Technologies for healthy lifestyle in people with HIV: a systematic review

Cunha, Gilmara Holanda da; Urbina Rojas, Yrene Esperanza; Dantas, Maiara Bezerra; Gomes, Maria Elisa Curado; Siqueira, Larissa Rodrigues; Fontenele, Marina Soares Monteiro

doi:10.1590/1980-220X-REEUSP-2024-0396en

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REVIEW • Rev. esc. enferm. USP 59 • 2025 • https://doi.org/10.1590/1980-220X-REEUSP-2024-0396en linkcopy

Technologies for healthy lifestyle in people with HIV: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to analyze clinical trials that assessed the effectiveness of technologies for healthy lifestyles in people with HIV.

Method: A systematic review, conducted in five databases, with association of controlled descriptors. Complete and electronically available randomized controlled clinical trial articles, without language or date restrictions, involving technologies for healthy lifestyles in people with HIV over 18 years of age were included. Studies involving children, adolescents, pregnant women and repeated articles were excluded. The Risk-of-Bias Tool for Randomized Trials and the Assessment of Multiple Systematic Reviews were used to assess bias and review quality.

Results: A total of 2,933 articles were identified and eight were selected. The technologies were mobile applications, booklets, motivational interviewing and telephone interventions, focusing on self-care, antiretroviral adherence, stress management, fatigue and depression, and encouraging reduction in smoking, alcohol and drug use.

Conclusion: The technologies were classified as soft-hard and hard, and improved the lifestyle of people with HIV. Registration in the International Prospective Register Systematic Reviews (PROSPERO): CRD42023422772.

DESCRIPTORS
HIV; Acquired Immunodeficiency Syndrome; Healthy Lifestyle; Educational Technology; Nursing

Databases	Crossings in databases	Number of articles
MEDLINE	(“Acquired Immunodeficiency Syndrome”[Mesh] OR “HIV”[Mesh]) AND “Technology”[Mesh]	1,371
Scopus	(Technologies OR Technology) AND Lifestyle AND HIV	53
Embase	(‘Human Immunodeficiency Virus’/exp OR ‘Human Immunodeficiency Virus’ OR ‘Acquired Immune Deficiency Syndrome’/exp OR ‘Acquired Immune Deficiency Syndrome’) AND (‘Technology’/exp OR Technology) AND (‘Lifestyle’/exp OR Lifestyle)	218
Web of Science	(“HIV Infections” OR “Acquired Immunodeficiency Syndrome”) AND (Technology OR Technologies)	841
LILACS	(HIV) AND (Technology) AND (“Healthy Lifestyle”) OR (“Life Style”)	196

Study title/country	Objectives	Sample	Intervention group	Control group	Outcomes
Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study(²⁰)/United States	Assess motivational interviewing to improve adherence to ART in PLWHIV.	Total: 247 IG: 125 CG: 122	In-person motivational interview, applied by a nurse in five sessions, lasting 20-90 minutes, for three months in person and by telephone.	Institutional standard care.	IG was superior to CG in adherence to ART six months after the start of the intervention (p < 0.001).
A feasibility study to develop and test a cognitive behavioral stress management mobile health application for HIV-related fatigue(²¹)/United States	Determine the feasibility and acceptability of the CBSM mHealth smartphone application to address and manage stress and fatigue in PLWHIV.	Total: 30 IG: 15 CG: 15	They downloaded and used the CBSM mHealth app on their smartphones, and were asked to complete one module per week.	Downloaded the Lifesum app, which is a generic healthy lifestyle app, and used it once a week.	IG: superior reduction in fatigue than CG: (mean difference: 1.6; 95% CI: 0.3-2.8). IG: superior decrease in depression up to the 5^th week (mean difference: 9.7; 95% CI: 1.1-18.4).
Knowledge, attitude and practice of people with HIV regarding a healthy lifestyle: clinical trial(³)/Brazil	Assess the effectiveness of a booklet on knowledge, attitude and practice for healthy lifestyle in PLWHIV.	Total: 144 IG: 70 CG: 74	Received the booklet in his office, read it completely and took it home to read every 15 days for six months.	Usual service care.	The educational booklet improved knowledge, attitude and practice about healthy lifestyle among PLWHIV.
Mobile health technology for improving symptom management in low income persons living with HIV(²³)/Canada	Examine the impact of an mHealth application (mVip) with self-care strategies for symptoms of PLWHIV.	Total: 76 IG: 40 CG: 40	They logged into mVip at least once a week to assess symptoms and receive self-care guidance.	They downloaded the mVIP, but did not receive self-care strategies.	IG: improvement in 12 of the 13 symptoms of HIV infection and in adherence to ART (p = 0.017) compared to CG.
Booklet for healthy lifestyle in people with HIV: a clinical trial(¹¹)/Brazil	Assess the effectiveness of an educational booklet to promote a healthy lifestyle and adherence to ART in PLWHIV.	Total: 174 IG: 70 CG: 74	Routine medical consultation, reading the booklet at the clinic, taking the booklet home to read fortnightly for six months.	Routine medical consultation.	At baseline, the lifestyle of most PLWHIV was unsatisfactory. The booklet improved lifestyle and ART adherence in IG compared to baseline and CG.
Efficacy of a mobile phone-based intervention on health behaviors and HIV/AIDS treatment management: randomized controlled trial(²⁴)/Vietnam	Assess the feasibility and effectiveness of mHealth intervention on ART adherence, self-efficacy and health behavior in PLWHIV in Vietnam.	Total: 425 IG: 238 CG: 187	Regular HIV/AIDS consultations, use of the Ecare app and one and three month follow-up.	Regular HIV/AIDS consultations. One and three month follow-up.	IG increased adherence to ART after one and three months, compared to CG. Improvement in risk behavior (smoking, drugs and alcohol) was positive in IG, but limited.
A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS(²²)/United States	Assess the effectiveness of an intervention for PLWHIV to cease smoking.	Total: 95 IG: 48 CG: 47	Standard medical advice and telephone intervention, with eight proactive face-to-face counseling sessions.	Standard counseling for smoking cessation.	IG was 3.6 times more likely to quit smoking compared to CG (p = 0.0059). Abstinence rates were 10.3% in CG and 36.8% in IG.
Effect of a WeChat-Based Intervention (Run4Love) on depressive symptoms among people living with HIV in China: randomized controlled trial(²⁵)/China	Assess the effectiveness of a WeChat-based intervention (Run4Love) using a randomized clinical trial with 300 PLWHIV with depression in China.	Total: 300 PLWHIV with depression IG: 150 CG: 150	They received the Run4Love program with a course on stress management and coping, short articles on self-care and a physical activity promotion program, with established goals and personalized feedback.	They received a document on nutrition and routine care for PLWHIV on WeChat.	IG had reduced depression severity (23.9 to 17.7 versus 24.3 to 23.8), improved quality of life (77.4 to 82.6 versus 76.6 to 77.0), reduced stress (20.0 to 15.7 versus 20.7 to 18.9), and improved coping (18.4 to 20.7 versus 18.3 to 17.8) compared to CG.

Risk of study bias	Articles assessed
Risk of study bias	(20)	(21)	(3)	(23)	(11)	(24)	(22)	(25)
1. Bias arising from the randomization process	+	−	+	+	+	+	+	?
2. Bias due to deviations from intended interventions	+	+	?	+	?	?	+	?
3. Bias due to missing outcome data	+	+	+	+	?	+	+	+
4. Bias in measurement of the outcome	?	+	+	?	+	+	?	+
5. Bias in selection of the reported result	+	+	+	−	+	+	+	+
Other biases	+	+	+	+	+	+	+	+

Study authorship	Study biases according to Risk-of-Bias Tool For Randomized Trials(18)
Dilorio et al., 2008(²⁰)	The majority of the sample consisted of low-income African-American men, which prevents generalization of results. Patients without low adherence to ART were included. Difficulty in adhering to the pill counting technology, which was a device attached to the bottle cap.
Barroso et al., 2020(²¹)	Significant differences between groups, with a predominance of men and people with higher education in CG. There were three people in illicit drug recovery programs in IG and none in CG.
Lima et al., 2022(³)	A greater number of unemployed people in CG. Part of the study took place during the COVID-19 pandemic in 2020, which may interfere with the results due to social isolation.
Schnall et al., 2018(²³)	The researchers did not specify the components, the organization of the study team, or whether the evaluators knew the group that received the intervention.
Lima et al., 2023(¹¹)	A greater number of unemployed people were in CG. Part of the study took place during the COVID-19 pandemic in 2020, which may interfere with the results due to the social isolation of participants.
Tran et al., 2017(²⁴)	There was a difference in the number of participants in groups, which was lower in CG.
Vidrine et al., 2006(²²)	They did not report whether the outcome evaluators were aware of the intervention applied, or whether there was a script or standard operating procedure for applying the interventions.
Guo et al., 2020(²⁵)	There was no blinding of the data collection team or intervention participants. It was not reported whether the application of the quality of life or depression assessment instruments in the following months occurred online or in person. The number of women in the study was not addressed, only men, homosexuals or bisexuals.

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[T2FN1] Notes: ART – antiretroviral therapy; PLWHIV – people living with HIV; IG – intervention group; CG – control group; CI – confidence interval.