Efetividade das intervenções de telessaúde para a adesão ao tratamento antirretroviral em pessoas vivendo com HIV/AIDS em áreas rurais ou remotas: revisão sistemática

Abstract

Introduction: The introduction of highly active antiretroviral therapy (HAART) has drastically reduced the mortality of people living with Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (PLWHA). Despite these advances, HIV infection remains a critical public health issue, especially for PLWHA in rural or remote areas. Focusing on telehealth interventions is particularly relevant given the global shift toward digital health solutions and the increased reliance on telehealth during the COVID-19 pandemic. Therefore, this study aimed to evaluate the effectiveness of telehealth in promoting adherence to HAART among PLWHA in rural and/or remote areas. Methods: We conducted a systematic review following PRISMA guidelines, with a comprehensive search of the MEDLINE, Embase, LILACS, Cochrane, Web of Science, IEEE Xplore databases, and grey literature to identify studies published from 2010 to 2022 in English, Spanish, or Portuguese. We included randomized controlled trials, cohort studies, case-control studies, and qualitative studies that assessed telehealth interventions for HAART adherence in rural PLWHA. Two independent reviewers conducted the study selection, data extraction, and quality assessment using the revised Cochrane risk-of-bias tool (RoB 2.0) for randomized trials and the Joanna Briggs Institute (JBI) tools for observational studies. Discrepancies were resolved through discussion or by a third reviewer. The primary outcome was HAART adherence, and the secondary outcome was viral suppression. Data were synthesized qualitatively due to methodological heterogeneity among the included studies. Results: Out of 4,347 identified records, 12 full-text articles were assessed for eligibility, and 5 studies met the inclusion criteria. The interventions included SMS reminders, mobile health applications, and telehealth consultations. Key findings included a significant improvement in HAART adherence with weekly SMS reminders (53% adherence in the intervention group vs. 40% in the control group; p = 0.03) and enhanced retention in care and viral suppression with mobile health applications (88% retention at 6 months and 81% at 12 months; p<0.001). However, no significant differences were found in retention or viral load reduction with SMS reminders in rural settings (retention: 90.7% in the intervention group vs. 96.8% in the control group; p = 0.15). Limitations: The methodological and population diversity, as well as constraints related to specific geographic contexts, such as the predominance of studies conducted in developed countries, pose challenges to the generalization of results. Additionally, the lack of long-term studies with standardized measures to assess the efficacy of specific interventions was also identified as a significant limitation. Conclusion: This study highlights the critical role of telehealth in addressing healthcare disparities and improving treatment adherence among underserved populations. Telehealth interventions, particularly mobile health applications and weekly SMS reminders, have demonstrated potential to enhance adherence to HAART among PLWHA in rural and remote areas. These findings support the integration of telehealth into HIV care strategies. However, further research is required, employing standardized measures, diverse geographic settings, and long-term follow-up to confirm these benefits and identify the most effective types of interventions. Study Registration and Funding: This study was registered in PROSPERO (CRD42022353083) and was funded by CAPES (Postgraduate Development Program (PDPG Amazônia Legal) through the project: Consolidation of PPGs UFAM: telehealth reducing distances and the National Academic Cooperation Program in the Amazon (PROCAD/AMAZÔNIA/CAPES) to strengthen the inter-institutional research cooperation network among PPGCIS/UFAM, the PPG in Clinical Research in Infectious Diseases at the Evandro Chagas National Institute of Infectious Diseases INI/FIOCRUZ, and PPGBIO/ILMD/FIOCRUZ Amazônia. Keywords (MESH): HIV. Telehealth. HAART Adherence. Viral Suppression. Rural Health. Systematic Review.