The role of digital tools in enhancing antiretroviral therapy adherence among adolescents and young adults with HIV: a systematic review of randomized controlled trials

Abstract

BACKGROUND: Adolescents and Young Adults (AYA) face challenges in maintaining antiretroviral therapy (ART) adherence, necessitating the need for targeted and innovative interventions. Digital tools have shown potential in improving ART adherence following its integration into HIV care. However, there is paucity of comprehensive evidence on its usage and effectiveness in this population who exhibit higher levels of non-adherence to ART. Hence, we conducted a systematic review of randomized controlled trials (RCTs) to evaluate the effectiveness of digital tools in enhancing ART adherence among AYA. METHOD: We searched multiple databases including Google Scholar, PubMed, Cochrane and Web of Science using appropriate keywords and Boolean operators. We screened articles for eligibility and ensured that only RCTs focusing on the role of digital tools in ART adherence among AYA with HIV were included. RESULTS: Of the 4,270 studies screened, 8 studies published between 2020 to 2024 met the eligibility criteria. The included studies involved study population between the ages of 10-24 years. The studies assessed the effectiveness of digital tools on ART adherence among AYA living with HIV with sample sizes ranging from 21 to 349 participants. The digital tools in the studies included SMS, gamified text messages, social media group, interactive voice response system, video conferencing, and a gamified mobile app. Only two studies showed statistically significant improvement in ART adherence. Adherence measures were found to be a key factor in influencing adherence outcomes as viral load-based measures were associated with the statistically significant studies. CONCLUSION: Digital tools show potential in improving ART adherence among AYA living with HIV. Although only two studies reported statistically significant improvement in adherence, mHealth and SMS have shown promise as tools for improving ART adherence and achieving viral suppression. Future studies should employ viral load as a primary measure for the ART adherence as well as increase follow-up durations and sample size to ensure generalizability of results.