Using an Innovative Approach “Mixed Systematic-Realist Review” (MSRR) to Generate a New Pragmatic Framework of HIV Stigma Reduction

Background and Objectives: Pregnant women living with HIV (WLHIV) are likely to be traumatized and stigmatized, hindering their ARV treatment uptake and leading to the spread of the virus and low quality of life. Previous research has examined HIV stigma reduction interventions, yet syntheses of such evidence among pregnant WLHIV have not been presented. Our literature synthesis aims to identify effective HIV stigma reduction interventions and create an emergent pragmatic framework for future education, research, and clinical practice. Methods: Mixed Systematic-Realist Review (MSRR), an innovative approach developed by our team, was applied to synthesize studies on stigma reduction interventions among pregnant WLHIV. Combining the principles and processes of systematic review and realist review, MSRR is a 5-step evidence-based, context-bound strategy, starting from topic identification through pragmatic framework creation. Results: Using pre-determined inclusion criteria to search for relevant articles in five databases, we identified 238 articles and then reduced them to four after using pre-determined exclusion criteria. All four studies were conducted in Sub-Saharan countries with adult pregnant WLHIV (n = 824). Multicomponent stigma reduction interventions in the literature yielded positive outcomes (de-creased stigma and lessened depressive symptoms). The emergent framework, depicted in a diagram format, was based on the input-process-output framework. Conclusions: The novel MSRR adopts the strengths of both systematic and realist reviews and can be applied across diverse populations. Additionally, the results and emergent pragmatic framework can be used for HIV stigma reduction education and to advance research and clinical practice.