Social Determinants of Health Informed Interventions to Address or Reduce Sexually Transmitted and Blood Borne Infections Among 2SGBTMSM in High-Income Countries Between 2012 – 2024: A Scoping Review Protocol

Social Determinants of Health Informed Interventions to Address or Reduce Sexually Transmitted and Blood Borne Infections Among 2SGBTMSM in High-Income Countries Between 2012 – 2024: A Scoping Review Protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Social Determinants of Health Informed Interventions to Address or Reduce Sexually Transmitted and Blood Borne Infections Among 2SGBTMSM in High-Income Countries Between 2012 – 2024: A Scoping Review Protocol Robert Ainsley Chin-see, Grace Henry, Fiona Inglis, Anna Do, Todd Coleman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4664249/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Two-Spirit, Gay, Bisexual, Transgender, and Men who have Sex with Men (2SGBTMSM) still bear a disproportionate burden of sexually transmitted and blood borne infections (STBBI) such as HIV, despite local and national initiatives aiming to improve screening, testing, and treatment measures. In recent years, interventions aimed at mitigating HIV/STBBI risk and acquisition have leveraged principles of the Social Determinants of Health (SDoH), which encompass social, economic, and political factors known to influence behavior and health outcomes. The primary objective of this scoping review is to evaluate the effectiveness of interventions that are informed by the SDoH framework in preventing or addressing HIV/STBBI among 2SGBTMSM in high-income countries. Methods A scoping review of academic and grey literature between 2012 and 2024 will be conducted to identify the landscape of SDoH-informed interventions targeting HIV/STBBI and associated outcomes. The review will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and guidance from Arksey and O’Malley. The search strategy will be supported by a subject matter librarian and involve the use of relevant search terms (e.g., Chlamydia, 2SGBTMSM, HIV, infection) and Boolean operators across several electronic databases (e.g., MEDLINE, CINAHL, APA PsychInfo). Studies will be selected based on a title and abstract review, followed by a full-text review using inclusion and exclusion criteria determined a priori. Data extracted will include study information, intervention descriptions, and outcomes. Findings will be synthesized narratively and descriptively tabulated. If possible, quality appraisal will be conducted. Discussion This review will provide evidence on the current landscape on prevention efforts aimed at 2SGBTMSM regarding HIV/STBBI’s. The utilization of the SDoH in these approaches demonstrate significant promise in the field of public health and equity justice as a low-cost alternative, yet to date, no study has systematically summarized and synthesized the available literature. To fill this gap, the present review will systematically identify and summarize the effectiveness underpinning existing SDoH-informed interventions to address future HIV/STBBI’s prevention efforts for 2SGBTMSM. Scoping review registration: This scoping review protocol is registered with Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/E8D4Z ) Two-spirit Sexually Transmitted Infections Social Determinants of Health HIV Gay Bisexual Transgender Men Who Have Sex with Men Intervention Background Sexually Transmitted and Blood-Borne Infections (STBBIs) pose a significant challenge to social, economic, and public health systems. The global prevalence of STBBIs remains alarmingly high despite international efforts to address the complexity of the issue. The World Health Organization estimates that more than 1 million curable STBBIs are acquired daily, with the majority of cases being asymptomatic ( 1 ). Two-Spirit, Gay, Bisexual, Transgender, and Men who have Sex with Men (2SGBTMSM) experience disproportionally high rates and elevated risk of Human Immunodeficiency Virus (HIV) and other STBBIs, compared to the general population, even in high-income countries, despite concerted federal and provincial/territorial efforts to increase access to testing and treatment among populations at higher risk of acquiring STBBIs ( 2 – 5 ). According to the Centre for Disease Prevention and Control, gay, bisexual and men who reported male-to-male sexual contact accounted for approximately 67% of new HIV cases in 2023 in the United States ( 6 ). In England, men who have sex with men (MSM) have experienced a rising incidence of bacterial STBBI (e.g., chlamydia, gonorrhea) diagnoses, with those over 45 showing the highest increase in STBBI diagnoses between 2014 and 2019 ( 7 , 8 ). Similar rates of infection are observed in Australia, where HIV and STBBIs, such as gonorrhea, are three times more common compared to heterosexuals, and syphilis rates are upwards of 10 times higher ( 9 , 10 ). This resurging epidemic cannot simply be understood as a result of increased screening measures implemented at the clinical level, public health surveillance practices, or changing sexual behavioural patterns among 2SGBTMSM. This knowledge gap necessitates meaningful research and strategies to mitigate the burden of HIV/STBBIs. Extant literature shows that 2SGBTMSMs’ risk profile is further complicated by different sociodemographic and ecological factors (e.g., race/ethnicity, age, income, geography), that influence the acquisition and transmission of HIV/STBBIs ( 11 – 14 ). For example, young GBTMSMs’ engagement with HIV/STBBI care remains low across the globe which may be explained through delayed access to and engagement with health services, lower adherence to treatment modalities, stigma and discrimination, and mistrust with healthcare providers ( 15 – 21 ). The Minority Stress Model—a psychosocial framework often used to explain health disparities among 2SGBTMSM—illustrates how discriminatory and stigmatizing structures create internal- and external-stressors tied to their unique socio-political identities, ultimately leading to adverse physiological and psychological health outcomes ( 22 ). For instance, qualitative research involving 2SGBTMSM find that stereotypes of promiscuity impeded timely HIV testing and influenced risk perceptions along with recurrent patterns of discrimination from healthcare providers ( 23 ). Additionally, this can be understood through the lens of intersectionality, as 2SGBTMSM could be particularly marginalized by cis-heteronormative hegemony and other forms of oppression (e.g., ableism, racism). This marginalization exposes them to hostile stressors due to their social and political positions, resulting in poorer health outcomes ( 24 ). For 2SGBTMSM who occupy multiple social or political categories, the risk for adverse health outcomes appears even more pronounced ( 25 ). The Social Determinants of Health (SDoH) constitute a complex network of largely modifiable factors that threaten, promote, or protect health and are often interrelated and condition the health-disease process over the life-course ( 26 ). The World Health Organization (WHO) defines the SDoH as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”, driven by social, economic, and political forces and are largely responsible for health inequities ( 27 ). In Canada, SDoH are defined as “… the broad range of personal, social, economic and environmental factors that determine individual and population health” ( 28 ). Recently, investigators have acknowledged the significance of SDoH in altering the vulnerability or susceptibility of individuals in acquiring or transmitting HIV/STBBIs. In 2019, HIV disproportionally affected GBMSM (69%) in the United States and Black GBMSM accounted a significant proportion of new HIV diagnoses (37%) within GBMSM ( 29 ). While governments across the globe have committed to addressing HIV/STBBIs through an integrated approach to surveillance, testing, prevention, and treatment, provincial variations in HIV/STBBI reporting highlight significant knowledge gaps in the implementation of policies and programs. Approaches to mitigating HIV/STBBI risk and acquisition among 2SGBTMSM with intersecting identities could greatly benefit from public health models, such as the SDoH, which consider how salient characteristics of a person or community can shape and impact epidemic trends and disease dynamics. Furthermore, these interventions would serve as invaluable tools in rural enclaves, where community members may lack sufficient social networks, offering a low-cost alternative with a positive long-term impact on health and well-being ( 30 , 31 ). As the social and political landscape continuously changes, there is significant need to design and deliver innovative intervention approaches that demonstrate effectiveness to meet the needs of today’s 2SGBTMSM and curb transmission significantly. For that reason, we pose the following research question: What research is available on social determinants of health-informed interventions for reducing or addressing HIV/STBBIs among 2SGBTMSM in high-income countries between 2012 and 2024? This review seeks to: ( 1 ) identify and describe SDoH-informed interventions targeting HIV/STBBIs among 2SGBTMSM; ( 2 ) explore the use of intersectionality in the design and execution of SDoH interventions among 2SGBTMSM; ( 3 ) describe the overall quantity and quality of existing SDoH-informed interventions; and ( 4 ) synthesize evidence on the role and effects of SDoH-informed interventions in addressing or reducing HIV/STBBIs. Methods This scoping review will employ the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines and the PCC (Population, Concept, Context) framework suggested by the Joanna Briggs Institute to structure and develop the protocol and search strategy. The review will be registered with the Open Science Framework. The PRISMA-ScR checklist will be available in Supporting Methods File 1. We will report our review methods in detail, based on a protocol to be published later. Evidence mapping will be employed to complement the traditional scoping review to facilitate policy, practice, and a future research agenda of implementation science nature. Given the emergent nature of SDoH’s in recent years, we elect to create an evidence map. Key features of an evidence map include early involvement of stakeholders, a systematic search strategy, and a visual representation that presents the identified literature ( 32 ). Evidence maps are nominally a way to systematically synthesis, organize, and interpret a wide array of literature on specific subject matter, using data collection methods that encourage rigor, transparency, and reproducibility ( 33 ). As such, the search will be conducted in five phases, using an iterative multi-pronged data collection strategy, common for evidence mapping studies. Information Sources The scoping review will be conducted in February 2025 across several databases: MEDLINE (ProQuest), APA PsycINFO (ProQuest), ERIC (ProQuest), Education Source (EBSCO), CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. Management and deduplication of records will be automatically conducted during the import process within Covidence, with remaining errors resolved manually corrected. Canvassing of grey literature will occur through manual searches of Google Scholar and relevant organizations or institutions with searchable repositories (e.g., Centre for Addiction and Mental Health). Search Strategy We will collaborate with an experienced research librarian and experts in the fields of SDoH, social equity, and 2SGBTMSM health to develop the search strategy. Our search strings will include terms for key concepts and the search strategy will include relevant terms in combination with appropriate Boolean operators for specificity, with some variations depending on the database. In general, filters will include, whenever possible: English language, publication years from 2012 to 2024, human studies, and journal articles or review articles (the latter to facilitate reference hand searching). The selected start date coincides with adoption of the Rio Political Declaration on Social Determinants of Health, by the World Health Conference on Social Determinants of Health, where Canada and other member states pledged to take steps to improve health equity and the increasing recognition of SDoH within the health sciences during that period. The search will focus on subject heading terms or keywords related to three key themes: 2SGBTMSM (e.g., homosexuality OR bisexuality OR transgender men OR men who have sex with men OR gay men OR MSM OR gbMSM) HIV/STBBI (e.g., HIV OR AIDS OR STI/STD OR gonorrhea OR syphilis OR chlamydia OR herpes OR hepatitis) SDoH’s (e.g., race OR income OR environment OR education OR access) A filter for high-income countries will be applied at the initial stage if applicable. If not, they will be manually selected for out of the de-duplicated pool of literature according to the Organization for Economic Co-operation and Development (OECD). Our decision to limit to high-income countries was made in recognition of the similarities with regard to structural, social, and economic systems, including health care infrastructure, social safety nets, and legal protections related to sexual orientation and gender identity. Given that high-income countries often allocate substantial resources to addressing health disparities among 2SGBTMSM populations, focusing on these settings enables a deeper exploration of policies and programs that may serve as models for adaptation elsewhere. Additionally, we will manually search the bibliographies of relevant published works and previous reviews. Our complete electronic search strategy will be provided in a supplemental file. A full electronic search strategy, including any limits used, for PubMed is (see Appendix 1) presented elsewhere. Eligibility Criteria Inclusion Criteria The inclusion and exclusion criteria will be modeled after the PCC framework (Table 1 ) to ensure precision and conceptual clarity of the research topic. This will enable us to gather more information accurately and develop sophisticated search strategies that yield superior results. Additionally, we will employ the 'negotiated consensual validation' approach, as devised by Sambunjak and colleagues, to reach consensus on all methodological items, including eligibility criteria, search terms, screening, extraction tools, and quality appraisal ( 34 ). Table 1 PCC framework for study inclusion Criteria Definition Population 1 Two-spirit, Gay, Bisexual, Trans, or Men who have Sex with Men ≥ 16 years Concept 2 HIV/STBBIs and interventions that address or prevent them through the targeting of the SDoH’s Context High-income countries as listed by the OECD Eligible studies will be original research articles written in English and published in a peer-reviewed journals between the years of 2012 and 2024. Studies will be restricted to “high-income” countries which are defined as members of the OECD. These studies will need to incorporate at least one SDoH factor, either as a major intervention component or target or as part of the analytical stage. For instance, a SDoH intervention that aims to bridge participants to screening measures for HIV through universal basic income or the variable is included in the analysis as a predictor but not a control. We will anchor our understanding of SDoH constructs based on an iteration from the Public Health Agency of Canada, similar frameworks (e.g., Healthy People 2030), extent literature and, and expert input. Studies must adhere to one of the twelve tenets of the SDoH’s outlined by the Public Health Agency of Canada (Table 2 ). Table 2 Inclusion and exclusion criteria for title/abstract and full-length screening. Record available Full text record available Full text irretrievable Year published 2012–2024 Before 2012 Language English Non-English Country High Income countries as described and listed by the OECD (e.g., Canada, US); multinational studies only if a high-income country is included and country-level findings are reported. Any non-high-income country or not listed by the OECD; multinational studies reported in aggregate Population 2SGBTMSM aged 16 years or older; populations with participants younger than and older than 18 years (e.g., aged 16–30 years); age group not explicit. Populations younger than 16 years Study design and publication type Peer-reviewed empirical studies involving primary or secondary data collection and analysis (e.g., experimental studies, quasi-experimental, observational, qualitative) or grey literature. Nonempirical records (e.g., commentaries, debates, editorials, conceptual articles) Intervention studies included randomized controlled trials, nonrandomized studies with a comparison group, or single-arm designs. Observational quantitative or qualitative studies that report on findings of an intervention. Observational quantitative and/or qualitative studies that do not report findings from an intervention. Social determinants of health (SDoH) Any constructs relevant to one or more domain: Income and social status; Employment and working conditions; Education and literacy; Childhood experiences; Physical environments; Social supports and coping skills; Healthy behaviours; Access to health services; Biology and genetic endowment; Gender; Culture; Race / Racism. (Government of Canada, Public Health Agency of Canada) No mention of relevant SDoH; SDoH constructs collected only as demographic or contextual information Exclusion Criteria We will exclude studies published before 2012 and those not available in English. Studies conducted in countries not classified as high-income per the specifications of the World Bank, or multinational studies that include high-income countries but do not report country-specific findings will not be considered. We will also exclude nonempirical articles, such as editorials and commentaries, and other non-peer-reviewed sources. While we will not include reviews or meta-analyses, we will manually search the references of pertinent reviews to ascertain if they contain any studies suitable for our review. Additionally, we will forward search protocol articles to identify eligible articles that report study outcomes, excluding methodological or protocol-focused articles. Studies will be deemed ineligible if they relate solely to individual-level changes in their intervention, such as diet or therapy. Finally, we will exclude studies that consider SDoH solely as demographic or control variables. Selection of Evidence Sources We will use Covidence, a collaborative, web-based platform designed to manage and streamline systematic reviews, for both screening and data extraction. The screening team will pilot 50 citations and refine procedures before commencing each review phase. For title and abstract screening, we will conduct pilot screenings over four rounds, each consisting of 50 records. Once we achieve satisfactory interrater reliability (Fleiss kappa > 0.76), we will employ a double-coder approach to screen abstracts for eligibility. Throughout the title and abstract screening process, the screening team will regularly assess interrater reliability. For full-text screening, we will adopt a dual-independent approach, where each article will be assessed by two reviewers, each blind to the other's decision. If an article fails to meet all the inclusion criteria, the screeners will apply the first relevant exclusion code. Screening pairs will meet to discuss any disagreements, and if necessary, a third coder will be consulted to reach a consensus. We will manually search the references of excluded review articles and forward search relevant protocols to identify potential eligible records. Once full-text screening is complete, two coders will perform a validation check to ensure that all articles meet the inclusion criteria and to categorize records based on study design (e.g., intervention, observational-qualitative, observational-quantitative). Data Extraction Data from the identified studies will be collected and charted to provide a descriptive summary of the results which addresses the systematic review's objectives and answers the research questions of the review. From each eligible article, the reviewers will include key pieces of study information and other relevant information to be extracted and any other key findings which are listed below. Extracted data will be saved in a master Excel file. Using a customized charting table, based on potential study items (Table 3 ), two authors will independently pilot the standardized data extraction form with a random sample of eligible studies and suggest productive changes to the template before extraction officially commences. This is to facilitate a consistent data extraction approach between the reviewers. Any required modifications to the form to ensure that all relevant data are captured will be made and included. Key areas to extract will include publication details (e.g., authorship, publication year, journal, citation), study details (e.g., country of origin, study design, objectives, sample size), sample characteristics, intervention characteristics, outcomes, and relevant effect estimates. The extraction variables based on pilot tests may undergo a series of updates if there exist significant inconsistencies between reviewers, as well as emerging information from the eligible scholarship. If multiple included records pertained to a single study, we would group these records for extraction. We will apply a dual non-independent approach in which primary coders conducted extraction and secondary coders reviewed the extraction for accuracy and completeness. If the primary and secondary coders disagreed, the pair will meet to discuss, consulting a third reviewer as needed. Table 3 Article information and data to be extracted from eligible study articles. Data Extraction Criteria Details Study Characteristics Author(s), year of publication, study location, study design, sample size, participant demographics. Social Determinants of Health Specific social determinants discussed or analyzed in the study (e.g., socioeconomic status, education, employment, social support, community environment) Interventions Details of any interventions studied, including type, duration, and outcomes. Outcomes Outcomes described and measured as a result of the intervention in question, which may include changes in; physical, mental health, social or epidemiological indicators; clinical or diagnostic biomarkers; and changes in behaviour, perception, knowledge, or awareness Key Findings Summary of the main findings related to the interventions conducted with the 2SGBTMSM population. Risk of bias In either qualitative, quantitative, or mixed methods study, assess risk of bias using appropriate tools. Quality Assessment Quality appraisal, although not mandatory, will be conducted of empirical studies if evaluation permits using different tools (e.g., GRADE, MMAT) and carried out by two independent authors, with any disagreements resolved through discussion. For cases where an agreement is not reached, the matter will be referred to a third reviewer for final adjudication. Results will be presented in tables for each primary outcome. For randomized studies, Risk of Bias (RoB) may also be assessed independently by two reviewers against the revised Cochrane risk-of-bias tool 2.0 ( 35 ). For non-randomized studies, we will use the ROBINS-I tool ( 36 ). Results Synthesis Study characteristics will be summarized narratively in the text, and/or summary tables in the report; such data may be presented as frequencies and percentages, medians, and interquartile ranges, or means and standard deviations, where appropriate. Open-ended items will be synthesized by coding responses, for example, organizing SDoH variables according to selected domains from the Public Health Agency of Canada. Summaries will be created using tables, figures, and narratives. The literature will be critically evaluated to identify knowledge gaps and will be discussed in the context of modern approaches to public health interventions and their efficacy. Our main contributions to the literature will include a comprehensive description of work done so far, a robust conceptual diagram for understanding and applying public health interventions and outlining a future research agenda in this domain. To ensure objectivity, weekly reflexive meetings and consensus discussions will be held. Any discrepancies will be resolved through consensus between the primary author and other screeners. Discussion This review will advance our understanding of innovative health interventions aiming to address or eliminate HIV/STBBI’s among 2SGBTMSM that use SDoH-informed strategies. Results will have important equity implications for 2SGBTMSM and other structurally disadvantaged groups at higher risks of HIV/STBBI’s, including racialized communities, substance users, and those with a history of intimate partner violence. We anticipate researchers, policy makers, and public health stakeholders will use evidence for several purposes: ( 1 ) providing a novel avenue of exploration for future implementation research that could effectively uses tenants of SDoH that confer the greatest impact on health and well-being, ( 2 ) informing local and national policy options for HIV/STBBI prevention and elimination in distinct policy environments, and ( 3 ) informing local prevention strategies for HIV/STBBI control through a better understanding of effective intervention design across the globe. Findings of this systematic review will be published in a peer-review journal and will be presented to relevant health authorities to inform HIV/STBBI prevention and intervention strategies. Abbreviations AIDS : Acquired Immunodeficiency Syndrome CENTRAL : Cochrane Central Register of Controlled Trials CI : Confidence Interval GBMSM : Gay, Bisexual, and Men who have Sex with Men GRADE : Grading of Recommendations, Assessment, Development and Evaluation HIV : Human Immunodeficiency Virus MMAT : Mixed Methods Appraisal Tool OECD : Organization for Economic Co-operation and Development OSF : Open Science Framework PRISMA-ScR : Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews PubMed : Public/Publisher MEDLINE ROBINS-I : Risk of Bias in Non-randomized Studies of Interventions SDoH : Social Determinants of Health STBBI : Sexually Transmitted and Blood Borne Infections WHO : World Health Organization 2SGBTMSM : Two-spirit, gay, bisexual, transgender, and men who have sex with men Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article and its supplementary information files. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Authors' contributions RC conceptualized and drafted the article. GH prepared additional file 1 & 2. FI devised the search strategy and relevant databases. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Alam N, Chamot E, Vermund SH, Streatfield K, Kristensen S. Partner notification for sexually transmitted infections in developing countries: a systematic review. BMC Public Health. 2010 Jan 18;10:19. Hart TA, Moore DM, Noor SW, Lachowsky N, Grace D, Cox J, et al. 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Fast Facts: HIV and Gay and Bisexual Men. Available from: https://www.cdc.gov/hiv/data-research/facts-stats/gay-bisexual-men.html Kazyak E. Disrupting Cultural Selves: Constructing Gay and Lesbian Identities in Rural Locales. Qual Sociol. 2011 Dec 1;34(4):561–81. McKay T, Lampe NM, Barbee H, Prasad A, Gonzales G. An Evidence-Based Framework for Supporting Older LGBTQ+ Adults in Rural Communities: Findings From the LGBTQ+ Social Networks, Aging, and Policy Study. Public Policy Aging Rep. 2024 Dec 1;34(4):150–3. Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev. 2016 Feb 10;5(1):28. Whyle E, Olivier J. Social values and health systems in health policy and systems research: a mixed-method systematic review and evidence map. Health Policy Plan. 2020 May 6;35(6):735–51. Sambunjak D, Straus SE, Marusic A. A Systematic Review of Qualitative Research on the Meaning and Characteristics of Mentoring in Academic Medicine. J Gen Intern Med. 2010 Jan;25(1):72–8. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. The BMJ. 2011 Oct 18;343:d5928. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919. Footnotes Studies will be included if they have a sample comprising ≥ 50% GBTMSM. Studies that included a mix of GBTMSM and other key populations at risk of HIV were only included if they reported one or more primary outcomes separately for GBTMSM. Interventions encompassed strategies and programs informed by the tenets of the SDoH framework/model, as articulated by the Government of Canada, Public Health Agency of Canada (Table 2 ). This includes health initiatives designed to address underlying socio-economic and environmental conditions that impact health outcomes, such as those addressing housing, education, economic stability, social connections, and the broader environment. We will not include interventions that do not explicitly base their methodology and objectives on SDoH guidelines. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 17 Feb, 2025 Reviewers invited by journal 10 Jan, 2025 Editor assigned by journal 06 Jan, 2025 First submitted to journal 06 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4664249","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":400507530,"identity":"455dfbde-a974-4d6d-b6b8-e971fc31ba02","order_by":0,"name":"Robert Ainsley Chin-see","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYDACCcYGho//JHj4GRgYDwD5PERpYZzBZiEn2cDAQKwWBgZmDrYKY4MDEC2EAf/s5rbHDDwSiZuvnTE48LPtngy/9AHGDz/wWXLnYLtxgYRE4rbbOQYHe9uKeST7Epgle/BoMZBIbJOeYQDRcoC3LYHH4AwDG14fgbXwJAAdNhtoy1+gFnugFsY/BLUckDA2kM4xOAy2hYeBjRmfLRI3EtskZzZIyEncTis4LHMugUfiDGOztAweLfwz0p9JfGyo4+Gfnbzx4ZuyBHv+HuaDH9/g0YIEOAygDGB6IBKwPyBW5SgYBaNgFIwwAABamUpF3lgqiAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-7860-183X","institution":"Wilfrid Laurier University","correspondingAuthor":true,"prefix":"","firstName":"Robert","middleName":"Ainsley","lastName":"Chin-see","suffix":""},{"id":400507531,"identity":"462bcb01-f57d-480b-a0ad-4286b0dacf4f","order_by":1,"name":"Grace Henry","email":"","orcid":"","institution":"Wilfrid Laurier University - Waterloo Campus: Wilfrid Laurier University","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"","lastName":"Henry","suffix":""},{"id":400507532,"identity":"85f7f95c-d2e6-4a7a-b559-a38b8404db9a","order_by":2,"name":"Fiona Inglis","email":"","orcid":"","institution":"Wilfrid Laurier University","correspondingAuthor":false,"prefix":"","firstName":"Fiona","middleName":"","lastName":"Inglis","suffix":""},{"id":400507533,"identity":"8dc90724-e4a6-43a9-99bd-2cc29ed623ba","order_by":3,"name":"Anna Do","email":"","orcid":"","institution":"Wilfrid Laurier University","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Do","suffix":""},{"id":400507534,"identity":"af636365-8ddc-4475-a1cd-fa4198c6cdee","order_by":4,"name":"Todd Coleman","email":"","orcid":"","institution":"Wilfrid Laurier University","correspondingAuthor":false,"prefix":"","firstName":"Todd","middleName":"","lastName":"Coleman","suffix":""}],"badges":[],"createdAt":"2024-06-30 20:50:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4664249/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4664249/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73682021,"identity":"926d5595-fe20-4a77-b87b-e785b406b8fb","added_by":"auto","created_at":"2025-01-13 14:02:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":713414,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4664249/v1/fe9570aa-5e2c-4c49-bde6-96d56b7904b4.pdf"},{"id":73680600,"identity":"0f9036a7-81ad-4818-afa6-645d8ad250da","added_by":"auto","created_at":"2025-01-13 13:46:10","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21248,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4664249/v1/9a8511481a5c269a27a20a51.docx"}],"financialInterests":"","formattedTitle":"Social Determinants of Health Informed Interventions to Address or Reduce Sexually Transmitted and Blood Borne Infections Among 2SGBTMSM in High-Income Countries Between 2012 – 2024: A Scoping Review Protocol","fulltext":[{"header":"Background","content":"\u003cp\u003eSexually Transmitted and Blood-Borne Infections (STBBIs) pose a significant challenge to social, economic, and public health systems. The global prevalence of STBBIs remains alarmingly high despite international efforts to address the complexity of the issue. The World Health Organization estimates that more than 1\u0026nbsp;million curable STBBIs are acquired daily, with the majority of cases being asymptomatic (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Two-Spirit, Gay, Bisexual, Transgender, and Men who have Sex with Men (2SGBTMSM) experience disproportionally high rates and elevated risk of Human Immunodeficiency Virus (HIV) and other STBBIs, compared to the general population, even in high-income countries, despite concerted federal and provincial/territorial efforts to increase access to testing and treatment among populations at higher risk of acquiring STBBIs (\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to the Centre for Disease Prevention and Control, gay, bisexual and men who reported male-to-male sexual contact accounted for approximately 67% of new HIV cases in 2023 in the United States (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In England, men who have sex with men (MSM) have experienced a rising incidence of bacterial STBBI (e.g., chlamydia, gonorrhea) diagnoses, with those over 45 showing the highest increase in STBBI diagnoses between 2014 and 2019 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Similar rates of infection are observed in Australia, where HIV and STBBIs, such as gonorrhea, are three times more common compared to heterosexuals, and syphilis rates are upwards of 10 times higher (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis resurging epidemic cannot simply be understood as a result of increased screening measures implemented at the clinical level, public health surveillance practices, or changing sexual behavioural patterns among 2SGBTMSM. This knowledge gap necessitates meaningful research and strategies to mitigate the burden of HIV/STBBIs. Extant literature shows that 2SGBTMSMs\u0026rsquo; risk profile is further complicated by different sociodemographic and ecological factors (e.g., race/ethnicity, age, income, geography), that influence the acquisition and transmission of HIV/STBBIs (\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For example, young GBTMSMs\u0026rsquo; engagement with HIV/STBBI care remains low across the globe which may be explained through delayed access to and engagement with health services, lower adherence to treatment modalities, stigma and discrimination, and mistrust with healthcare providers (\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Minority Stress Model\u0026mdash;a psychosocial framework often used to explain health disparities among 2SGBTMSM\u0026mdash;illustrates how discriminatory and stigmatizing structures create internal- and external-stressors tied to their unique socio-political identities, ultimately leading to adverse physiological and psychological health outcomes (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). For instance, qualitative research involving 2SGBTMSM find that stereotypes of promiscuity impeded timely HIV testing and influenced risk perceptions along with recurrent patterns of discrimination from healthcare providers (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Additionally, this can be understood through the lens of intersectionality, as 2SGBTMSM could be particularly marginalized by cis-heteronormative hegemony and other forms of oppression (e.g., ableism, racism). This marginalization exposes them to hostile stressors due to their social and political positions, resulting in poorer health outcomes (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). For 2SGBTMSM who occupy multiple social or political categories, the risk for adverse health outcomes appears even more pronounced (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Social Determinants of Health (SDoH) constitute a complex network of largely modifiable factors that threaten, promote, or protect health and are often interrelated and condition the health-disease process over the life-course (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The World Health Organization (WHO) defines the SDoH as \u0026ldquo;the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life\u0026rdquo;, driven by social, economic, and political forces and are largely responsible for health inequities (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In Canada, SDoH are defined as \u0026ldquo;\u0026hellip; the broad range of personal, social, economic and environmental factors that determine individual and population health\u0026rdquo; (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Recently, investigators have acknowledged the significance of SDoH in altering the vulnerability or susceptibility of individuals in acquiring or transmitting HIV/STBBIs. In 2019, HIV disproportionally affected GBMSM (69%) in the United States and Black GBMSM accounted a significant proportion of new HIV diagnoses (37%) within GBMSM (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile governments across the globe have committed to addressing HIV/STBBIs through an integrated approach to surveillance, testing, prevention, and treatment, provincial variations in HIV/STBBI reporting highlight significant knowledge gaps in the implementation of policies and programs. Approaches to mitigating HIV/STBBI risk and acquisition among 2SGBTMSM with intersecting identities could greatly benefit from public health models, such as the SDoH, which consider how salient characteristics of a person or community can shape and impact epidemic trends and disease dynamics. Furthermore, these interventions would serve as invaluable tools in rural enclaves, where community members may lack sufficient social networks, offering a low-cost alternative with a positive long-term impact on health and well-being (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). As the social and political landscape continuously changes, there is significant need to design and deliver innovative intervention approaches that demonstrate effectiveness to meet the needs of today\u0026rsquo;s 2SGBTMSM and curb transmission significantly. For that reason, we pose the following research question: What research is available on social determinants of health-informed interventions for reducing or addressing HIV/STBBIs among 2SGBTMSM in high-income countries between 2012 and 2024?\u003c/p\u003e \u003cp\u003eThis review seeks to: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) identify and describe SDoH-informed interventions targeting HIV/STBBIs among 2SGBTMSM; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) explore the use of intersectionality in the design and execution of SDoH interventions among 2SGBTMSM; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) describe the overall quantity and quality of existing SDoH-informed interventions; and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) synthesize evidence on the role and effects of SDoH-informed interventions in addressing or reducing HIV/STBBIs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis scoping review will employ the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines and the PCC (Population, Concept, Context) framework suggested by the Joanna Briggs Institute to structure and develop the protocol and search strategy. The review will be registered with the Open Science Framework. The PRISMA-ScR checklist will be available in Supporting Methods File 1. We will report our review methods in detail, based on a protocol to be published later.\u003c/p\u003e \u003cp\u003eEvidence mapping will be employed to complement the traditional scoping review to facilitate policy, practice, and a future research agenda of implementation science nature. Given the emergent nature of SDoH’s in recent years, we elect to create an evidence map. Key features of an evidence map include early involvement of stakeholders, a systematic search strategy, and a visual representation that presents the identified literature (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Evidence maps are nominally a way to systematically synthesis, organize, and interpret a wide array of literature on specific subject matter, using data collection methods that encourage rigor, transparency, and reproducibility (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). As such, the search will be conducted in five phases, using an iterative multi-pronged data collection strategy, common for evidence mapping studies.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInformation Sources\u003c/h2\u003e \u003cp\u003eThe scoping review will be conducted in February 2025 across several databases: MEDLINE (ProQuest), APA PsycINFO (ProQuest), ERIC (ProQuest), Education Source (EBSCO), CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus (EBSCOhost), Web of Science Core Collection (Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar. Management and deduplication of records will be automatically conducted during the import process within Covidence, with remaining errors resolved manually corrected. Canvassing of grey literature will occur through manual searches of Google Scholar and relevant organizations or institutions with searchable repositories (e.g., Centre for Addiction and Mental Health).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSearch Strategy\u003c/h3\u003e\n\u003cp\u003eWe will collaborate with an experienced research librarian and experts in the fields of SDoH, social equity, and 2SGBTMSM health to develop the search strategy. Our search strings will include terms for key concepts and the search strategy will include relevant terms in combination with appropriate Boolean operators for specificity, with some variations depending on the database. In general, filters will include, whenever possible: English language, publication years from 2012 to 2024, human studies, and journal articles or review articles (the latter to facilitate reference hand searching). The selected start date coincides with adoption of the Rio Political Declaration on Social Determinants of Health, by the World Health Conference on Social Determinants of Health, where Canada and other member states pledged to take steps to improve health equity and the increasing recognition of SDoH within the health sciences during that period. The search will focus on subject heading terms or keywords related to three key themes:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e2SGBTMSM (e.g., homosexuality OR bisexuality OR transgender men OR men who have sex with men OR gay men OR MSM OR gbMSM)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHIV/STBBI (e.g., HIV OR AIDS OR STI/STD OR gonorrhea OR syphilis OR chlamydia OR herpes OR hepatitis)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSDoH’s (e.g., race OR income OR environment OR education OR access)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eA filter for high-income countries will be applied at the initial stage if applicable. If not, they will be manually selected for out of the de-duplicated pool of literature according to the Organization for Economic Co-operation and Development (OECD). Our decision to limit to high-income countries was made in recognition of the similarities with regard to structural, social, and economic systems, including health care infrastructure, social safety nets, and legal protections related to sexual orientation and gender identity. Given that high-income countries often allocate substantial resources to addressing health disparities among 2SGBTMSM populations, focusing on these settings enables a deeper exploration of policies and programs that may serve as models for adaptation elsewhere. Additionally, we will manually search the bibliographies of relevant published works and previous reviews. Our complete electronic search strategy will be provided in a supplemental file. A full electronic search strategy, including any limits used, for PubMed is (see Appendix 1) presented elsewhere.\u003c/p\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion and exclusion criteria will be modeled after the PCC framework (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) to ensure precision and conceptual clarity of the research topic. This will enable us to gather more information accurately and develop sophisticated search strategies that yield superior results. Additionally, we will employ the 'negotiated consensual validation' approach, as devised by Sambunjak and colleagues, to reach consensus on all methodological items, including eligibility criteria, search terms, screening, extraction tools, and quality appraisal (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePCC framework for study inclusion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCriteria\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinition\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo-spirit, Gay, Bisexual, Trans, or Men who have Sex with Men ≥ 16 years\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcept\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHIV/STBBIs and interventions that address or prevent them through the targeting of the SDoH’s\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContext\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh-income countries as listed by the OECD\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eEligible studies will be original research articles written in English and published in a peer-reviewed journals between the years of 2012 and 2024. Studies will be restricted to “high-income” countries which are defined as members of the OECD. These studies will need to incorporate at least one SDoH factor, either as a major intervention component or target or as part of the analytical stage. For instance, a SDoH intervention that aims to bridge participants to screening measures for HIV through universal basic income or the variable is included in the analysis as a predictor but not a control. We will anchor our understanding of SDoH constructs based on an iteration from the Public Health Agency of Canada, similar frameworks (e.g., Healthy People 2030), extent literature and, and expert input. Studies must adhere to one of the twelve tenets of the SDoH’s outlined by the Public Health Agency of Canada (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInclusion and exclusion criteria for title/abstract and full-length screening.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecord available\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull text record available\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFull text irretrievable\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear published\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012–2024\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBefore 2012\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEnglish\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-English\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh Income countries as described and listed by the OECD (e.g., Canada, US); multinational studies only if a high-income country is included and country-level findings are reported.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny non-high-income country or not listed by the OECD; multinational studies reported in aggregate\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2SGBTMSM aged 16 years or older; populations with participants younger than and older than 18 years (e.g., aged 16–30 years); age group not explicit.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePopulations younger than 16 years\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy design and publication type\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer-reviewed empirical studies involving primary or secondary data collection and analysis (e.g., experimental studies, quasi-experimental, observational, qualitative) or grey literature.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNonempirical records (e.g., commentaries, debates, editorials, conceptual articles)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention studies included randomized controlled trials, nonrandomized studies with a comparison group, or single-arm designs. Observational quantitative or qualitative studies that report on findings of an intervention.\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObservational quantitative and/or qualitative studies that do not report findings from an intervention.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial determinants of health (SDoH)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAny constructs relevant to one or more domain:\u0026nbsp;\u003cem\u003eIncome and social status; Employment and working conditions; Education and literacy; Childhood experiences; Physical environments; Social supports and coping skills; Healthy behaviours; Access to health services; Biology and genetic endowment; Gender; Culture; Race / Racism.\u003c/em\u003e\u0026nbsp;(Government of Canada, Public Health Agency of Canada)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo mention of relevant SDoH; SDoH constructs collected only as demographic or contextual information\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eWe will exclude studies published before 2012 and those not available in English. Studies conducted in countries not classified as high-income per the specifications of the World Bank, or multinational studies that include high-income countries but do not report country-specific findings will not be considered. We will also exclude nonempirical articles, such as editorials and commentaries, and other non-peer-reviewed sources. While we will not include reviews or meta-analyses, we will manually search the references of pertinent reviews to ascertain if they contain any studies suitable for our review. Additionally, we will forward search protocol articles to identify eligible articles that report study outcomes, excluding methodological or protocol-focused articles. Studies will be deemed ineligible if they relate solely to individual-level changes in their intervention, such as diet or therapy. Finally, we will exclude studies that consider SDoH solely as demographic or control variables.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Evidence Sources\u003c/h2\u003e \u003cp\u003eWe will use Covidence, a collaborative, web-based platform designed to manage and streamline systematic reviews, for both screening and data extraction. The screening team will pilot 50 citations and refine procedures before commencing each review phase. For title and abstract screening, we will conduct pilot screenings over four rounds, each consisting of 50 records. Once we achieve satisfactory interrater reliability (Fleiss kappa \u0026gt; 0.76), we will employ a double-coder approach to screen abstracts for eligibility. Throughout the title and abstract screening process, the screening team will regularly assess interrater reliability.\u003c/p\u003e \u003cp\u003eFor full-text screening, we will adopt a dual-independent approach, where each article will be assessed by two reviewers, each blind to the other's decision. If an article fails to meet all the inclusion criteria, the screeners will apply the first relevant exclusion code. Screening pairs will meet to discuss any disagreements, and if necessary, a third coder will be consulted to reach a consensus. We will manually search the references of excluded review articles and forward search relevant protocols to identify potential eligible records. Once full-text screening is complete, two coders will perform a validation check to ensure that all articles meet the inclusion criteria and to categorize records based on study design (e.g., intervention, observational-qualitative, observational-quantitative).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eData from the identified studies will be collected and charted to provide a descriptive summary of the results which addresses the systematic review's objectives and answers the research questions of the review. From each eligible article, the reviewers will include key pieces of study information and other relevant information to be extracted and any other key findings which are listed below. Extracted data will be saved in a master Excel file.\u003c/p\u003e \u003cp\u003eUsing a customized charting table, based on potential study items (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), two authors will independently pilot the standardized data extraction form with a random sample of eligible studies and suggest productive changes to the template before extraction officially commences. This is to facilitate a consistent data extraction approach between the reviewers. Any required modifications to the form to ensure that all relevant data are captured will be made and included. Key areas to extract will include publication details (e.g., authorship, publication year, journal, citation), study details (e.g., country of origin, study design, objectives, sample size), sample characteristics, intervention characteristics, outcomes, and relevant effect estimates.\u003c/p\u003e \u003cp\u003eThe extraction variables based on pilot tests may undergo a series of updates if there exist significant inconsistencies between reviewers, as well as emerging information from the eligible scholarship. If multiple included records pertained to a single study, we would group these records for extraction. We will apply a dual non-independent approach in which primary coders conducted extraction and secondary coders reviewed the extraction for accuracy and completeness. If the primary and secondary coders disagreed, the pair will meet to discuss, consulting a third reviewer as needed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eArticle information and data to be extracted from eligible study articles.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData Extraction Criteria\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetails\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthor(s), year of publication, study location, study design, sample size, participant demographics.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocial Determinants of Health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecific social determinants discussed or analyzed in the study (e.g., socioeconomic status, education, employment, social support, community environment)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInterventions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetails of any interventions studied, including type, duration, and outcomes.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcomes described and measured as a result of the intervention in question, which may include changes in; physical, mental health, social or epidemiological indicators; clinical or diagnostic biomarkers; and changes in behaviour, perception, knowledge, or awareness\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKey Findings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSummary of the main findings related to the interventions conducted with the 2SGBTMSM population.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk of bias\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn either qualitative, quantitative, or mixed methods study, assess risk of bias using appropriate tools.\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e \u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eQuality Assessment\u003c/h3\u003e\n\u003cp\u003eQuality appraisal, although not mandatory, will be conducted of empirical studies if evaluation permits using different tools (e.g., GRADE, MMAT) and carried out by two independent authors, with any disagreements resolved through discussion. For cases where an agreement is not reached, the matter will be referred to a third reviewer for final adjudication. Results will be presented in tables for each primary outcome. For randomized studies, Risk of Bias (RoB) may also be assessed independently by two reviewers against the revised Cochrane risk-of-bias tool 2.0 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). For non-randomized studies, we will use the ROBINS-I tool (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e "},{"header":"Results Synthesis","content":"\u003cp\u003eStudy characteristics will be summarized narratively in the text, and/or summary tables in the report; such data may be presented as frequencies and percentages, medians, and interquartile ranges, or means and standard deviations, where appropriate. Open-ended items will be synthesized by coding responses, for example, organizing SDoH variables according to selected domains from the Public Health Agency of Canada. Summaries will be created using tables, figures, and narratives.\u003c/p\u003e\u003cp\u003eThe literature will be critically evaluated to identify knowledge gaps and will be discussed in the context of modern approaches to public health interventions and their efficacy. Our main contributions to the literature will include a comprehensive description of work done so far, a robust conceptual diagram for understanding and applying public health interventions and outlining a future research agenda in this domain. To ensure objectivity, weekly reflexive meetings and consensus discussions will be held. Any discrepancies will be resolved through consensus between the primary author and other screeners.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review will advance our understanding of innovative health interventions aiming to address or eliminate HIV/STBBI\u0026rsquo;s among 2SGBTMSM that use SDoH-informed strategies. Results will have important equity implications for 2SGBTMSM and other structurally disadvantaged groups at higher risks of HIV/STBBI\u0026rsquo;s, including racialized communities, substance users, and those with a history of intimate partner violence. We anticipate researchers, policy makers, and public health stakeholders will use evidence for several purposes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) providing a novel avenue of exploration for future implementation research that could effectively uses tenants of SDoH that confer the greatest impact on health and well-being, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) informing local and national policy options for HIV/STBBI prevention and elimination in distinct policy environments, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) informing local prevention strategies for HIV/STBBI control through a better understanding of effective intervention design across the globe. Findings of this systematic review will be published in a peer-review journal and will be presented to relevant health authorities to inform HIV/STBBI prevention and intervention strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAIDS\u003c/strong\u003e: Acquired Immunodeficiency Syndrome\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCENTRAL\u003c/strong\u003e: Cochrane Central Register of Controlled Trials\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e: Confidence Interval\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGBMSM\u003c/strong\u003e: Gay, Bisexual, and Men who have Sex with Men\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGRADE\u003c/strong\u003e: Grading of Recommendations, Assessment, Development and Evaluation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e: Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMMAT\u003c/strong\u003e: Mixed Methods Appraisal Tool\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOECD\u003c/strong\u003e: Organization for Economic Co-operation and Development\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOSF\u003c/strong\u003e: Open Science Framework\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePRISMA-ScR\u003c/strong\u003e: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePubMed\u003c/strong\u003e: Public/Publisher MEDLINE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROBINS-I\u003c/strong\u003e: Risk of Bias in Non-randomized Studies of Interventions\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSDoH\u003c/strong\u003e: Social Determinants of Health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTBBI\u003c/strong\u003e: Sexually Transmitted and Blood Borne Infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO\u003c/strong\u003e: World Health Organization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2SGBTMSM\u003c/strong\u003e: Two-spirit, gay, bisexual, transgender, and men who have sex with men\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRC conceptualized and drafted the article. GH prepared additional file 1 \u0026amp; 2. FI devised the search strategy and relevant databases. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlam N, Chamot E, Vermund SH, Streatfield K, Kristensen S. Partner notification for sexually transmitted infections in developing countries: a systematic review. BMC Public Health. 2010 Jan 18;10:19. \u003c/li\u003e\n\u003cli\u003eHart TA, Moore DM, Noor SW, Lachowsky N, Grace D, Cox J, et al. Prevalence of HIV and sexually transmitted and blood-borne infections, and related preventive and risk behaviours, among gay, bisexual and other men who have sex with men in Montreal, Toronto and Vancouver: results from the Engage Study. 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Available from: https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities\u003c/li\u003e\n\u003cli\u003eCamacho C, Camacho E, Lee D. Trends and projections in sexually transmitted infections in people aged 45\u0026thinsp;years and older in England: analysis of national surveillance data. Perspect Public Health. 2023 Sep;143(5):263\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eMacGregor L, Speare N, Nicholls J, Harryman L, Horwood J, Kesten JM, et al. Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM. Sex Transm Infect. 2021 Nov;97(7):507\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eIngleton A, Hope K, Najjar Z, Templeton DJ, Gupta L. Characteristics of gonorrhoea cases notified in inner and south-western Sydney, Australia: results of population-based enhanced surveillance. Sex Health. 2016 Jun 23; \u003c/li\u003e\n\u003cli\u003eHIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2021 | Kirby Institute [Internet]. [cited 2025 Jan 6]. Available from: https://www.kirby.unsw.edu.au/research/reports/asr2021\u003c/li\u003e\n\u003cli\u003eSullivan PS, Knox J, Jones J, Taussig J, Valentine Graves M, Millett G, et al. Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia. J Int AIDS Soc. 2021 Apr 6;24(4):e25689. \u003c/li\u003e\n\u003cli\u003eMillett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. The Lancet. 2012 Jul 28;380(9839):341\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSaxby K, Chan C, Bavinton BR. Structural Stigma and Sexual Health Disparities Among Gay, Bisexual, and Other Men Who Have Sex With Men in Australia. JAIDS J Acquir Immune Defic Syndr. 2022 Mar 1;89(3):241. \u003c/li\u003e\n\u003cli\u003eEmlet CA, Fredriksen-Goldsen KI, Kim HJ, Jung H. Accounting for HIV Health Disparities: Risk and Protective Factors Among Older Gay and Bisexual Men. J Aging Health. 2020;32(7\u0026ndash;8):677\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eRossman K, Salamanca P, Macapagal K. \u0026ldquo;The doctor said I didn\u0026rsquo;t look gay\u0026rdquo;: Young adults\u0026rsquo; experiences of disclosure and non-disclosure of LGBTQ identity to healthcare providers. J Homosex. 2017;64(10):1390\u0026ndash;410. \u003c/li\u003e\n\u003cli\u003eNilsson Sch\u0026ouml;nnesson L, Dahlberg M, Reinius M, Zeluf-Andersson G, Ekstr\u0026ouml;m AM, Eriksson LE. Prevalence of HIV-related stigma manifestations and their contributing factors among people living with HIV in Sweden \u0026ndash; a nationwide study. BMC Public Health. 2024 May 20;24:1360. \u003c/li\u003e\n\u003cli\u003eGiannouchos TV, Crouch E, Merrell MA, Brown MJ, Harrison SE, Pearson WS. Racial, Ethnic, and Rural/Urban Disparities in HIV and Sexually Transmitted Infections in South Carolina. J Community Health. 2023;48(1):152\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHussen SA, Harper GW, Bauermeister JA, Hightow-Weidman LB. Psychosocial Influences on Engagement in Care Among HIV-Positive Young Black Gay/Bisexual and Other Men Who Have Sex with Men. AIDS Patient Care STDs. 2015 Feb 1;29(2):77\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eWeinstein ER, Lozano A, Jones MA, Jimenez DE, Safren SA. Factors Associated with Antiretroviral Therapy Adherence Among a Community-Based Sample of Sexual Minority Older Adults with HIV. AIDS Behav. 2023 Oct;27(10):3285\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eMalefo MA, Ayo-Yusuf O, Mokgatle MM. Risk factors for sexually transmitted infections among men who have sex with men. Afr J Prim Health Care Fam Med. 2023 Oct 17;15(1):4080. \u003c/li\u003e\n\u003cli\u003eDai M, Xia S, Calabrese C, Ma X, Chen T. Risk and demographic factors associated with STI testing adherence among non-single men who have sex with men (MSM) in the United States. J Behav Med. 2024 Dec 1;47(6):1107\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eMeyer IH. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychol Bull. 2003 Sep;129(5):674\u0026ndash;97. \u003c/li\u003e\n\u003cli\u003eIott BE, Loveluck J, Benton A, Golson L, Kahle E, Lam J, et al. The impact of stigma on HIV testing decisions for gay, bisexual, queer and other men who have sex with men: a qualitative study. BMC Public Health. 2022 Mar 9;22(1):471. \u003c/li\u003e\n\u003cli\u003eWyatt TR, Johnson M, Zaidi Z. Intersectionality: a means for centering power and oppression in research. Adv Health Sci Educ. 2022 Aug 1;27(3):863\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eSouleymanov R, Star J, McLeod A, Amjad S, Moore S, Campbell C, et al. Relationship between sociodemographics, healthcare providers\u0026rsquo; competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study. BMJ Open. 2022 Jan 31;12(1):e054596. \u003c/li\u003e\n\u003cli\u003eHahn RA. What is a social determinant of health? Back to basics. J Public Health Res. 2021 Jun 23;10(4):2324. \u003c/li\u003e\n\u003cli\u003eIslam MM. Social Determinants of Health and Related Inequalities: Confusion and Implications. Front Public Health. 2019 Feb 8;7:11. \u003c/li\u003e\n\u003cli\u003eCanada PHA of. Social determinants of health and health inequalities [Internet]. 2001 [cited 2025 Jan 6]. Available from: https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html\u003c/li\u003e\n\u003cli\u003eCDC. HIV. 2024 [cited 2025 Jan 6]. Fast Facts: HIV and Gay and Bisexual Men. Available from: https://www.cdc.gov/hiv/data-research/facts-stats/gay-bisexual-men.html\u003c/li\u003e\n\u003cli\u003eKazyak E. Disrupting Cultural Selves: Constructing Gay and Lesbian Identities in Rural Locales. Qual Sociol. 2011 Dec 1;34(4):561\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eMcKay T, Lampe NM, Barbee H, Prasad A, Gonzales G. An Evidence-Based Framework for Supporting Older LGBTQ+ Adults in Rural Communities: Findings From the LGBTQ+ Social Networks, Aging, and Policy Study. Public Policy Aging Rep. 2024 Dec 1;34(4):150\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eMiake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev. 2016 Feb 10;5(1):28. \u003c/li\u003e\n\u003cli\u003eWhyle E, Olivier J. Social values and health systems in health policy and systems research: a mixed-method systematic review and evidence map. Health Policy Plan. 2020 May 6;35(6):735\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eSambunjak D, Straus SE, Marusic A. A Systematic Review of Qualitative Research on the Meaning and Characteristics of Mentoring in Academic Medicine. J Gen Intern Med. 2010 Jan;25(1):72\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHiggins JPT, Altman DG, G\u0026oslash;tzsche PC, J\u0026uuml;ni P, Moher D, Oxman AD, et al. The Cochrane Collaboration\u0026rsquo;s tool for assessing risk of bias in randomised trials. The BMJ. 2011 Oct 18;343:d5928. \u003c/li\u003e\n\u003cli\u003eSterne JA, Hern\u0026aacute;n MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Studies will be included if they have a sample comprising\u0026thinsp;\u0026ge;\u0026thinsp;50% GBTMSM. Studies that included a mix of GBTMSM and other key populations at risk of HIV were only included if they reported one or more primary outcomes separately for GBTMSM.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e Interventions encompassed strategies and programs informed by the tenets of the SDoH framework/model, as articulated by the Government of Canada, Public Health Agency of Canada (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This includes health initiatives designed to address underlying socio-economic and environmental conditions that impact health outcomes, such as those addressing housing, education, economic stability, social connections, and the broader environment. We will not include interventions that do not explicitly base their methodology and objectives on SDoH guidelines.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Two-spirit, Sexually Transmitted Infections, Social Determinants of Health, HIV, Gay, Bisexual, Transgender, Men Who Have Sex with Men, Intervention","lastPublishedDoi":"10.21203/rs.3.rs-4664249/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4664249/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTwo-Spirit, Gay, Bisexual, Transgender, and Men who have Sex with Men (2SGBTMSM) still bear a disproportionate burden of sexually transmitted and blood borne infections (STBBI) such as HIV, despite local and national initiatives aiming to improve screening, testing, and treatment measures. In recent years, interventions aimed at mitigating HIV/STBBI risk and acquisition have leveraged principles of the Social Determinants of Health (SDoH), which encompass social, economic, and political factors known to influence behavior and health outcomes. The primary objective of this scoping review is to evaluate the effectiveness of interventions that are informed by the SDoH framework in preventing or addressing HIV/STBBI among 2SGBTMSM in high-income countries.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA scoping review of academic and grey literature between 2012 and 2024 will be conducted to identify the landscape of SDoH-informed interventions targeting HIV/STBBI and associated outcomes. The review will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and guidance from Arksey and O\u0026rsquo;Malley. The search strategy will be supported by a subject matter librarian and involve the use of relevant search terms (e.g., Chlamydia, 2SGBTMSM, HIV, infection) and Boolean operators across several electronic databases (e.g., MEDLINE, CINAHL, APA PsychInfo). Studies will be selected based on a title and abstract review, followed by a full-text review using inclusion and exclusion criteria determined a priori. Data extracted will include study information, intervention descriptions, and outcomes. Findings will be synthesized narratively and descriptively tabulated. If possible, quality appraisal will be conducted.\u003c/p\u003e\u003ch2\u003eDiscussion\u003c/h2\u003e \u003cp\u003eThis review will provide evidence on the current landscape on prevention efforts aimed at 2SGBTMSM regarding HIV/STBBI\u0026rsquo;s. The utilization of the SDoH in these approaches demonstrate significant promise in the field of public health and equity justice as a low-cost alternative, yet to date, no study has systematically summarized and synthesized the available literature. To fill this gap, the present review will systematically identify and summarize the effectiveness underpinning existing SDoH-informed interventions to address future HIV/STBBI\u0026rsquo;s prevention efforts for 2SGBTMSM.\u003c/p\u003e\u003ch2\u003eScoping review registration:\u003c/h2\u003e \u003cp\u003eThis scoping review protocol is registered with Open Science Framework (DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.17605/OSF.IO/E8D4Z\u003c/span\u003e\u003cspan address=\"10.17605/OSF.IO/E8D4Z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e","manuscriptTitle":"Social Determinants of Health Informed Interventions to Address or Reduce Sexually Transmitted and Blood Borne Infections Among 2SGBTMSM in High-Income Countries Between 2012 – 2024: A Scoping Review Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 13:46:05","doi":"10.21203/rs.3.rs-4664249/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-02-17T13:58:30+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-10T13:50:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-07T03:42:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2025-01-06T16:57:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7364a60-29ac-48f7-a1d7-21197308b9b5","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T13:46:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-13 13:46:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4664249","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4664249","identity":"rs-4664249","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}