Evaluating the Efficacy of Digital Health Interventions in Advancing HIV Pre-Exposure Prophylaxis and Therapeutic Adherence Among Transgender Populations: A Systematic Review and Meta-Analysis

Alex Siu Wing Chan^1*Rayner Kay Jin Tan Tan²Alston Choong³Kean Chang Phang³Sijia Li¹Rongrong Wu¹Patrick Ming-Kuen Tang⁴Eleanor J. Ong²Jocelyn Cheung⁵Jakkrapatara Boonruang⁶Phoenix Mo⁷

• ¹Hong Kong Baptist University Department of Social Work, Hong Kong, Hong Kong, SAR China
• ²National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
• ³Universiti Malaya Faculty of Medicine, Federal Territory of Kuala Lumpur, Malaysia
• ⁴The Chinese University of Hong Kong Department of Anatomical and Cellular Pathology, Hong Kong, Hong Kong, SAR China
• ⁵The University of Queensland Faculty of Health Medicine and Behavioural Sciences, Herston, Australia
• ⁶Institute of HIV Research and Innovation, Bangkok, Thailand
• ⁷The Chinese University of Hong Kong The Jockey Club School of Public Health and Primary Care, Hong Kong, Hong Kong, SAR China

Background: Transgender individuals face significant barriers to HIV prevention and care, including stigma and limited access to services, affecting engagement in HIV care and antiretroviral therapy (ART). Digital health interventions (DHIs) can improve access to HIV testing, ART initiation, and care retention. However, the effectiveness of DHIs in enhancing ART adherence remains underexplored. Objectives: This systematic review and meta-analysis aimed to assess the effectiveness of digital health interventions in HIV prevention and care engagement among transgender individuals. Methods: A literature search across PubMed, Science Direct, Google Scholar, and Wiley Online Library identified studies on digital health interventions (DHIs) for HIV prevention and care in transgender populations. Studies evaluating HIV testing, PrEP adherence, and ART uptake were included. Quality was assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and JBI checklists. Meta-analysis was performed using RevMan 5.4.1 with random-effects models to calculate effect sizes and 95% confidence intervals (CIs). Results: Thirty-six studies (n = 2,847) were included. The pooled effect size for digital health interventions (DHIs) was 1.364 (95% CI: 1.306–1.421), indicating a statistically significant positive impact on HIV-related health outcomes. HIV testing rates increased from 35-46% at baseline to 89-100% at follow-up. The effect size for PrEP adherence ranged from 1.2 to 1.4 across studies, with most studies reporting a significant increase in adherence. In terms of HIV care retention, the pooled effect size was 1.3 (95% CI: 1.1–1.5), and improvements in stigma reduction were also noted. Digital platforms showed high feasibility and acceptability across studies. Conclusion: Digital health interventions significantly increase HIV testing and enhance HIV care engagement among transgender individuals, highlighting their potential to address healthcare disparities in this population. Further research is needed to explore long-term behavioral changes and sustained health outcomes.