Kathryn J Vanderzwan, Susan Kilroy, Leah Burt, Jennifer O'Rourke
Don't interrupt me! development of a handoff education bundle to simulate the real world
International journal of nursing education scholarship
high coverage preexposure prophylaxis prep reduce hiv transmission help end hivaids pandemic however prep users face challenges including longterm adherence study aimed document proportions individuals restart hiv prep stop reasons restarting prep study systematic review metaanalysis systematically searched cinahl embase emcare global health medline scopus psychinfo peerreviewed date restrictions grey literature search conducted google search search abstract books aids conferences websites unaids data search conducted april 2023 updated february 2024 two authors extracted data proportion people stopped restarted prep reasons restarting strategies support people restarting prep two authors appraised data using joanna briggs institute appraisal tools used randomeffects metaanalysis pool estimates restarting conducted metaregression determine potential sources heterogeneity study registered prospero crd42023416777 however deviated original plan identify enough studies strategies support restarting prep primary objective subsequently revised plan strengthen secondary objective quantify proportion people stopped restarted prep explore possible reasons heterogeneity 988 studies 30 unique studieswere included 27 reported proportion restarting prep 7 also reported reasons restarting prep 3 studies reported reasons restarting prep study evaluated interventions restarting prep metaanalysis included 27 studies studies highincome countries 1727 63 usa 1527 56 overall 238 95 ci 159327 i2 998 n 85683 people stopped prep restarted prep lower proportion restarting studies middleincome countries compared highincome countries adjusted odds ratio aor 06 95 ci 050073 p 0001 higher restarting studies africa compared usa aor 155 95 ci 130186 heterosexual populations compared men sex men transgender women aor 150 95 ci 125181 p 0001 studies defining restarting stopped prep 1 month compared stopped 1 month aor 120 95 ci 106136 p 0001 reasons restarting prep included perceived higher risk hiv acquisition removal barriers access prep terms quality assessment overall randomised controlled trials low risk bias observational studies used metaanalysis potential risk bias related explicitly addressing potential confounders 1525 60 describing strategies address incomplete followup 2425 96 quarter people stopped prep would restart substantial variation across countries populations important understand motivations contextual factors influencing restarting prep support systems enable restarting prep ongoing risk australian national health medical research council