Comparison of mHealth and Face-to-Face Interventions for Smoking Cessation Among People Living With HIV: Meta-Analysis

Abstract

Background: The prevalence of smoking among people living with HIV (PLHIV) is higher than that reported in the general population, and it is a significant risk factor for noncommunicable diseases in this group. Mobile phone interventions to promote healthier behaviors (mobile health, mHealth) have the potential to reach a large number of people at a low cost. It has been hypothesized that mHealth interventions may not be as effective as face-to-face strategies in achieving smoking cessation, but there is no systematic evidence to support this, especially among PLHIV.

Objective: This study aimed to compare two modes of intervention delivery (mHealth vs face-to-face) for smoking cessation among PLHIV.

Methods: Literature on randomized controlled trials (RCTs) investigating effects of mHealth or face-to-face intervention strategies on short-term (4 weeks to <6 months) and long-term (≥6 months) smoking abstinence among PLHIV was sought. We systematically reviewed relevant RCTs and conducted pairwise meta-analyses to estimate relative treatment effects of mHealth and face-to-face interventions using standard care as comparison. Given the absence of head-to-head trials comparing mHealth with face-to-face interventions, we performed adjusted indirect comparison meta-analyses to compare these interventions.

Results: A total of 10 studies involving 1772 PLHIV met the inclusion criteria. The average age of the study population was 45 years, and women comprised about 37%. In the short term, mHealth-delivered interventions were significantly more efficacious in increasing smoking cessation than no intervention control (risk ratio, RR, 2.81, 95% CI 1.44-5.49; n=726) and face-to-face interventions (RR 2.31, 95% CI 1.13-4.72; n=726). In the short term, face-to-face interventions were no more effective than no intervention in increasing smoking cessation (RR 1.22, 95% CI 0.94-1.58; n=1144). In terms of achieving long-term results among PLHIV, there was no significant difference in the rates of smoking cessation between those who received mHealth-delivered interventions, face-to-face interventions, or no intervention. Trial sequential analysis showed that only 15.16% (726/1304) and 5.56% (632/11,364) of the required information sizes were accrued to accept or reject a 25% relative risk reduction for short- and long-term smoking cessation treatment effects. In addition, sequential monitoring boundaries were not crossed, indicating that the cumulative evidence may be unreliable and inconclusive.

Conclusions: Compared with face-to-face interventions, mHealth-delivered interventions can better increase smoking cessation rate in the short term. The evidence that mHealth increases smoking cessation rate in the short term is encouraging but not sufficient to allow a definitive conclusion presently. Future research should focus on strategies for sustaining smoking cessation treatment effects among PLHIV in the long term.

Keywords: HIV; mHealth; smoking cessation.

Conflict of interest statement

Conflicts of Interest: OAU is supported by the National Institute of Health Research using Official Development Assistance funding and Wellcome Trust strategic award. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health, or Wellcome Trust.

©Olalekan A Uthman, Chidozie U Nduka, Mustapha Abba, Rocio Enriquez, Helena Nordenstedt, Fred Nalugoda, Andre P Kengne, Anna M Ekström. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 07.01.2019.

Figures

Figure 1

Adjusted indirect comparison network meta-analysis framework. A: mhealth delivered; B: face to face; C: standard of care.

Figure 2

Trial sequential analysis.

Figure 3

Study selection flow diagram. SMS: short message service.

Figure 4

Risk of bias in included studies.

Figure 5

Pairwise comparisons of all interventions, short-term effect. RR: risk ratio; SMS: short message service; SoC: standard of care, no intervention control.

Figure 6

Trial sequential analysis for mHealth for smoking cessation in people living with HIV, short-term effect. mHealth: mobile health.

Figure 7

Pairwise comparisons of all interventions, long-term effect. RR: risk ratio; SMS: short message service; SoC: standard of care, no intervention control.

Figure 8

Trial sequential analysis for mHealth for smoking cessation in people living with HIV, long-term effect. mHealth: mobile health.