assessments and AG cross-checked these. SB, AG and OLM discussed conflicting or complex screening, ROB and GRADE assessment decisions with CF until reaching agreement; SB wrote the first draft of the manuscript; CF and OLM contributed to the writing of the manuscript, and all authors commented on revised versions and approved the final manuscript.

  • Funding This review has been sponsored by the LSHTM and funded under the National Institute for Health Research (NIHR) Public Health Research (PHR) Programme (Project ref 14/182/07). (Funders have not directly been involved in protocol development, review conduct, data analysis, interpretation and dissemination of the final report).

  • Competing interests CF, OM and MJP are coauthors on one of the studies included in this review. Otherwise, the authors declare that they have nothing to disclose.

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