Exploring the equity impact of mHealth-based HIV interventions: a systematic review of reviews and evidence synthesis

Objective: While mHealth-based HIV interventions are often designed to promote health equity, systematic differences in the use of and access to mobile technologies may counteract that and widen treatment gaps. This systematic review applies an equity lens to investigate whether existing research provides adequate evidence on the ethical implications of mHealth technologies in HIV treatment and prevention. Methods: A two-stage methodology, consisting of 1) a systematic review of systematic reviews and 2) an evidence synthesis of primary studies. For the review of reviews we searched eight electronic databases, eight electronic journals, and Google Scholar We also screened reference lists and consulted authors of included studies. Primary studies were extracted from eligible reviews. We based our data extraction and analysis on the PROGRESS-Plus framework and the use of harvest plots, focusing on the socio-demographic distribution of mHealth effects. Results: 8786 citations resulted in 19 eligible reviews and 39 eligible primary studies. Existing reviews did not provide any analyses of the equity impacts of mHealth-based HIV initiatives. Information availability was higher in primary studies, predominantly suggesting no social gradient of mHealth-based HIV interventions. Overall, evidence remains weak and not sufficient to allow for confident equity statements. Conclusions: Despite the negative force of socio-demographic inequities and the emerging nature of mobile health technologies, evidence on the equity implications of mHealth interventions for HIV care remains scarce. Not knowing how the effects of mHealth technologies differ across population subgroups inevitably limits our capacities to equitably adopt, adjust, and integrate mobile health interventions towards reaching those disproportionally affected by the epidemic.