Exploring current nutritional programming and resources available to people living with HIV/AIDs in Canada: a scoping review protocol : JBI Evidence Synthesis

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Exploring current nutritional programming and resources available to people living with HIV/AIDs in Canada: a scoping review protocol

Mannette, Jessica1; Zhang, Yingying1; Rothfus, Melissa2,3; Purdy, Chelsey1; Tesfatsion, Winta1; Lynch, Mary4,5; Hamilton-Hinch, Barb6; Williams, Patricia1,7; Joy, Phillip1; Grant, Shannan1,8,9

Author Information
doi: 10.11124/JBIES-21-00369
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Abstract

Introduction

An estimated 62,050 Canadians are currently living with HIV/AIDS.1 HIV is a virus that attacks the body's immune system and, if left untreated, can progress into AIDS and result in death.1 People living with HIV/AIDS (PLWHA) are also at higher risk of acquiring life-threatening infections (eg, cryptococcal meningitis, toxoplasmosis, pneumonia) and diseases (eg, cancer). Dietitians of Canada report that HIV/AIDS has had “a significant impact on domestic and global health, social, political, and economic outcomes.”2(p.1) Rates of these diseases are highest among marginalized populations who have historically experienced barriers in accessing medical care,2 including, but not limited to, people who inject drugs1 and men who have sex with men.1,3 There are 2 key forms of treatment for signs, symptoms, and virus progression: i) medical nutrition therapy (MNT) and ii) antiretroviral therapy (ART).4 As per standard care, health care providers encourage PLWHA to start MNT/ART as soon as possible after positive diagnosis to achieve/maintain optimal health/wellness.5

The nutrition care process (NCP) and MNT aim to prevent and manage the signs, symptoms, and progression of HIV/AIDS through nutrition assessment and co-developed support.6 MNT assessment includes nutrition-related problems, causes, and significance; medical, physical, social, economic, and dietary history; pharmacotherapy; and recognition/integration of social determinants of health (SDoH).6 Specific, non-medical, social, and economic factors contribute to SDoH, which impact health and medical outcomes, and include income, education, and employment.5-6 For example, Indigenous people(s), lesbian, gay, bisexual, and transgender people, and Black Canadians may experience discrimination, racism, and inter-generational trauma, which has been associated with negative health and medical outcomes.8 MNT interventions often target behavior or include education/content delivered through a variety of delivery systems. As part of the NCP, monitoring and evaluating behavioral changes and patient health is ongoing.7 Another key consideration for PLWHA in ongoing nutrition assessment is pharmacotherapy, which includes ART.

ART involves taking a combination of HIV medications daily to slow the progression of HIV and to prolong life and quality of life.5 There are, however, some nutritional problems/diagnoses associated with ART,6,9 including hyperlipidemia, hyperglycemia, and fat maldistribution. MNT can mitigate medication side effects5-6 and help the individual avoid negative food-drug interactions, such as a decrease in drug effectiveness.5 Together with improved medication adherence, MNT can reduce drug non-adherence, associated drug resistance, and progression to AIDS.6-7

PLWHA who are nutritionally vulnerable are also more likely to experience medication non-adherence and increased food-drug interactions, both of which can lead to malnutrition and/or wasting. Additionally, financial insecurity (income and social protection, and SDoH) has been correlated with poor adherence to ART.6 Moreover, an estimated 49% to 71% of PLWHA experience food insecurity in resource-high settings, which can be related to financial insecurity and increased nutritional vulnerability.10-11 Community food security occurs when “individuals, families and communities have access to enough affordable, healthy and culturally appropriate food, produced in socially, economically and ecologically sustainable ways.”12(p.1) Thus, food insecurity is experienced when there is a lack of access to healthy, culturally appropriate foods.12 PLWHA also experience higher rates of social stigma associated with financial and food insecurity in comparison to people not living with this diagnosis.13 This stigma may cause PLWHA to seek treatment later than recommended, further impacting their nutritional and medical health.13 In addition, PLWHA are more likely to experience competing demands for available resources, which can negatively impact the quality and quantity of the food they recieve.13

MNT and/or nutrition and food programming for PLWHA in Canada varies greatly, despite Canada having a national, publicly funded health care system,4 which provides universal coverage for medically necessary health care services on the basis of need, rather than the ability to pay.4 In Canada, the federal government distributes health care funding to provinces and territories, with the aim of meeting the needs and priorities of each region.4 Although it is generally accepted that NCP/MNT offer substantial benefits for PLWHA, there remains no official standard plan for treating this dynamic chronic disease.9,13 While programming tailored to regional- and population-specific needs is a key component of community-based intervention,14 a lack of consistency and communication may result in knowledge gaps and resource wastage.10,14 Research on other chronic diseases (eg, diabetes, obesity) and conditions (eg, pregnancy) has demonstrated dietitian-developed and delivered MNT and self-management support can offer significant positive health outcomes, economic benefits (eg, lower costs for patients, less hospitalizations), and increased self-efficacy, compared with non-dietitian-delivered interventions.15,16

A preliminary search of MEDLINE, the Cochrane Database of Systematic Reviews, PROSPERO, and JBI Evidence Synthesis was conducted in May and June 2021. No current or in-progress systematic or scoping reviews on the topic in the Canadian context were identified. There was, however, a 2015 report on the status of community-based HIV/AIDS food program organizations in Canada.11 This preliminary search supported the need for a Canadian-focused scoping review, as expressed by both peer-reviewed works13 and stakeholders.17 The objective of this proposed scoping review is to map the current literature available on nutrition and food programming available for PLWHA in Canada, including who is offering the programs and who the programs are targeting.

Tailoring interventions supports context-appropriate action and is a key step in the knowledge-to-action cycle (Canadian Health Institutes of Health Research Knowledge Translation/KT Model).14 The results of this scoping review will be a starting point for FoodNOW, a provincially funded, community-based nutritional needs assessment project and community of practice including health care workers, service providers, and PLWHA in Nova Scotia. Community consultation is part of integrative KT (iKT),17 and involved inviting stakeholders and end-users to provide feedback on programs and policies that impact them directly. Project stakeholders (including steering and advisory committees) have identified that there is a lack of resource mapping of Canadian nutrition and food programming available for PLWHA, confirmed by preliminary searches12 and community consultation.14 Lack of resource mapping has created knowledge silos across Canada, limiting knowledge sharing, exchange, and access. Preliminary searches also confirmed that this knowledge gap impacts PLWHA experiences of stigma, homophobia, racism, and food security when seeking or using nutrition and food programming.11,13,19-20 Research also supports that, given the multiple social identities of PLWHA, an intersectional approach to HIV/AIDS prevention and management would greatly benefit food programming research and planning toward inclusivity.19,21

Review question

What nutrition and food programming is available to people living with HIV/AIDS in Canada?

Inclusion criteria

Participants

The review will consider PLWHA in Canada of any age, gender, race, and sexual identity, as well as pregnant and/or lactating PLWHA.

Concept

The concept to be explored in this mapping activity is nutrition and food programming. Any food programming available in Canada targeted towards PLWHA will be eligible for review. This includes, but is not limited to, food provision services, clinical recommendations, nutritional assessments, and nutrition education and counseling. Any programming that specifically includes PLWHA (even if they are not the main target group) will be eligible for review.

Context

Relevant literature discussing or describing food and nutrition programming available in any province or territory in Canada will be included in this scoping review.

Types of sources

This scoping review will consider peer-reviewed and gray literature, including, but not limited to, primary research studies, systematic reviews, guidelines, reports, websites, and online newspaper articles. Both quantitative and qualitative studies will be considered for inclusion. Qualitative data will include, but is not limited to, method designs such as phenomenology, grounded theory, ethnography, qualitative description, participatory-action research, expert opinion text, and feminist research.

Methods

The proposed scoping review will be conducted in accordance with the JBI Manual for Evidence Synthesis.22,23

Search strategy

The search strategy, including all identified keywords and index terms, will be adapted for each included database and/or information source to capture both peer-reviewed and gray literature. To develop the search strategy, a preliminary search was conducted (JM) to locate relevant papers, from which a JBI-certified research librarian (MR, in collaboration with JM) used the index terms listed in the relevant papers to develop a full search strategy for CINAHL (see Appendix I). After the final search strategy was developed (MR), it underwent a Peer Review of Electronic Search Strategy (PRESS) by a second research librarian before being adapted for each included database and/or information source. For feasibility reasons, this review will include papers written or translated in English only, as this is the language of the first (JM) and second reviewers (YZ). Any studies excluded at this stage of the selection process will be recorded and reported in the review. No publication date restrictions will be set as we aim to capture as many studies as possible.

We will search MEDLINE (EBSCO), CINAHL (EBSCO), Academic Search Premier (EBSCO), Social Services Abstracts (ProQuest), and Scopus. Sources of gray literature will include organization websites and Google searches. The reference lists of all included studies will be reviewed. Types of gray literature documents eligible for review will include reports from service providers and health care providers, as well as publicly available online newspaper articles. Theses and dissertations will not be included in this review. If evidence includes work that proliferates racist, ableist, or homophobic language or concepts, articles will be brought to the steering committee for discussion. These articles will either be omitted or contextualized and critically appraised.

Study selection

Following the search, all identified citations will be collated and uploaded into Covidence (Veritas Health Innovation, Melbourne, Australia) and duplicates will be removed. Titles and abstracts will then be screened by 2 independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant papers will be retrieved in full and imported into Covidence. The full text of selected citations will be assessed in detail against the inclusion criteria by 2 independent reviewers. Reasons for exclusion of sources of evidence that do not meet the inclusion criteria at full-text stage will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers (JM and YZ) at each stage of the selection process will be resolved through discussion or with a third reviewer (PJ or SG).

The results of the search and study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram,24 while the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)25 will be used throughout the review process for guidance and writing.

Data extraction

Data and information will be obtained from materials and papers to be included in the scoping review by 2 independent reviewers (JM and YZ) using a data extraction tool. This extraction tool will then be transferred into Covidence. A draft data extraction tool is provided in Appendix II.22 The draft data extraction tool will be modified as necessary during the process of extracting data from each included paper. Any modifications will be described in the scoping review. Two independent reviewers will test the extraction tool during a calibration exercise with 10 papers. This will be followed by a team discussion to resolve any issues and revise the extraction tool, if needed. Another calibration exercise with another 3 papers will be conducted, if needed.

Data analysis and presentation

The extracted data will be presented in diagrammatic or tabular format in a manner that aligns with the scoping review objective and questions. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review objective and questions.

As part of the larger project's iKT, we will engage in purposeful and transparent, community-informed KT and exchange18 with stakeholders through workshops, reports, and academic publications. To this end, the first reviewer (JM) will include stakeholders in consultations before submitting the final review. Dissemination will be participatory, formative, and summative. Review results will be disseminated via traditional academic routes, including conferences, manuscripts, and reports, but will also include innovative approaches, such as infographics and short videos, depending on audience (eg, funders, academics, government, PLWHA), as this review is part of a larger iKT initiative, committed to ongoing co-learning, consultation, and transparency. The results of this review will also be used to evaluate the need for subsequent reviews and inform development of subsequent study phases (eg, interviews, questionnaires, interventions). Preliminary searches have highlighted that a systematic review would be beneficial to analyze the reach, impact, and quality of the programming that will be mapped in this scoping review.

Stakeholder consultation

Arksey and O’Malley (2005) advocate consultation as part of a scoping review.26 Current evidence suggests that systematic reviews can be enhanced and the results made more useful if stakeholders and end-users contribute to the work.27

Stakeholder consultation will be guided by the Delphi method, a technique for the systematic collection and aggregation of data provided by a group of experts.28 In this case, the Delphi method will provide a framework to guide stakeholder consultation and subsequent decision-making (eg, how the review will inform subsequent surveying). See Appendix III for a Delphi method chart,29 adapted from Green (2014)28 to reflect the objectives of the proposed scoping review.

The Delphi method will be employed by a trained facilitator and include 7 panelists from existing steering and advisory committees, as well as community members. Panelists will be invited to share feedback in the form of typed responses collected via email and/or pre-recorded video.29 The panelists will be asked to comment on their perceptions of the practical application of the findings and express any reservations about materials included and/or excluded. In line with Hemming et al.30 and Williams and Webb,31 the facilitator will collect responses aimed at identifying the panelists’ priorities, main feedback, and themes. The facilitator will collate the feedback into an anonymous summary report and circulate it to the panelists for review 1 week before the round 2 feedback submission deadline. If consensus is not reached, additional rounds will be arranged. The responses and feedback will help fine-tune the dissemination plan.

Acknowledgments

ResearchNS for funding this research, and to our steering committee and advisory committee for their contributions. Mount Saint Vincent University's Centre for Applied Research in Human Health, Food Action Research Centre (FoodARC) and Department of Applied Human Nutrition, and Dalhousie University's WK Kellogg Health Sciences Library for providing invaluable resources and support during this study. Dr. Erna-Snelgrove Clarke, JBI trainer for Queen's University, Faculty of Health Sciences, JBI Comprehensive Systematic Review Training Program, for training SG, MR, JM, and YZ. AIDS Coalition of Nova Scotia for their partnership and guidance throughout this project; their reports and ongoing communications with Nova Scotians have provided invaluable information for this review. Dr. Peter Stilwell, McGill University, for his input on the protocol and search strategy.

Data collected during this study will be used to inform subsequent work and the larger iKT initiative funded by ResearchNS and led by PJ and SG, examining nutritional needs of people living with HIV/AIDS in Nova Scotia.

Funding

Funding to conduct this review was provided by ResearchNS and Mount Saint Vincent University Committee on Research and Publications’ (CRP) CN Research Internship (YZ).

Author contributions

SG led the writing of this manuscript as senior and corresponding author. JM and YZ wrote the manuscript and co-developed the search strategy. MR and SG oversaw the scoping review training of JM and YZ. All authors provided feedback on the protocol and search strategy development. MR facilitated the PRESS for the search strategy.

Appendix I: Search strategy

CINAHL (EBSCO)

Date searched: July 14, 2021

figure1

Appendix II: Draft data extraction tool

figure2

Appendix III: Delphi method flow diagram

figure3

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Keywords:

acquired immunodeficiency syndrome; education; food provisions; human immunodeficiency virus; nutrition

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