Evaluating equity reporting within systematic reviews of pre-exposure prophylaxis (PrEP).

Abstract

Background: Pre-exposure prophylaxis (PrEP) is a medicine that can reduce HIV transmission. Given the disproportionate impact of HIV on minority communities, health equity is an important consideration in PrEP research. We aimed to assess equity reporting in systematic reviews of PrEP using the PROGRESS Plus framework.

Methods: We conducted a systematic search of PubMed (MEDLINE), Embase and Cochrane databases for systematic reviews or meta analyses of PrEP usage. We then used the PROGRESS Plus framework to extract inclusion of the following domains: place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, social capital, age and disability.

Results: After screening search articles, our sample included 36 systematic reviews and meta-analyses (SRMAs). 24 (66.7%) were conducted within the USA. Few (2/36, 5.6%) were found to mention adherence to any equity reporting framework. Place and gender/sex were the most reported elements of the framework with inclusion in 34 of 36 studies. Age (30/36, 83.3%) and race/ethnicity (24/36, 66.7%) were also commonly reported. All other criteria were reported in less than half of included SRMAs; religion had the lowest inclusion at 0/36 (0%), followed by disability (1/36, 2.8%). Among the 36 SRMAs, 19 (52.78%) did not conduct any subgroup analyses among domains; those most commonly analysed were gender/sex and age.

Conclusion: Our study found nearly all SRMAs regarding HIV PrEP reported on gender/sex and age; however, other influential equity criteria were often overlooked. Further attention to the reporting of PROGRESS Plus items within these SRMAs may reduce barriers for PrEP utilisation, thus improving HIV prevention strategies.