We developed this protocol based on the scoping review framework proposed by Arksey and O’Malley (2005) and as recommended by Levac and colleagues [17-19]. In addition, we plan to follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist to perform the scoping review . The detailed research process and content are as follows:
Framework stage 1: Identifying the research question
The research questions in this review will help to identify the factors affecting the care continuum of PLHIV. The specific research questions are as follows:
1) What are the barriers that affect the care continuum of PLHIV identified in the existing evidence?
2) What are the facilitators that affect the care continuum of PLHIV identified in the existing evidence?
3) Are each identified barriers and/or facilitators located at any particular period or the entire period of the HIV care continuum?
Framework stage 2: Identifying related studies
As a research team, with the assistance of a librarian, we have developed a comprehensive search strategy (supplemental materials 1). We plan to conduct a literature search from the database of MEDLINE, EBSCO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Cochrane library that will include peer-reviewed articles published in English or Korean between 2013 and 2020. The search period was set to begin from 2013 because the guidelines to start ART changed from when the number of CD4 immune cells fell below a certain level to immediately after the diagnosis of HIV infection [21, 22].
In addition, we will review guidelines and policies on HIV care published by organizations related to HIV infection such as the World Health Organization (WHO), International Association of Providers of AIDS Care (IAPAC), Centers for Disease Control and Prevention (CDC), The U.S. Department of Health and Human Services (HHS), and Korean Centers for Disease Control and Prevention (KCDC). These will be useful to review the methodological quality of the studies included in the scoping review.
Framework stage 3: Study selection
First, the results retrieved from each database will exclude duplicate articles using the Endnote X9.2 program. Three researchers will screen titles and abstracts to exclude articles that do not meet eligibility criteria. Second, a review of full-text articles will determine which to include in the final analysis. Last, we will report this process using the PRISMA flow diagram (Fig. 1). To ensure systematic processing, we will conduct adequate discussions and training prior to screening and selection, and report the progress through weekly research meetings and discussion of results.
For this review, the inclusion criteria are articles on (1) people with HIV over the age of 19 and (2) outcomes (barriers and facilitators) that present the factors affecting HIV care. Concurrently, the exclusion criteria are articles on (1) children and adolescents, (2) HIV prevention in non-infected persons, (3) only for the population in a specific context or situation (e.g., transgender people, inmates, pregnant women, refugees, etc.), (4) methodological research, such as scale development or program development, (5) trial or review protocol, and (6) expert opinions and insights articles that do not include original data.
Framework stage 4: Charting the data
The research team will build a charting form through discussions, including characteristics of the screened articles and outcomes. Table 1 shows the expected contents to be included in the charting form. Prior to charting, researchers will be provided sufficient training on the methods of data abstraction. Subsequently, each researcher will perform data abstraction of five randomly selected articles and discuss the results, modifying the charting form if necessary. If the need arises for a collaborative discussion on specific aspects during the charting process, each researcher will record and present these at weekly review meetings.
Framework stage 5: Collating, summarizing, and reporting the results
The barriers and facilitators will be classified according to the care continuum presented in each study, followed by frequency analysis. Through this process, the research team can identify barriers and facilitators that show (1) high frequency and (2) conflicting results from the research thus far. Furthermore, the synthesized results will enable the research team to present the framework on barriers and facilitators in the HIV care continuum and propose implications for future research, practice, and policy.
Framework stage 6: Consultation exercise
This review will not include the consultation exercise stage.
Levac and colleagues suggested collecting evidence from stakeholder consultation and using a critical appraisal tool to ensure that the scoping review meets the standard quality . To identify the evidence from stakeholder consultation, we will gather experts’ opinion from the PLHIV, who are consumers of these exploration topic, and nurses and physicians who provide health services across the care continuum. List of barriers and facilitators configured through the five-step process will be provided to the experts in order to evaluate the validity of each item of list based on their own experience and knowledge. The quality of the selected studies will be evaluated using the mixed method appraisal tool (MMAT) version 2011 . Moreover, at a weekly review meeting, we will discuss the quality of these selected studies and whether to exclude them from the analysis.