Effectiveness of mobile health (mHealth) interventions on ART adherence among people living with HIV in low- and middle-income countries: a systematic review and meta-analysis

Antiretroviral therapy (ART) is essential for HIV treatment, yet maintaining high adherence remains challenging in resource-limited settings. Mobile health (mHealth) interventions offer a scalable approach to support adherence. This meta-analysis evaluated the effectiveness of mHealth interventions in improving ART adherence and clinical outcomes among people living with HIV (PLHIV) in low- and middle-income countries. Eight databases were searched through February 2025, and randomised controlled trials (RCTs) evaluating mHealth interventions were included. Risk of bias was assessed using the Cochrane tool, and random-effects models were applied. Seventeen RCTs (n = 2172) met the inclusion criteria. mHealth interventions significantly improved ART adherence compared with standard or alternative approaches (OR = 2.03; 95% CI: 1.44-2.86; p<0.0001). Subgroup analyses indicated moderating effects of geographic region (χ² = 8.84, p = 0.01) and country income level (χ² = 6.44, p = 0.04), with the greatest adherence benefits observed in the Americas (OR = 5.46; 95% CI: 2.20-13.57) and in upper-middle-income countries (OR = 3.45; 95% CI: 1.69-7.06). mHealth interventions also improved viral suppression (OR = 2.27; 95% CI: 1.18-4.36). Although CD4 count improvements were noted, sensitivity analysis suggested this effect was not robust. Overall, mHealth interventions show promise for strengthening ART adherence in resource-limited settings, while further research should explore contextual factors influencing effectiveness.