The use of the telephone to improve the health of people with HIV infection

More than 34 million people were living with HIV in 2010, and more than 2.7 million new infections occurred in that year. Improvements in drug treatments for HIV mean that the life expectancy of people living with HIV/AIDS (PLHIV) is now almost the same as that of non-infected people. However, the disease is still incurable, and patients require support to cope with their chronic illness and need for lifelong medication. Interventions often require people to go for face to face consultations, but barriers to healthcare, such as lack of money, transportation problems and the stigma sometimes associated with attending a clinic for HIV treatment, can prevent people from receiving the care they need. Using the telephone to deliver care to PLHIV may overcome some of these barriers, and ultimately improve health. It may also reduce costs, save time, and reduce effort. This could allow for a greater frequency of contact with patients, and the opportunity to reach more people in need of care. Mobile phones are widely used in both developed and developing countries, making them a feasible method to deliver health interventions for PLHIV.  

The aim of this review was to assess the effectiveness of using the telephone to deliver interventions to improve the health of PLHIV compared to standard care. A comprehensive search of various scientific databases and other resources found 11 relevant studies. All of the studies were performed in the United States, and so the results may not apply to other countries, particularly developing countries. Some studies were aimed at any HIV positive person in the area in which the study was carried out, and others focused on specific groups of people, such as young substance using PLHIV, or older PLHIV. There were a lot of differences in the types of telephone interventions used in each study. There was some evidence that telephone interventions can improve medication adherence, reduce risky sexual behaviour, and reduce symptoms of depression in PLHIV. However, there were also a number of studies that suggested that telephone interventions were no more effective than usual care alone. We need more studies conducted in different settings to assess the effectiveness of telephone interventions for improving the health of PLHIV.

Authors' conclusions: 

Telephone voice interventions may have a role in improving medication adherence, reducing risky sexual behaviour, and reducing depressive and psychiatric symptoms, but current evidence is sparse, and further research is needed.

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Background: 

This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV.

Objectives: 

To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection.

Search strategy: 

We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation’s The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles.

Selection criteria: 

Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded.

Data collection and analysis: 

Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the mode of communication, and whether underlying factors for change were altered. Meta-analyses, each of three studies, were performed for medication adherence and depressive symptoms. A narrative synthesis is presented for all other outcomes due to study heterogeneity.

Main results: 

Out of 14 717 citations, 11 RCTs met the inclusion criteria (1381 participants).

Six studies addressed outcomes relating to medication adherence, and there was some evidence from two studies that telephone interventions can improve adherence. A meta-analysis of three studies for which there was sufficient data showed no significant benefit (SMD 0.49, 95% CI -1.12 to 2.11). There was some evidence from a study of young substance abusing HIV positive persons of the efficacy of telephone interventions for reducing risky sexual behaviour, while a trial of older persons found no benefit. Three RCTs addressed virologic outcomes, and there is very little evidence that telephone interventions improved virologic outcomes. Five RCTs addressed outcomes relating to depressive and psychiatric symptoms, and showed some evidence that telephone interventions can be of benefit. Three of these studies which focussed on depressive symptoms were combined in a meta-analysis, which showed no significant benefit (SMD 0.02, 95% CI -0.18 to 0.21 95% CI).

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