Digital health interventions for HIV-related sexual risk behaviors: a systematic review and network meta-analysis

HIV-related sexual risk behaviors (e.g., condomless anal intercourse, inconsistent condom use, multiple sexual partners) remain a major driver of HIV infection globally. Digital health interventions (DHIs), ranging from SMS and mHealth to AI-driven programs, offer promising strategies to modify these behaviors. We systematically reviewed the comparative effectiveness of DHIs targeting HIV-related sexual risk behaviors. A comprehensive literature search was conducted in five databases, including the Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, and Scopus, with the search date up to March 4, 2026. Based on a network meta-analysis of 35 randomized controlled trials (RCTs) involving 33,183 participants, SMS or phone call interventions were associated with the largest reductions in unprotected anal intercourse prevalence (OR 0.18, 95% CI 0.04-0.79) and inconsistent condom use frequency (MD -3.49, 95% CI -5.17 to -1.81). eHealth was associated with a significant reduction in the number of sexual partners (MD -0.28, 95% CI -0.52 to -0.03). Subgroup analyses indicated that follow-up duration significantly modified intervention effects for inconsistent condom use frequency and the number of sexual partners, with mHealth showing the most favorable relative ranking over longer periods ( ≥ 6 months). These findings suggest the potential of specific digital modalities, particularly SMS or phone call and eHealth, to complement comprehensive HIV prevention frameworks. However, the majority of network comparisons were supported by low or very low certainty evidence, indicating that future high-quality trials may alter these rankings.