A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017)
Aids and Behavior
National HIV prevention goals call for interventions that address Continuum of HIV Care (CoC) for persons living with HIV. Electronic health (eHealth) can leverage technology to rapidly develop and disseminate such interventions. We conducted a qualitative review to synthesize (a) technology types, (b) CoC outcomes, (c) theoretical frameworks, and (d) behavior change mechanisms. This rapid review of eHealth, HIV-related articles (2007-2017) focused on technology-based interventions that
... CoC-related outcomes. Forty-five studies met inclusion criteria. Mobile texting was the most commonly reported technology (44.4%, k = 20). About 75% (k = 34) of studies showed proven or preliminary efficacy for improving CoC-related outcomes. Most studies (60%, k = 27) focused on medication adherence; 20% (k = 9) measured virologic suppression. Many eHealth interventions with preliminary or proven efficacy relied on mobile technology and integrated knowledge/cognition as behavior change mechanisms. This review identified gaps in development and application of eHealth interventions regarding CoC. One study demonstrated that the risk of HIV transmission was reduced by ≥ 93% when a PLWH had an undetectable viral load (< 50 RNA copies/ml) . Health outcomes for PLWH must be improved, including: (a) diagnosing all persons who are living with HIV; (b) linking all previously undiagnosed PLWH to care (linkage); (c) retaining all linked PLWH in care (retention); (d) re-engaging those PLWH who have fallen out of care (re-engagement); (e) and achieving viral suppression (< 200 RNA copies/ml) via medication adherence . This sequence of steps is known as the Continuum of HIV Care (CoC). PLWH face many challenges to staying in care and maintaining a suppressed viral load . Addressing these challenges through more intensive care strategies such as case management and patient navigation services (e.g., coordinating transportation, accompanying to medical appointments, etc.) has been prioritized on a national scale . However, these strategies can often be costly, and resources for scaling up these types of strategies may be limited . One way to keep costs low and deliver timely health information to consumers, including PLWH, may be through electronic health (eHealth) technology , such as video interventions being shown in medical waiting rooms . eHealth can be a key tool for addressing HIV-related public health challenges in various capacities including disease surveillance, health care access, health education, and health care provider training . Individuals are increasingly using the internet to access health information, and mobile technology (mHealth), such as delivering risk reduction messages to personal cell phones, is rapidly becoming the primary means of broadband access and health information  . Therefore, eHealth approaches, including those that involve mHealth, have been shown to help expand the dissemination of HIV prevention and treatment interventions , particularly for more resource-challenged adults. Despite eHealth's demonstrated effectiveness, its broad application, rapid innovation, and reporting heterogeneity make it difficult to evaluate for HIV prevention purposes  . Thus, research on interventions that can be scaled up to reach a large number of PLWH can inform how eHealth technology can be used as an additional HIV prevention tool. We sought to examine the landscape and efficacy of using technology to support outcomes related to steps (b) through (e) in the CoC. Identification of specific eHealth intervention components responsible for the observed HIVrelated outcomes among PLWH participants remains unaddressed in the literature. Analyses would provide insight into which eHealth approaches are effective and what specific components are necessary to increase the likelihood of obtaining favorable outcomes related to the CoC. To address this issue, we conducted a rapid qualitative systematic review to synthesize (a) what types of technologies are being used in eHealth interventions for PLWH, (b) specific health outcomes related to HIV care that are addressed in eHealth interventions, (c) the theoretical basis driving the interventions' designs, and (d) the mechanisms of change used to achieve favorable behavioral change consistent with the CoC and the national HIV prevention goals. We also will discuss major gaps in the research literature, as well as recommendations for future efforts in the field. Henny et al.