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Abstract
Introduction HIV pre-exposure prophylaxis (PrEP) is an effective intervention to reduce acquisition of HIV. PrEP provision has increased in recent years, however, it is not known whether PrEP implementation has been equitably implemented across all risk groups, particularly groups experiencing high levels of health inequity. A PrEP care continuum (PCC) has been proposed to evaluate the success of PrEP implementation programmes, but the extent to which health equity characteristics are currently taken into account in the PCC has not been described. The objectives of this proposed systematic review are to (i) identify and collate outcome measure definitions for the main stages of the PCC (awareness, acceptability, uptake, adherence and retention), (ii) describe how equity characteristics are considered in outcome definitions of the PCC and (iii) describe data sources for capturing equity characteristics.
Methods and analysis Quantitative studies published between 1 January 2012 and 3 March 2020 will be included. Five databases (MEDLINE, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts) will be searched to identify English language publications that include an outcome measure definition of at least one of the five main stages of the PCC. Risk of bias will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Data on outcome measure definitions and equity characteristics will be extracted. Results will be presented in a narrative synthesis and all findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Ethics and dissemination Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. The review findings will have relevance to healthcare professionals, policymakers and commissioners in informing how to best evaluate PrEP implementation programmes and inform new implementation strategies for vulnerable and less advantaged populations.
PROSPERO registration number CRD42020169779.
- HIV & AIDS
- preventive medicine
- sexual medicine
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Footnotes
Contributors MC and LKM designed the study. MC developed and refined the study protocol with contributions from all coauthors (DS, JS, GR, HM and LKM). MC prepared the manuscript. MC will undertake data collection (literature search, data extraction), analysis, interpretation and report writing. All coinvestigators will contribute to the design, analysis, interpretation and report writing. All authors read and approved the final manuscript. This protocol was informed by input from a patient and public involvement (PPI) representative. A one-off PPI session was held to discuss the acceptability and accessibility of investigating equity considerations in the PCC and the appropriateness of using the PROGRESS-Plus framework to do so. The authors would like to thank the PPI representative for their contributions to the research question and study design.
Funding MC is funded by the Medical Research Council Doctoral Training Partnership (grant number: MR/N013867/1). The research is funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (reference number: NIHR200911). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the Medical Research Council, the National Institute for Health Research, the Department of Health or Public Health England.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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