Evaluating the effectiveness of digital health interventions for HIV prevention and treatment adherence among transgender populations: a systematic review and meta-analysis

Background:
Transgender individuals face a disproportionate burden of HIV due to systemic barriers including stigma, discrimination, and limited access to gender-affirming healthcare. Digital health interventions (DHIs), such as mobile applications, telehealth, and online platforms, offer a promising avenue for delivering accessible, tailored, and potentially less stigmatizing HIV prevention and care services to this marginalized population.

Objectives:
This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs in improving HIV-related outcomes among transgender individuals. Specifically, it assessed the impact on HIV testing rates, care engagement, and stigma reduction.

Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across five electronic databases—PubMed, Web of Science, Google Scholar, ScienceDirect, and Wiley Online Library—from January 2020 to March 2025. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, and observational studies focusing on transgender populations and evaluating DHIs for HIV prevention or care. Screening, data extraction, and quality assessment were performed independently by two reviewers. A random-effects meta-analysis was conducted for quantitative synthesis, with heterogeneity assessed using I2 statistics. Subgroup analyses were performed by intervention type and year. Publication bias was evaluated using funnel plots and Egger's test.

Results:
A total of 11 studies were included in this meta-analysis. The pooled analysis demonstrated a significant positive effect of DHIs on HIV prevention and care outcomes, with an overall effect size (θ) of 1.82 (95% CI: 1.61–2.02). Heterogeneity was low (I2 = 13.32%), indicating consistent results across studies. Subgroup analyses confirmed sustained effectiveness across different years (2018–2024) and intervention types. No significant publication bias was detected (Egger's test, p = 0.147). The findings indicate that DHIs are acceptable and feasible, effectively improving key outcomes such as testing uptake and adherence.

Conclusion:
Digital health interventions are effective tools for enhancing HIV prevention and care engagement among transgender populations. Their success is likely attributable to increased accessibility, reduced stigma, and tailored design. To maximize impact and equity, future DHIs must be intentionally designed to be culturally competent, gender-affirming, and inclusive of the diverse spectrum of transgender identities, with ongoing research needed to evaluate long-term efficacy and scalability across diverse global settings.