Effectiveness of text messaging interventions on prevention, detection, treatment, and knowledge outcomes for sexually transmitted infections (STIs)/HIV: a systematic review and meta-analysis

Table 2 GRADE assessment of three important outcomes: appointment adherence, antiretroviral adherence by pill count and self-report

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Text messaging	Control	Relative (95% CI)	Absolute (95% CI)
Effectiveness of text messaging to support STI prevention and treatment interventions—appointment adherence
8^a	Randomized trials	Serious	Serious^b	Serious^c	Serious	Publication bias strongly suspected	1995/2499 (79.8%)	1869/2528 (73.9%)	OR 1.64 (1.28 to 2.10)	84 more per 1000 (from 45 more to 117 more)	Very low	Important
Effectiveness of text messaging to support HIV adherence–effectiveness of text messaging to support HIV adherence-pill count
10	Randomized trials	Serious^d	Serious^e	Serious^f	Not serious	None	512/1039 (49.3%)	372/862 (43.2%)	OR 1.31 (1.06 to 1.60)	67 more per 1000 (from 14 more to 117 more)	Very low	Important
Effectiveness of text messaging to support HIV adherence–effectiveness of text messaging to support HIV adherence-self-reported
5	Randomized trials	Serious^g	Not serious	Serious^h	Seriousⁱ	None	340/522 (65.1%)	275/515 (53.4%)	OR 1.64 (1.28 to 2.11)	119 more per 1000 (from 61 more to 173 more)	Very low	Important

CI confidence interval, OR odds ratio
^aSerious risk of bias. Although all studies were single-blinded, the outcome assessment appeared free from bias because the investigators blinded outcome assessors. We downgraded because of the lack of blinding of patients in studies and only one study clearly used intention to treat analysis
^bSerious inconsistency. There was unexplained inconsistency and moderate I² values with no statistically significant heterogeneity of effect estimates; however, the confidence intervals did overlap
^cSerious indirectness. One trial included children only, one trial adult soldiers, and one trial adults and children (> = 14 years). The effect in adults living in the community may be different
^dSerious risk of bias. We downgraded because 7 out of 10 RCTs were at high risk of bias
^eSerious inconsistency. There was unexplained inconsistency and moderate I² values with statistically significant heterogeneity of effect estimates. One study’s confidence intervals did not overlap ([71])
^fSerious indirectness. Populations varied, as well as frequency of text reminders sent
^gSerious risk of bias. One study had unclear risk of allocation concealment. Four out of five RCTs did not have adequate blinding of personnel to the study arms
^hSerious indirectness. Populations varied, as well as frequency of text reminders sent
ⁱSerious imprecision. Wide confidence intervals present

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