West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Front Public Health. 2023 Aug 24;11:1224461. doi: 10.3389/fpubh.2023.1224461. eCollection 2023.
The effectiveness of pre-exposure prophylaxis has been extensively documented. However, there are substantial gaps between the actual implementation of pre-exposure prophylaxis and the ideal goal, especially in low-and middle-income countries. Healthcare workers play critical roles in the pre-exposure prophylaxis implementation, and they have more multi-level experiences about the barriers of pre-exposure prophylaxis implementation and how to facilitate it. However, the evidence aiming to synthesize their experiences is limited.
This study aims to aggregate the healthcare workers' experiences of providing pre-exposure prophylaxis in low-and middle-income countries, and find the barriers, facilitators, and recommendations of pre-exposure prophylaxis implementation.
The ENTREQ (Enhancing transparency in reporting the synthesis of qualitative research) statement was used to guide the design and reporting of this qualitative meta-synthesis. A comprehensive search was conducted from inception of databases to 16 March 2023 in four databases: PubMed, CINAHL Plus with Full Text, Embase, Web of Science. The quality appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Checklist. JBI's meta-aggregation approach was used to guide the data extraction and synthesis, and the JBI ConQual approach was used to evaluate the evidence level of the synthesized findings.
Fourteen articles with good methodological quality were included in this review. A total of 122 findings were extracted and 117 findings with credibility ratings of "unequivocal" or "equivocal" were included in this meta-synthesis. The eligible findings were aggregated into 13 new categories and subsequently developed into 3 synthesized findings: the barriers, facilitators, and recommendations of pre-exposure prophylaxis implementation in low-and middle-income countries. The overall ConQual score of all three synthesized findings was rated as "low."
This review aggregated the experience of health care workers implementing pre-exposure prophylaxis in low-and middle-income countries and we could focus on the following key points to promote the uptake of pre-exposure prophylaxis: improve knowledge about pre-exposure prophylaxis, create a supportive environment, address medication-related barriers, increase the human resources and financial investments, and diversify the providing models.
https://www.crd.york.ac.uk/PROSPERO/. The protocol of this review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023411604).
暴露前预防的有效性已得到广泛证实。然而，实际实施暴露前预防与理想目标之间存在很大差距，特别是在中低收入国家。医护人员在实施暴露前预防方面发挥着关键作用，他们对实施暴露前预防的障碍以及如何促进实施有更多多层次的经验。然而，旨在综合他们经验的证据有限。
本研究旨在综合中低收入国家医护人员提供暴露前预防的经验，发现实施暴露前预防的障碍、促进因素和建议。
本研究使用 ENTREQ（提高报告定性研究综合的透明度）声明来指导设计和报告这项定性元综合。从数据库建立之初到 2023 年 3 月 16 日，在四个数据库中进行了全面搜索：PubMed、CINAHL Plus with Full Text、Embase 和 Web of Science。使用 Joanna Briggs 研究所批判性评价清单进行质量评估。使用 JBI 元综合方法指导数据提取和综合，使用 JBI ConQual 方法评估综合结果的证据水平。
本综述纳入了 14 篇方法学质量较好的文章。共提取了 122 项发现，其中 117 项发现的可信度评级为“明确”或“模棱两可”，被纳入本次元综合。合格发现被综合成 13 个新类别，并进一步发展成 3 个综合发现：中低收入国家实施暴露前预防的障碍、促进因素和建议。所有三个综合发现的总体 ConQual 评分均被评为“低”。
本综述综合了中低收入国家医护人员实施暴露前预防的经验，我们可以关注以下关键点来促进暴露前预防的实施：提高对暴露前预防的认识，创造支持性环境，解决与药物相关的障碍，增加人力资源和财政投入，以及多样化提供模式。
https://www.crd.york.ac.uk/PROSPERO/。本综述的方案已在国际前瞻性系统评价注册库（PROSPERO，CRD42023411604）中注册。
