A scoping review maps the literature on the available topic to recognize critical concepts, theories, sources of evidence, and gaps in literature(25, 26). It helps to know the nature, range, and extent of research available on a subject, summarize and circulate the findings across a body of research evidence (27). Therefore, a scoping review synthesizes the literature to provide an overview of what is available in the research topic area as evidence (28, 29).
The methodological framework proposed by Arksey and O'Malley (2005) will be adopted for this proposed review. Therefore, the following five stages will be followed in this scoping review: (i) recognizing the research question, (ii) recognizing relevant studies, (iii) selection of eligible studies, (iv) charting the data, and (v) collating, summarizing, and reporting the results. This current scoping review intends to chart all research activities in this area; therefore, a quality appraisal will not be carried out.
Recognizing The Research Question
The main research question this review seeks to provide an answer to is: "what is the evidence that HIV-positive women experience unintended pregnancies, including those that may be on contraceptives?"
The research sub-questions are:
1. What is the evidence of the incidence of unintended pregnancies among HIV-positive women of reproductive age?
Recognizing Relevant Studies
Published and unpublished (grey) literature will be explored on unintended pregnancies among HIV-positive women using electronic databases including Cochrane Library, World of Science, PubMed, and WorldCat. Studies reported from the year 2000 until August 2021 will be included. The Medical Subject Headings (MeSH) terms or keywords will include "HIV positive women", "unintended pregnancies", "contraception” "Sub-Saharan Africa (SSA)", "low- and middle-income countries", "unplanned birth", "unwanted pregnancy", "unplanned pregnancy", "unintended births" and "unwanted births". The appropriateness of keywords and databases will be ascertained by piloting the search strategy. To ensure no vital information is left out, keywords may be refined to include different groups of HIV-positive women, such as those using antiretrovirals (ARVs). A hand search will also be conducted of the references cited in the included studies and search on websites including World Health Organization (WHO) to identify other potentially relevant literature. Potentially relevant grey literature will be identified through specific searches of dissertations/theses (ProQuest Dissertations & Theses Global) and conference abstracts. The PEO framework (Table 1) will guide title and abstract screening. Further eligibility criteria will ensure that the content of the included studies is relevant to the research question.
Table 1
A PEO framework for eligible studies
P- population HIV positive women of reproductive age (15-49 years) in SSA
E – exposure Unintended pregnancy
O –outcome Prevalence
Incidence
Risk factors of unintended pregnancies
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Selection Of Eligible Studies
Inclusion criteria
Studies must meet the following criteria to be included:
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HIV positive women of reproductive age who experienced unintended pregnancies
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Published from the year 2000 to August 2021
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Qualitative and quantitative studies
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Sub Saharan African countries (SSA)
Exclusion Criteria
Studies must have the following characteristics to be excluded:
All eligible articles will be imported into Mendeley Desktop software following a comprehensive search using the keywords mentioned earlier. Duplicate reports will be identified and removed. Two separate reviewers will screen the title and abstract of the eligible articles to ascertain if they fit the review. The full-text screening will also be done. There will be the involvement of a third reviewer should there be any discrepancies at the stage of full-text screening. The full text of selected articles will be gotten by making all possible efforts to either search the internet, intreating with the UKZN librarian, or reach the author if need be. Search record details such as search date, database, number of studies identified, keywords, and number of studies eligible will be appropriately documented. The guideline to report screening results will be adopted from the recommendations in the Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (30). Mapping will be done using the PRISMA-P chart (31). Table 2 will be used to present the results of the titles searched from various databases.
Table 2
Records of the database searched
Date of search
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Search engine used
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Keyword searched
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Number of articles found
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Number of eligible articles
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Table 3
Pilot search in PubMed database
Date of search
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Search engine used
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Keyword searched
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Number of publications retrieved
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26/08/21 Pubmed
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("pregnancy, unplanned"[MeSH Terms] OR ("pregnancy"[All Fields] AND "unplanned"[All Fields]) OR "unplanned pregnancy"[All Fields] OR ("unintended"[All Fields] AND "pregnancy"[All Fields]) OR "unintended pregnancy"[All Fields]) AND ("hiv seropositivity"[MeSH Terms] OR ("hiv"[All Fields] AND "seropositivity"[All Fields]) OR "hiv seropositivity"[All Fields] OR ("hiv"[All Fields] AND "positive"[All Fields]) OR "hiv positive"[All Fields]) AND ("women"[MeSH Terms] OR "women"[All Fields]) AND ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "prevalence"[All Fields] OR "prevalence"[MeSH Terms]) AND ("risk factors"[MeSH Terms] OR ("risk"[All Fields] AND "factors"[All Fields]) OR "risk factors"[All Fields]) AND ("epidemiology"[Subheading] OR "epidemiology"[All Fields] OR "incidence"[All Fields] OR "incidence"[MeSH Terms]) AND ("africa south of the sahara"[MeSH Terms] OR ("africa"[All Fields] AND "south"[All Fields] AND "sahara"[All Fields]) OR "africa south of the sahara"[All Fields] OR ("sub"[All Fields] AND "saharan"[All Fields] AND "africa"[All Fields]) OR "sub saharan africa"[All Fields])
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1640
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Charting The Data
Relevant information will be extracted from each of the studies included utilizing a data charting form, generated electronically using google forms. The data extracted will consist of the following (Table 4):
Table 4
Author and date of publication
Study title
Study aim/objective
Type of study design
Study setting
Study population
Sampling method
Data collection methods
Data analysis method
Significant findings
Conclusion
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Collating, Summarizing, And Reporting The Results
A narrative approach will present the findings from the studies that meet the inclusion criteria via thematic content analysis. NVivo version 11.0 software will be employed for the extraction themes that are relevant to the study. Collation, summary, and reporting of themes will focus on the outcomes of prevalence, incidence, and risk factors of unintended pregnancy among HIV-positive women. Also, emerging themes will be reported. These results will be described in accordance with the overall purpose of the research and help identify knowledge gaps.