BACKGROUND The management of people living with HIV/AIDS (PLWHA) is multidimensional and complex. It is increasingly recognized that the use of patient reported outcome measures (PROMs) is the key to providing patient-centered health care to meet the lifelong needs of PLWHA from diagnosis to the end of life. However, there is no consensus on which PROM should be recommended for healthcare providers and researchers to assess health outcomes of PLWHA currently. OBJECTIVE This review aims to assess HIV-specific PROMs for adult PLWHA using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. METHODS This systematic review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The literature search was conducted in 3 recommended databases (PubMed, Embase, and PsychINFO) on January 15, 2021. Eligible studies were included if they assessed any psychometric property of HIV-specific PROMs in adult PLWHA. The PROMs were assessed for 9 psychometric properties, which were assessed in each included study using the COSMIN methodology by assessing (1) the methodological quality assessed using the COSMIN risk of bias checklist, (2) overall rating of results, (3) level of evidence assessed using the modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and (4) level of recommendation. RESULTS A total of 88 PROMs in 8 categories were identified, assessing the psychometric properties of PROMs for adult PLWHA in 152 studies involving 79213 PLWHA. The psychometric properties of the majority of included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation was the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the ACTG, and People Living with HIV Resilience Scale. In addition, due to insufficient evidence, most of remaining assessed PROMs cannot make recommendations regarding their use (received class B recommendation). CONCLUSIONS This systematic review recommended 3 PROMs to assess health outcomes of adult PLWHA, however, they all have some shortcomings. It is necessary to conduct a more thorough assessment of the psychometric properties of existing PROMs. These findings may provide a reference to the selection of high-quality HIV-specific PROMs by healthcare providers and researchers for clinical practice and research.
BACKGROUND Electronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions. OBJECTIVE The purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed. METHODS We systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen <italic>d</italic>, and their 95% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity. RESULTS Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen <italic>d</italic>=0.25; 95% CI 0.05 to 0.46; <italic>P</italic>=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen <italic>d</italic>=0.25; 95% CI 0.11 to 0.38; <italic>P</italic><.001). The effect was sensitive to sample size (<italic>Q</italic>=5.56; <italic>P</italic>=.02) and study duration (<italic>Q</italic>=8.89; <italic>P</italic>=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses. CONCLUSIONS Some of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes.
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