Translational framework for implementation evaluation and research: Protocol for a qualitative systematic review of studies informed by Normalization Process Theory (NPT) [version 1; peer review: 2 approved].

Background: Normalization Process Theory (NPT) identifies mechanisms that have been demonstrated to play an important role in implementation processes. It is now widely used to inform feasibility, process evaluation, and implementation studies in healthcare and other areas of work. This qualitative synthesis of NPT studies aims to better understand how NPT explains observed and reported implementation processes, and to explore the ways in which its constructs explain the implementability, enacting and sustainment of complex healthcare interventions. Methods: We will systematically search Scopus, PubMed and Web of Science databases and use the Google Scholar search engine for citations of key papers in which NPT was developed. This will identify English language peer-reviewed articles in scientific journals reporting (a) primary qualitative or mixed methods studies; or, (b) qualitative or mixed methods evidence syntheses in which NPT was the primary analytic framework. Studies may be conducted in any healthcare setting, published between June 2006 and 31 December 2021. We will perform a qualitative synthesis of included studies using two parallel methods: (i) directed content analysis based on an already developed coding manual; and (ii) unsupervised textual analysis using Leximancer® topic modelling software. Other: We will disseminate results of the review using peer reviewed publications, conference and seminar presentations, and social media (Facebook and Twitter) channels. The primary source of funding is the National Institute for Health Research ARC North Thames. No human subjects or personal data are involved and no ethical issues are anticipated.

"Belt and braces approach; added benefit and extra reassurance": a multi-stakeholder examination of the challenges to effective provision of pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Northern and Central England.

Pre-exposure prophylaxis (PrEP) involves HIV negative individuals taking antiretroviral drugs to reduce the probability of infection if exposed and is available through the IMPACT trial in England. This study aimed to explore men who have sex with men (MSM) and service provider (SP) perspectives on provision and accessibility of PrEP in Northern and Central England. Twenty MSM and 25 SPs from four Northern cities and one city in the West Midlands region were recruited for semi-structured interviews (December 2018 to October 2019). Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three key themes emerged: "Self-sourcing PrEP"; "Service delivery learnings"; and "Impact of using PrEP". Problems with equity of access and accessibility were noted, and recommendations for the future of PrEP programming and equitable service delivery were also presented. The study highlighted divergence in PrEP service experience from patients and providers, with results informing policy, practice and professional training.

Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among Men Who Have Sex with Men (MSM): A Scoping Review on PrEP Service Delivery and Programming.

Pre-exposure prophylaxis (PrEP) is an evidence-based new biomedical HIV prevention intervention, which involves the pre-emptive use of daily (or event-based) antiretroviral drugs, to reduce risk of HIV acquisition if exposed. PrEP has recently been positioned as an integral prevention tool to reduce HIV acquisition risk among men who have sex with men (MSM) at country-level and within global prevention strategies. Given this global scale up of PrEP, we conducted a scoping review of extant international literature documenting service related perspectives, models and lessons learnt in PrEP programming for MSM. A systematic search of literature was conducted, and restricted to English language records in the timeframe 2008 to February 2019. Eligibility criteria centered on whether studies broadly described PrEP programming and service delivery for MSM as well as health communication. Following exclusion of ineligible records and removal of duplicates, 84 records were charted and thematically analysed according to scoping review methods. Four themes emerged from the thematic analysis of data; 'PrEP service aspects, settings and staff'; 'PrEP prescriber experiences, therapeutic alliance and care planning'; 'PrEP adherence within formal service structures'; and 'Multi-disciplinary and innovative PrEP care pathways'. The review highlights the complexities in providing optimal PrEP services for MSM by mapping and illustrating the importance of understanding the informal and formal routes to PrEP use among this HIV risk population; the barriers to uptake; the requirement for the presence of a positive therapeutic alliance between patient and prescriber in supporting patient initiation and adherence to PrEP regimes; and the need for availability in different culturally and ethnically sensitive models of PrEP service delivery according to low to high risk groups within the MSM communities.

'Prison facilities were not built with a woman in mind': an exploratory multi-stakeholder study on women's situation in Malawi prisons.

PURPOSE: Sub-Saharan African prisons have seen a substantial increase in women prisoners, including those incarcerated with children. There is very little strategic literature available on the health situation and needs of women prisoners and their circumstantial children in Malawi. The study aims to explore this issue. DESIGN/METHODOLOGY/APPROACH: A qualitative exploratory study using in-depth key informant interviews with senior correctional stakeholders (commissioner of prison farms, senior correctional management staff, senior health officials and senior officers in charge) (n = 5) and focus group discussions (FGD) with women in prison of age between 18 and 45 years (n = 23) and two FGD with correctional staff (n = 21) was conducted in two prisons in Malawi, Chichiri and Zomba. Narratives were transcribed and analysed using thematic analysis. FINDINGS: Three key themes emerged and are as follows: "hygiene and sanitary situation across multiple prison levels and subsequent health implications for women"; "nutritional provision and diets of women and children in prison"; and "women's access to prison-based and external health services". Divergence or agreement across perspectives around sanitation and disease prevention, adequacy of nutrition for pregnant or breast-feeding women, health status and access to prison-based health care are presented. PRACTICAL IMPLICATIONS: Garnering a contemporary understanding of women's situation and their health-care needs in Malawian prisons can inform policy and correctional health practice change, the adaptation of technical guidance and improve standards for women and their children incarcerated in Malawi. ORIGINALITY/VALUE: There is a strong need for continued research to garner insight into the experiences of women prisoners and their children, with a particular emphasis on health situation.

Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000-2019).

Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons. Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed. Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison. Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.