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Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review
  1. Carinne Brody1,
  2. Say Sok2,
  3. Sovannary Tuot2,
  4. Marija Pantelic3,4,5,
  5. Enrique Restoy4,6,
  6. Siyan Yi1,2,7
  1. 1Center for Global Health Research, Touro University California, Vallejo, California, USA
  2. 2KHANA Center for Population Health Research, Phnom Penh, Cambodia
  3. 3Department of Social Policy and Intervention, Oxford University, Oxford, UK
  4. 4Frontline AIDS, Brighton, UK
  5. 5Department of Medical Education, Brighton and Sussex Medical School, Brighton, United Kingdom
  6. 6School of Global Studies, Sussex University, Brighton, United Kingdom
  7. 7Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
  1. Correspondence to Dr Siyan Yi; siyan{at}


Introduction This systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes.

Methods An electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised.

Results This review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome.

Conclusion These findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the ‘how’ of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes.

PROSPERO registration number CRD42018106909

  • HIV
  • human rights
  • intervention
  • key and marginalised populations
  • prevention
  • low-and middle-income countries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Stephanie M Topp

  • Twitter @PantelichMarija

  • Contributors CB, SS, ST, MP, ER and SY conceived the study. CB and SS conducted the search and retrieval. CB, SS and SY conducted the analyses. CB, SS and SY drafted the manuscript. ST, MP and ER reviewed and provided critical inputs. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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