Technology-Mediated Interventions and Quality of Life for Persons Living with HIV/AIDSA Systematic Review Funding This work was supported by the Agency for Healthcare Research and Quality under award number R21HS023963 (PI: Schnall) and the National Institute of Nursing Research of the National Institute of Health under award number R01NR015737 (PI: Schnall). At the time of this study, Dr. Sarah Iribarren was funded by a Comparative and Cost-Effectiveness Research Training for Nurse Scientists Award (T32-NR014205; PI: Stone) by the National Institute of Nursing Research of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institute of Health.
16 October 2016
accepted: 27 January 2017
21 December 2017 (online)
Background: As HIV/AIDS is considered a chronic disease; quality of life (QoL) has become an important focus for researchers and healthcare providers. Technology-mediated interventions have demonstrated improved clinical effectiveness in outcomes, such as viral suppression, for persons living with HIV/AIDS (PLWH). However, the evidence to support the impact of these interventions on QoL is lacking.
Objectives: The aim of this paper was to assess the impact of technology-mediated interventions on QoL and to identify the instruments used to measure the QoL of PLWH.
Methods: For this review we followed the PRISMA guidelines. A literature search was conducted in PubMed, CINAHL, Cochrane, and EMBASE databases in April 2016. Inclusion criteria limited articles to those with technology-mediated interventions as compared to usual care; articles with the population defined as HIV-infected patients; and articles with QoL measured as a health outcome in randomized controlled trials. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality.
Results: Of the 1,554 peer-reviewed articles returned in the searches, 10 met the inclusion criteria. This systematic review identified four types of technology-mediated interventions and two types of QoL instruments used to examine the impact of technology-mediated interventions on PLWH. Four studies of technology-mediated interventions resulted in improvement in QoL. Four studies considered QoL as a secondary outcome and resulted in a negative or neutral impact on QoL. Overall, four studies had a low risk of bias, one study had a moderate risk of bias, and the other five studies had a high risk of bias.
Conclusions: The evidence to support the improvement of QoL using technology-mediated interventions is insufficient. This lack of research highlights the need for increased study of QoL as an outcome measure and the need for consistent measures to better understand the role of technology-mediated interventions in improving QoL for PLWH.
Citation: Hwayoung Cho, Sarah Iribarren, Rebecca Schnall. Technology-Mediated Interventions and Quality of Life for Persons Living with HIV/AIDS: A Systematic Review. Appl Clin Inform 2017; 8: 348–368 https://doi.org/10.4338/ACI-2016-10-R-0175
KeywordsTechnology-mediated interventions - internet and the web technology - eHealth - telemedicine and telehealth - mobile computing and communication - mHealth - HIV/AIDS - quality of life
Clinical Relevance Statement
Although technology-mediated interventions have been considered an effective tool in HIV/AIDS care, and quality of life has been recognized as an important outcome for persons living with HIV, the impact of technology-mediated interventions on quality of life still remains unclear. This review has implications for future research evaluating the effectiveness of technology-mediated interventions on quality of life as a primary outcome using a validated instrument in persons living with HIV.
Human Subjects Protections
Human and/or animal subjects were not included in this review.
- 1 World Health Organization. HIV/AIDS 2016. Available from: http://www.who.int/mediacentre/factsheets/fs360/en/
- 2 Clayson DJ, Wild DJ, Quarterman P, Duprat-Lomon I. A Comparative Review of Health-Related Quality-of-Life Measures for Use in HIV/AIDS Clinical Trials. PharmacoEconomics 2006; 24 (08) 751-765.
- 3 Clayson DJ, Wild DJ, Quarterman P, Duprat-Lomon I, Kubin M, Coons SJ. A comparative review of health-related quality-of-life measures for use in HIV/AIDS clinical trials. PharmacoEconomics 2006; 24 (08) 751-765.
- 4 Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological medicine 1998; 28 (03) 551-558.
- 5 Liping M, Peng X, Haijiang L, Lahong J, Fan L. Quality of Life of People Living with HIV/AIDS: A Cross-Sectional Study in Zhejiang Province, China. PloS one 2015; 10 (08) e0135705.
- 6 de Boer-van der Kolk IM, Sprangers MA, Prins JM, Smit C, de Wolf F, Nieuwkerk PT. Health-related quality of life and survival among HIV-infected patients receiving highly active antiretroviral therapy: a study of patients in the AIDS Therapy Evaluation in the Netherlands (ATHENA) Cohort. Clinical Infectious Diseases 2010; 50 (02) 255-263.
- 7 Degroote S, Vogelaers D, Vandijck DM. What determines health-related quality of life among people living with HIV: an updated review of the literature. Archives of Public Health 2014; 72 (01) 40.
- 8 Schnall R, Liu J, Cho H, Hirshfield S, Siegel K, Olender S. A health-related quality of life measure for use in patients with HIV: A validation study. AIDS Patient Care and STDs. 2016 doi: 10.1089/apc.2016.0252.
- 9 Jongbloed K, Parmar S, van der Kop M, Spittal PM, Lester RT. Recent Evidence for Emerging Digital Technologies to Support Global HIV Engagement in Care. Current HIV/AIDS Reports 2015; 12 (04) 451-461.
- 10 Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical Infectious Diseases 2011; 52 (06) 793-800.
- 11 Schnall R, Bakken S, Rojas M, Travers J, Carballo-Dieguez A. mHealth Technology as a Persuasive Tool for Treatment, Care and Management of Persons Living with HIV. AIDS and Behavior 2015; 19 (02) 81-89.
- 12 Schnall R, Wantland D, Velez O, Cato K, Jia H. Feasibility testing of a web-based symptom self-management system for persons living with HIV. The Journal of the Association of Nurses in AIDS Care: JANAC 2014; 25 (04) 364-71.
- 13 Finitsis DJ, Pellowski JA, Johnson BT. Text message intervention designs to promote adherence to anti-retroviral therapy (ART): a meta-analysis of randomized controlled trials. PloS one 2014; 9 (02) e88166.
- 14 Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. The Cochrane Database of Systematic Reviews. 2012 (3) CD009756.
- 15 Mbuagbaw L, Mursleen S, Lytvyn L, Smieja M, Dolovich L, Thabane L. Mobile phone text messaging interventions for HIV and other chronic diseases: an overview of systematic reviews and framework for evidence transfer. BMC Health Services Research 2015; 15: 33.
- 16 Collier AC, Ribaudo H, Mukherjee AL, Feinberg J, Fischl MA, Chesney M. A randomized study of serial telephone call support to increase adherence and thereby improve virologic outcome in persons initiating antiretroviral therapy. The Journal of Infectious Diseases 2005; 192 (08) 1398-1406.
- 17 Reynolds NR, Testa MA, Su M, Chesney MA, Neidig JL, Frank I, Smith S, Ickovics J, Robbins GK. Telephone support to improve antiretroviral medication adherence: a multisite, randomized controlled trial. Journal of Acquired Immune Deficiency Syndromes 2008; 47 (01) 62-68.
- 18 Vidrine DJ, Marks RM, Arduino RC, Gritz ER. Efficacy of cell phone-delivered smoking cessation counseling for persons living with HIV/AIDS: 3-month outcomes. Nicotine & Tobacco Research 2012; 14 (01) 106-110.
- 19 Kempf M-C, Huang C-H, Savage R, Safren SA. Technology-Delivered Mental Health Interventions for People Living with HIV/AIDS (PLWHA): a Review of Recent Advances. Current HIV/AIDS Reports 2015; 12 (04) 472-480.
- 20 Schnall R, Cimino JJ, Bakken S. Development of a Prototype Continuity of Care Record with Context-Specific Links to Meet the Information Needs of Case Managers for Persons Living with HIV. International Journal of Medical Informatics 2012; 81 (08) 549-555.
- 21 Mannheimer SB, Matts J, Telzak E, Chesney M, Child C, Wu AW, Friedland G. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care 2005; 17 (01) 10-22.
- 22 Lorenz KA, Shapiro MF, Asch SM, Bozzette SA, Hays RD. Associations of symptoms and health-related quality of life: findings from a national study of persons with HIV infection. Annals of Internal Medicine 2001; 134 9 Pt 2 854-860.
- 23 Abboud S, Noureddine S, Huijer HA, DeJong J, Mokhbat J. Quality of life in people living with HIV/AIDS in Lebanon. AIDS Care 2010; 22 (06) 687-696.
- 24 Bastardo YM, Kimberlin CL. Relationship between quality of life, social support and disease-related factors in HIV-infected persons in Venezuela. AIDS Care 2000; 12 (05) 673-684.
- 25 Chin JJ, Botsko M, Behar E, Finkelstein R. More than ancillary: HIV social services, intermediate outcomes and quality of life. AIDS Care 2009; 21 (10) 1289-1297.
- 26 Schnall R, Mosley JP, Iribarren SJ, Bakken S, Carballo-Dieguez A, Brown Iii W. Comparison of a User-Centered Design, Self-Management App to Existing mHealth Apps for Persons Living With HIV. JMIR mHealth and uHealth 2015; 3 (03) e91.
- 27 World Health Organization. eHealth 2016. Available from: http://www.who.int/topics/ehealth/en
- 28 HealthIT.gov. What is telehealth? How is telehealth different from telemedicine?. 2014 Available from: https://www.healthit.gov/providers-professionals/faqs/what-telehealth-how-telehealth-different-telemedicine
- 29 World Health Organization. Digital health in TB care and control: Key definitions. 2016 Available from: http://www.who.int/tb/areas-of-work/digital-health/definitions/en
- 30 Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine 2009; 151 (04) 264-269.
- 31 Covidence 2016. Available from: http://www.covidence.org
- 32 Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovié J, Schulz KF, Weeks L, Sterne JAC. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011 343: d5928
- 33 Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with AIDS and HIV infection. Proceedings / the Annual Symposium on Computer Application [sic] in Medical Care Symposium on Computer Applications in Medical Care 1994: 604-608.
- 34 Huang D, Sangthong R, McNeil E, Chongsuvivatwong V, Zheng W, Yang X. Effects of a Phone Call Intervention to Promote Adherence to Antiretroviral Therapy and Quality of Life of HIV/AIDS Patients in Baoshan, China: A Randomized Controlled Trial. AIDS Research and Treatment 2013; 2013 (03) 1-9.
- 35 Leon A, Caceres C, Fernandez E, Chausa P, Martin M, Codina C, Rousaud A, Blanch J, Mallolas J, Martinez E, Blanco JL, Laguno M, Larrousse M, Milinkovic A, Zamora L, Canal N, Miro JM, Gatell JM, Gomez EJ, Garcia F. A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study. PloS one 2011; 6 (01) e14515.
- 36 Mbuagbaw L, Thabane L, Ongolo-Zogo P, Lester RT, Mills EJ, Smieja M, Dolovich L, Kouanfack C. The Cameroon Mobile Phone SMS (CAMPS) trial: a randomized trial of text messaging versus usual care for adherence to antiretroviral therapy. PloS one 2012; 7 (12) e46909.
- 37 Millard T, McDonald K, Girdler S, Slavin S, Elliot J. Online self-management for gay men living with HIV: a pilot study. Sexual Health 2015; 12 (04) 308-314.
- 38 Proeschold-Bell RJ, Belden CM, Parnell H, Cohen S, Cromwell M, Lombard F. A randomized controlled trial of health information exchange between human immunodeficiency virus institutions. Journal of Public Health Management and Practice: JPHMP 2010; 16 (06) 521-528.
- 39 Pyne JM, Fortney JC, Curran GM, Tripathi S, Atkinson JH, Kilbourne AM, Hagedorn HJ, Rimland D, Rodriguez-Barradas MC, Monson T, Bottonari KA, Asch SM, Gifford AL. Effectiveness of collaborative care for depression in human immunodeficiency virus clinics. Archives of Internal Medicine 2011; 171 (01) 23-31.
- 40 Robbins GK, Testa MA, Su M, Safren SA, Morse G, Lammert S, Shafer RW, Reynolds NR, Chesney MA. Site nurse-initiated adherence and symptom support telephone calls for HIV-positive individuals starting antiretroviral therapy, ACTG 5031: substudy of ACTG 384. HIV Clinical Trials 2013; 14 (05) 235-253.
- 41 Wang H, Zhou J, Huang L, Li X, Fennie KP, Williams AB. Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China. Journal of Clinical Nursing 2010; 19 3–4 380-388.
- 42 Wu AW, Snyder CF, Huang IC, Skolasky R, McGruder HF, Celano SA, Selnes OA, Andrade AS. A randomized trial of the impact of a programmable medication reminder device on quality of life in patients with AIDS. AIDS Patient Care and STDs 2006; 20 (11) 773-781.
- 43 Ware J. The MOS 36-Item Short-Form Health Survey (SF-36). In: Sederer LI, Dickey B. editors. Outcomes Assessment in Clinical Practice. Williams and Wilkins, Baltimore; 1996. p. 61-64.
- 44 Rehab Measures: Short Form 12 item (version 2) Health Survey [cited 2015 November 25th]. Available from: http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=1149
- 45 Ware J, Kosinski M, Dewey J. How to Score Version Two of the SF-36® Health Survey. Lincoln (RI): QualityMetric Incorporated2000.
- 46 The M.I.N.I. Medical Outcome Systems 2014 [cited 2015 November 25th]. Available from: http://www.medical-outcomes.com/index/mini
- 47 Reliability and validity of Japanese version of the Mini International Neuropsychiatric Interview. Psychiatry and Clinical Neurosciences 2005; 59 (Suppl. 05) 517-526.
- 48 Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry 1998; 59 (20) 22-33 quiz 4–57.
- 49 Fang CT, Hsiung PC, Yu CF, Chen MY, Wang JD. Validation of the World Health Organization quality of life instrument in patients with HIV infection. Quality of Life Research 2002; 11 (08) 753-762.
- 50 WHO. “WHOQOL-HIV BREF Geneva, Switzerland,” Mental Health: Evidence and Research Department of Mental Health and Substance Dependence 2002. Available from: http://www.who.int/mental_healthmedia/en/613.pdf
- 51 Duracinsky M, Herrmann S, Berzins B, Armstrong AR, Kohli R, Le Coeur S, Diouf A, Fournier I, Schechter M, Chassany O. The development of PROQOL-HIV: an international instrument to assess the health-related quality of life of persons living with HIV/AIDS. Journal of Acquired Immune Deficiency Syndromes 2012; 59 (05) 498-505.
- 52 Wu AW, Rubin HR, Mathews WC, Ware Jr. JE, Brysk LT, Hardy WD, Bozzette SA, Spector SA, Richman DD. A health status questionnaire using 30 items from the Medical Outcomes Study. Preliminary validation in persons with early HIV infection. Medical Care 1991; 29 (08) 786-798.
- 53 Naughton M, Wiklund I. Dimension-specific instruments that may be used across cultures. In: Spilker B. ed. Quality of Life and Pharmacoeconomics in Clinical Trials, Second Edition. Philadelphia: Lippincott-Raven Publishers; 1996: 633-658.
- 54 Marder K, Albert SM, McDermott MP, McArthur JC, Schifitto G, Selnes OA, Sacktor N, Stern Y, Palumbo D, Kieburtz K, Cohen B, Orme C, Epstein LG. Inter-rater reliability of a clinical staging of HIV-associated cognitive impairment. Neurology 2003; 60 (09) 1467-1473.
- 55 Clinical Trials Behavioral and Social Sciences Research [cited 2015 December 2nd]. Available from: http://www.esourceresearch.org/eSourceBook/ClinicalTrials/4Endpoints/tabid/200/Default.aspx
- 56 Higgins J, Green Se. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org 2011
- 57 Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, Jack W, Habyarimana J, Sadatsafavi M, Najafzadeh M, Marra CA, Estambale B, Ngugi E, Ball TB, Thabane L, Gelmon LJ, Kimani J, Ackers M, Plummer FA. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet 2010; 376 9755 1838-1845.
- 58 Sorensen JL, Haug NA, Delucchi KL, Gruber V, Kletter E, Batki SL, Tulsky JP, Barnett P, Hall S. Voucher Reinforcement Improves Medication Adherence in HIV-Positive Methadone Patients: A Randomized Trial. Drug and Alcohol Dependence 2007; 88 (01) 54-63.
- 59 van der Kop ML. The effect of weekly short message service communication on patient retention in care in the first year after HIV diagnosis: study protocol for a randomised controlled trial (WelTel Retain). BMJ Open 2013; 3 (06) e003155.
- 60 Christopoulos KA, Riley ED, Tulsky J, Carrico AW, Moskowitz JT, Wilson L, Coffin LS, Falahati V, Akerley J, Hilton JF. A text messaging intervention to improve retention in care and virologic suppression in a U.S. urban safety-net HIV clinic: study protocol for the Connect4Care (C4C) randomized controlled trial. BMC Infectious Diseases 2014; 14: 718.
- 61 Pildal J, Hrobjartsson A, Jorgensen KJ, Hilden J, Altman DG, Gotzsche PC. Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. International journal of epidemiology 2007; 36 (04) 847-857.
- 62 Fjeldsoe BS, Marshall AL, Miller YD. Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service. American Journal of Preventive Medicine 2009; 36 (02) 165-173.
- 63 Heckman TG. The chronic illness quality of life (CIQOL) model: Explaining life satisfaction in people living with HIV disease. Health Psychology 2003; 22 (02) 140-147.
- 64 Noordzij M, Tripepi G, Dekker FW, Zoccali C, Tanck MW, Jager KJ. Sample size calculations: basic principles and common pitfalls. Nephrology, Dialysis, Transplantation 2010; 25 (05) 1388-1393.
- 65 World Health Organization. International Classification of Functioning, Disability and Health (ICF).