title: Effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries: a realist review protocol.
abstract: BACKGROUND
  Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries.
  
  
  METHODS
  A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework.
  
  
  CONCLUSIONS
  This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose a theoretical framework that explains why and how HIV stigma reduction intervention strategies influence HIV test uptake in low- and middle-income countries. Our theoretical framework is meant to provide guidance to program managers on identifying the most effective stigma reduction intervention strategies to increase HIV test uptake. We also include advice on how to effectively implement these strategies to reduce the rate of HIV transmission.
  
  
  BACKGROUND
  PROSPERO CRD42015023687.
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. soobesh@gmail.com.|Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. soobesh@gmail.com.
authors.forename: Subash
authors.initials: S
authors.lastname: Thapa
authors.affiliation: Centre for Sociology Research, Faculty of Social Sciences, KU Leuven, 3000, Leuven, Belgium. karin.hannes@kuleuven.be.
authors.forename: Karin
authors.initials: K
authors.lastname: Hannes
authors.affiliation: School of Population Health, University of South Australia, Adelaide, SA, 5001, Australia. margaret.cargo@unisa.edu.au.
authors.forename: Margaret
authors.initials: M
authors.lastname: Cargo
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium. abuve@itg.be.
authors.forename: Anne
authors.initials: A
authors.lastname: Buve
authors.affiliation: Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium. catharina.mathei@med.kuleuven.be.
authors.forename: Catharina
authors.initials: C
authors.lastname: Mathei
mesh_terms: D003906:Developing Countries; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010342:Patient Acceptance of Health Care; D012107:Research Design; D063508:Social Discrimination; D057545:Social Stigma; D000078202:Systematic Reviews as Topic