Assessing the Impact of Digital Communication Tools on Oral PrEP Adherence: A Systematic Review and Meta-analysis

This systematic review and meta-analysis evaluated the effect of digital communication tools (e.g., text message reminders) on improving daily oral HIV pre-exposure prophylaxis (PrEP) adherence. Searching PubMed, Embase, Web of Science, and PsychInfo, alongside clinical trial registries, we identified randomized controlled trials from 2012 to 2024 that compared digital interventions with standard care. The primary outcome of interest was PrEP adherence. From 975 studies reviewed, ten met our criteria, encompassing interventions on text messaging (n = 3), mobile applications (n = 6) and mobile games (n = 1). One study exclusively included cisgender women in Kenya. Nine studies focused on gay, bisexual, and other men who have sex with men (GBM)-four of these included transgender women (TW)-based in the USA (n = 8) and Thailand (n = 1). Studies measured PrEP adherence using tenofovir-diphosphate (TFV-DP) blood levels (n = 8), self-report (n = 1), and electronic bottle pill monitoring (n = 1). Utilizing a random-effects meta-analysis, we estimated pooled risk ratios (RR) for adequate PrEP adherence (TFV-DP levels ≥700 fmol/punch) at 12- and 24-weeks post-intervention. Due to differences in outcome measurement and timing, eight studies were pooled for the 12-week RR and seven for the 24-week RR. Those studies involved GBM and TW. At 12 weeks (n = 977), results showed a modest improvement in adherence (RR = 1.08, 95% CI: 1.02-1.14). There were no effects at 24 weeks (n = 562) (RR = 1.10, 95% CI 0.92-1.32). These findings suggest that digital communication tools had a limited impact on improving PrEP adherence. Further research is needed to develop sustained and diverse intervention strategies to support PrEP adherence.