Identifying the barriers and facilitators to culturally responsive HIV and PrEP screening for racial, ethnic, sexual, and gender minoritized patients: A scoping review protocol

Abstract

Introduction While mainstream messaging about human immunodeficiency virus (HIV) disparities continues to highlight individual risk-taking behavior among historically marginalized groups, including racial, ethnic, sexual, and gender minoritized patients, the effect of structural factors and social determinants of health (SDOH) on morbidity and mortality remain underestimated. Systemic barriers, including a failure of adequate and acceptable screening, play a significant role in the disparate rates of disease. Primary care practitioner (PCP) competency in culturally responsive screening practices is key to reducing the impact of structural factors on HIV rates and outcomes. To address this issue, a scoping review will be performed to inform the development of a training series and social marketing campaign to improve the competency of PCPs in this area. Objectives This scoping review aims to analyze what recent literature identify as facilitators and barriers of culturally responsive HIV and pre-exposure prophylaxis (PrEP) screening practices for historically marginalized populations, specifically racial, ethnic, sexual, and gender minoritized groups. A secondary aim is to identify themes and gaps in the literature to help guide future opportunities for research. Methods This scoping review will be performed following the framework set forth by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Relevant studies between the years 2019–2022 will be identified using a rigorous search strategy across four databases: MEDLINE (via PubMed), Scopus, Cochrane (CENTRAL; via Wiley), and CINAHL (via EBSCO), using Boolean and Medical Subject Headings (MeSH) search terms. Studies will be uploaded to the data extraction tool Covidence to remove duplicates and perform a title/abstract screening, followed by a full-text screening and data extraction. Results Data will be extracted and analyzed for themes related to culturally responsive HIV and PrEP screening practices in clinical encounters with the identified target populations. Results will be reported according to PRISMA-ScR guidelines. Discussion To our knowledge, this is the first study to use scoping methods to investigate barriers and facilitators to culturally responsive HIV and PrEP screening practices for racial, ethnic, sexual, and gender minoritized populations. The limitations of this study include the analysis restrictions of a scoping review and the timeframe of this review. We anticipate that this study’s findings will interest PCPs, public health professionals, community activists, patient populations, and researchers interested in culturally responsive care. The results of this scoping review will inform a practitioner-level intervention that will support culturally sensitive quality improvement of HIV-related prevention and care for patients from minoritized groups. Additionally, the themes and gaps found during analysis will guide future avenues of research related to this topic.

Identifying facilitators and barriers to culturally responsive communication for racial, ethnic, sexual, and gender minoritized patients when screened for COVID-19 vaccinations: A scoping review protocol

“…We are conducting two separate scoping reviews to inform and validate the design of this training, corresponding social marketing campaigns, and policy recommendations. The protocol for one scoping review related to culturally responsive communication for HIV and PrEP has been published with its analysis underway [ 6 ].…”

“…This protocol informs a scoping review focused on understanding how, and whether CRC is occurring between PCPs and minoritized groups related to COVID-19 vaccination screening. As noted in the aforementioned published protocol, the data from the two reviews will be combined to inform 1) a training series for PCPs pertaining to CRC screening for COVID-19, HIV testing and PrEP screening, 2) a social marketing campaign by PCPs to encourage other PCPs to routinize culturally responsive conversations about testing, screening, and prevention; and 3) a white paper with policy recommendations for improved screening guidelines for HIV and to inform better implementation of current guidelines for HIV, PrEP/PEP and COVID-19 [ 6 ]. The remainder of this article describes the protocol guiding the scoping review on CRC related to COVID-19 screening by PCPs with the noted minoritized groups.…”

“…In existing published literature, CRC has been related to culturally competent care and has been defined as "communicating with awareness and knowledge of cultural differences and attempting to accommodate those differences," [12(p2)] and it necessarily involves "respect and an understanding that sociocultural issues such as race, gender, sexual orientation, disability, social class and status can affect health beliefs and behaviours" [12(p2)]. Xavier & colleagues expand upon this definition, while emphasizing that within primary care, PCPs must "engage with patients" in a responsive way that appreciates the role of culture, including their views as healthcare professionals [6]. According to these authors: "Cultural responsiveness centers unique patient experiences and understandings of health and illness, recognizes the individual biases that clinicians may hold, and seeks to work productively with patients who are not typically represented or valued in the Western understandings of care.…”