Adapted Targeted Literature Review (ATLR) Supported Robust Questionnaire Development for a Multi-National Survey Study Evaluating Human Immunodeficiency Virus (HIV) Care and Treatment and Experiences of People With HIV (PWH)

OBJECTIVES: Despite sincere intentions behind global HIV targets, persisting inequalities in the HIV care cascade are widening¹. An observational, multinational, direct-to-patient study using online quantitative survey methods, aimed to evaluate the experiences of PWH, the barriers and facilitators to the HIV care cascade, health-related quality of life (HRQoL), and the potential role of long-acting anti-retroviral therapies (LAART) in overcoming barriers.

Robust quantitative survey instrument (questionnaire) development is challenging² and merits careful design for credible data capture³ and selecting valid outcome assessment measures^2,3. To this end, we conducted an ATLR, applying adapted rapid review⁴ and qualitative evidence synthesis methods⁵.

METHODS: A search algorithm in Medline, aimed for high specificity to survey study objectives and included medical subject headings terms, free-text keywords, and specific study designs. Search “limits” for language and dates were applied.

Search output titles and abstracts were screened in order of recency for relevancy. The first 100 titles of which 15 to 20 abstracts were included and full texts retrieved.

We extracted design characteristics and any patient-reported outcome measures used. The results and discussion sections were thematically analyzed to extract and synthesize codes into subthemes merged into broader themes.

RESULTS: 18 of 1019 citations were included. 7 qualitative, 7 quantitative, and 4 mixed methods. Median publication year: 2022 (2020-2023). 11 studies were single country based (5 United States, 1 Canada, 2 Uganda, 1 Zambia, 1 Greece, 1 Australia). 7 were multinational.

Diverse and important barriers and facilitators were synthesized for key points in the HIV care cascade, i.e., care access, treatment initiation, continuous engagement, re-engagement following interruption, and achieving and maintaining viral suppression.

CONCLUSIONS: The ATLR supported rapid development of a robust questionnaire and provided key insights on the experiences and HRQoL of PWH, barriers and facilitators, and the potential role of LAART in overcoming barriers.