Table_1_The experience of healthcare workers to HIV pre-exposure prophylaxis (PrEP) implementation in low- and middle-income countries: a systematic review and qualitative meta-synthesis.docx

BackgroundThe 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.
ObjectiveThis 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.
MethodsThe 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 16th 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.
ResultsFourteen 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.”
ConclusionThis 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.
Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/. The protocol of this review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023411604).

背景
暴露前预防（pre-exposure prophylaxis）的有效性已得到广泛证实。然而，其实际落实与理想目标之间仍存在显著差距，在低收入和中等收入国家（low-and middle-income countries）尤为突出。医护人员（healthcare workers）在暴露前预防的落实工作中发挥着关键作用，他们对暴露前预防落实的阻碍因素及促进策略拥有更为丰富的多维度实践经验。然而，针对整合其经验的相关研究证据仍较为匮乏。
目的
本研究旨在整合低收入和中等收入国家中医护人员开展暴露前预防服务的实践经验，梳理暴露前预防落实过程中的阻碍因素、促进条件及优化建议。
方法
本项定性元合成研究的设计与报告撰写遵循增强定性研究合成报告透明度声明（Enhancing transparency in reporting the synthesis of qualitative research，ENTREQ）的规范。研究检索了PubMed、CINAHL Plus with Full Text、Embase、Web of Science四个数据库，检索时限为各数据库建库起至2023年3月16日。采用乔安娜·布里格斯研究所关键评价清单（Joanna Briggs Institute Critical Appraisal Checklist）进行质量评价。采用乔安娜·布里格斯研究所（Joanna Briggs Institute，JBI）元整合方法（meta-aggregation approach）指导数据提取与整合工作，并使用JBI证据质量分级法（ConQual approach）对整合后的研究结果的证据等级进行评估。
结果
本系统评价最终纳入14篇方法学质量良好的文献。共提取得到122项研究结果，最终将117项可信度评级为“明确（unequivocal）”或“疑似（equivocal）”的结果纳入本次元合成分析。符合纳入标准的研究结果被整合为13个新类别，进而提炼出3项核心整合结果：低收入和中等收入国家暴露前预防落实的阻碍因素、促进条件及优化建议。三项核心整合结果的整体JBI证据质量分级评级均为“低（low）”等级。
结论
本系统评价整合了低收入和中等收入国家医护人员开展暴露前预防工作的实践经验，可通过以下核心策略提升暴露前预防的服务覆盖率：强化暴露前预防相关知识宣教、营造支持性工作环境、破解药物相关障碍、增加人力资源与财政投入、丰富服务提供模式。
系统评价注册信息：https://www.crd.york.ac.uk/PROSPERO/。本研究的研究方案已在国际系统评价前瞻性注册平台（International Prospective Register of Systematic Reviews，PROSPERO，注册号：CRD42023411604）完成注册。