Article Text

Barriers and facilitators associated with steps of the HIV care cascade for migrants in OECD countries: a systematic mixed studies review protocol
  1. Anish Arora1,2,3,
  2. Amelie Quesnel-Vallee4,5,
  3. David Lessard2,3,
  4. Kedar Mate1,2,3,
  5. Adriana Rodriguez-Cruz1,2,3,
  6. Nadine Kronfli2,6,
  7. Kim Engler2,3,
  8. Isabelle Vedel1,
  9. Bertrand Lebouché1,2,3,6
  10. In collaboration with the Antiviral Speed Access Program (ASAP) Migrant Advisory Committee
  1. 1Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
  2. 2Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
  3. 3Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Canadian Institutes of Health Research, Montréal, Québec, Canada
  4. 4Department of Sociology, Faculty of Arts, McGill University, Montréal, Québec, Canada
  5. 5Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
  6. 6Department of Medicine, Chronic Viral Illness Service, Division of Infectious Diseases, McGill University Health Centre, Montréal, Québec, Canada
  1. Correspondence to Mr Anish Arora; anish.arora{at}


Introduction In 2019, the United Nations signalled a substantial rise in the number of international migrants, up to 272 million globally, about half of which move to only 10 countries, including 8 member nations of the Organization for Economic Co-operation and Development (OECD). Migrants in OECD countries are often at higher risk for acquiring HIV and have a higher frequency of delayed HIV diagnosis. The barriers and facilitators that migrant people living with HIV (PLWH) in OECD countries face in relation to HIV care are insufficiently understood. The five-step HIV Care Cascade Continuum (HCCC) is an effective model to identify gaps, barriers and facilitators associated with HIV care. The purpose of this study is to generate a comprehensive, multilevel understanding of barriers and facilitators regarding the five steps of the HCCC model in OECD countries by migration status.

Methods and analysis A systematic mixed studies review using a data-based convergent design will be conducted. Medline, Embase, Scopus, CINAHL and the Cochrane Library will be searched on 25 March 2020. Screening and critical appraisal will be conducted independently by the first author. Authors 3–5 will act as second reviewers, each independently conducting 33% of the screening and appraisal. Quantitative data will be transformed to qualitative data and be synthesised using thematic analysis. The Mixed Methods Appraisal Tool will be used for quality assessment. An advisory committee, composed of four migrant PLWH, will be involved in screening and appraising 5% of articles to build knowledge and experience with systematic reviews. They will also be involved in analysis and dissemination.

Ethics and dissemination Ethics approval was obtained from the McGill University Health Centre (15-188-MUHC, 2016-1697, eReviews 4688). Publications arising from this study will be open-access.

PROSPERO registration number CRD42020172122.

  • HIV & AIDS
  • international health services
  • organisation of health services
  • health policy
  • public health

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  • Collaborators Antiviral Speed Access Program (ASAP) Migrant Advisory Committee: CIHR/SPOR Mentorship Chair in Innovative Clinical trial in HIV Care.

  • Contributors This study was conceived by AA, AQ-V, DL, KM, KE and BL. The migrant patient advisory committee, collectively assigned the sixth author role, was also involved in the designing of this work. AA worked with an academic librarian to establish the search strategy and eligibility criteria. The search strategy, eligibility criteria and study design were further revised in consultation with AQ-V, DL, KM, KE, IV, BL and the migrant patient advisory committee. AA, DL, KM and AR-C will be involved in the data collection for this study. All authors will be involved in data interpretation and analysis. AA wrote several versions of this manuscript. All authors have provided substantial edits to multiple versions of this manuscript. All authors provided their final approval for the publication of this version of the manuscript and agree to be accountable for all aspects of this work.

  • Funding AA is supported by a studentship from the Research Institute of the McGill University Health Centre and a scholarship from the Fonds de Recherche Québec–Santé given in partnership with Unité de Soutien SRAP de Québec. BL is supported by Canadian Institutes for Health Research, Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials for HIV Care, Gilead Investigator Sponsored Research Program. BL is also supported by a career award LE 250 from the Quebec’s Ministry of Health for researchers in Family Medicine. NK is supported by a career award from the Fonds de Recherche Québec–Santé (FRQ-S; Junior 1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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