Availability, acceptability, and adoption of decision aids for HIV prevention and contraception for young people: A scoping review protocol

Young people aged 15-24 years have the worst HIV and sexual and reproductive health (SRH) outcomes of all ages globally. Across sub-Saharan Africa, only 65% of young people living with HIV aged 15-24 years know their HIV status, compared with 84% of older adults. There is suboptimum uptake of condoms and other HIV prevention interventions, including pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), and voluntary medical male circumcision (VMMC). Every week 7,800 15-24 year olds are infected with HIV globally [4], of whom 25% are African women. More than 80% of sexually active adolescents in sub-Saharan Africa do not use contraception; millions of young people face unintended pregnancy, unsafe abortions, and school drop-out. Poor engagement in HIV and SRH care and prevention is a huge public health challenge particularly among young people, for whom the negative health and socio-economic consequences may persist for decades. Young people face many barriers to the uptake of HIV and SRH services that include fear of disclosure of HIV status/sexual activity, negative attitudes of health workers towards sexual activity in young people, and lack of proximity to services. Poor knowledge and poor risk perception are also important: less than 50% of young Africans have comprehensive knowledge of HIV and 48% of those at high risk of infection perceive themselves to be at risk. In addition, health services fail to provide support to young people in making informed decisions about the range of available options. Decision aids support user informed choices tailored to their values and preferences and may be applied to provide support on various aspects of care. For a health intervention with a choice of options, decision aids provide information on each option, including effectiveness, advantages, disadvantages, matched with the specified personal values/preferences. Few decision aids have been evaluated for HIV prevention, yet the growing number of prevention options (different formulations of PrEP and PEP – tablets, vaginal ring, injectable, formulations with/without contraception, in addition to other prevention options) mean that young people need decision support. Decision aids for contraception have been developed and are widely used; however, there is need for additional research on how to adopt these contraception decision aids for use in diverse contexts. Our group is working with young people and relevant stakeholders to co-develop a peer-driven intervention for supporting uptake of HIV prevention and contraception services among young people. Decision aids for HIV prevention and contraception services will be critical to providing young people with support to make informed choices that are relevant to their circumstances and congruent with their values. To inform the development or adaptation of context-relevant decision aids for contraception and HIV prevention, we aim to conduct a scoping review to explore the availability, acceptability, and use of decision aids for HIV prevention and contraception for young people. The scoping review will follow the Arksey, and O’Malley methodological framework composed of five stages 1) identifying the research questions; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarizing, and reporting the results.