Development of a Framework to Identify Research Priorities for Mitigating the Impact of Climate Change on HIV Response in India: A Scoping Review coupled with Modified Delphi

Background Climate Change and extreme weather events are recognized as the critical threat to public health, with severe effects on vulnerable populations in low- and middle-income countries. In India, these climatic stressors may further undermine the HIV response by disrupting services, exacerbating vulnerabilities, augmenting transmission and straining health systems. However, the evidence based on how climate change intersects with HIV responses remains limited and fragmented. Present study aimed to develop a comprehensive framework for identifying research priorities aimed at mitigating the impact of climate change on the HIV response in India. Methods Present work was carried out through the scoping review followed by a modified Delphi. Scoping review included peer-reviewed articles and grey literatures published between 2000 to 2023 following PRISMA guidelines. The database search comprises of PubMed, Scopus, Web of Science, and regional sources, focusing on studies that explore the interface of climate and HIV-related health outcomes, service delivery, and system resilience. The data was extracted from the selected articles, then analysed to identify the lessons of contextual relevance. Building on the findings of the scoping review a Modified Delphi Consensus method was used in three interactive rounds to develop a research framework and finalise major priorities. Results An initial pool of 88,292 records and 55 additional grey literature sources was narrowed down to 119 documents (83 academic papers and 36 reports) after screening for relevance and eligibility. Most of the included studies focused on climate migration, health service disruptions. though a large proportion were narrative reviews with limited high-quality evidences. The Evidence Gap Map revealed significant research deficiencies, especially in areas such as food insecurity, co-infections, and policy-level responses. Using a modified Delphi method, the research team identified four major researchable domains namely food insecurity, migration, health system disruption, and co-infections. Conclusion This was a first of its kind endeavour in Indian setting to direct investments in cross cutting areas of Climate Change & HIV programs. The conceptual framework suggested that climate change affects the HIV response through interconnected pathways. The final research priorities aimed to guide evidence generation for policy action and resilient health systems.