短信干预对艾滋病患者抗病毒治疗依从性影响的Meta分析

SMS intervention on improving antiretroviral treatment adherence in HIV patients: a meta-analysis

目的采用Meta分析方法评价短信干预对艾滋病患者抗病毒治疗依从性效果。方法计算机检索PubMed、EMbase、CINAHL、Web of Science、ScienceDirect、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集短信干预对艾滋病患者抗病毒治疗依从性影响的随机对照试验(RCT),检索时限均从2000年1月至2018年12月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入10个研究,包括2 411例患者。Meta分析结果显示:与常规护理相比,短信干预能够提高艾滋病患者治疗依从性[RR=1.11,95%CI(1.03,1.20),P<0.01]。亚组分析显示,每周发送短信能够提高治疗依从性[RR=1.15,95%CI(1.00,1.33),P<0.05];但个性化发送[RR=1.17,95%CI(0.99,1.38),P=0.06]、每日发送短信[RR=1.02,95%CI(0.83,1.26),P=0.84]对治疗依从性影响无差异;干预期限为6个月能够提高治疗依从性[RR=1.11,95%CI(1.00,1.23),P=0.05],干预12个月对治疗依从性影响无差异[RR=1.07,95%CI(0.98,1.17),P=0.13];治疗前后检测的CD4^+细胞计数无差异[WMD=4.18,95%CI(-39.33,47.69),P=0.85]。结论短信干预与常规护理比较,持续半年每周发送短信提醒艾滋病患者服药能提高治疗依从性。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。

Objectives To evaluate the effects of short message service(SMS) intervention for improving antiretroviral treatment adherence in HIV patients by meta-analysis. Methods Databases including PubMed, EMbase,CINAHL, Web of Science, ScienceDirect, The Cochrane Library, CNKI, WanFang Data, VIP and CBM were searched electronically from January 2000 to December 2018 to collect randomized controlled trials(RCTs) on the efficacy of SMS intervention on HIV patients. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 10 RCTs with 2 411 patients were included. The meta-analysis showed that SMS intervention could improve significantly treatment adherence of HIV patients(RR=1.11, 95%CI 1.03 to 1.20, P<0.01). The subgroup analysis showed that weekly texting had an effect on treatment adherence(RR=1.15, 95%CI 1.00 to 1.33, P<0.05);personal sending(RR=1.17, 95%CI 0.99 to 1.38,P=0.06) and daily sending(RR=1.02, 95%CI 0.83 to 1.26, P=0.84) of SMS had no statistical significance on treatment adherence;the intervention duration of 6 months(RR=1.11, 95%CI 1.00 to 1.23, P=0.05) could improve the treatment adherence, while the intervention duration of 12 months(RR=1.07, 95%CI 0.98 to 1.17, P=0.13) had no statistical difference on treatment adherence;there was no statistical difference in CD4+ cell count before and after treatment(WMD=4.18, 95%CI-39.33 to 47.69, P=0.85). Conclusions By comparing SMS intervention with routine nursing,sending SMS weekly for 6 months to remind HIV patients to take medicine can improve treatment adherence. Due to the limitation of quantity and quality of the included studies, the above conclusions are required to be assessed by more highquality studies.