Evidence of perpetration of intimate partner violence among HIV-positive couples: a systematic scoping review protocol

Background Human immunodeficiency virus (HIV) infection and intimate partner violence (IPV) remain highly sensitive areas that have issues to do with stigmatization in many African countries. Despite the fact that there are several studies on the prevention of HIV, the prevalence of HIV in many African countries is still high. Literature shows that prevention of intimate partner violence is key in the spread of HIV infection. This study will focus on evidence of experiences of HIV positive couples with intimate partner violence and the types of violence experienced. This scoping review will map information about intimate partner violence in low- and middle-income countries as well as other countries with intimate partner violence. There is the need to review these studies on HIV positive couples with intimate partner violence to establish gaps and identify where primary research is necessary. The purpose of this study will be to explore evidence of experiences of HIV-positive couples with IPV and the types of violence experiences by HIV-positive couples. Methods This scoping review will involve electronic databases, which will include academic search premier, CINAHL, PsycARTICLES (EBSCO), PsycINFO (EBSCO), ScienceDirect, PubMed, MEDLINE (EBSCO) and Google Scholar. The study will be conducted in two stages: the first stage will map out the studies descriptively while the second stage will map the additional inclusion criteria of quality assessment. Two independent reviewers will undertake the data extraction. Relevant outcomes of the studies will be analyzed thematically using NVivo computer software. Results Results on the evidence of the experiences of HIV-positive couples with partner violence will be coded independently by the authors. Thereafter, the authors will critically cross-examine the relationship of the research questions to the emerging themes from the selected articles. Conclusion The authors hope to find studies on intimate partner violence among HIV-positive couples to establish gaps where primary research will be necessary. Systematic review registration PROSPERO CRD42017062190


Background
Intimacy issues in relationships are normally very sensitive and secretive especially when they are related to human immunodeficiency virus (HIV) disclosure. Although a lot of work has been done to either minimize it or eliminate it completely as much as possible, fear, ignorance and discrimination regarding HIV continue to exact profound human costs like abusive treatment and violence [4,16,18]. Spangenberg et al. identified that 46% of mothers of sick newborns in Ghana reported some form of violence. Women who are HIV positive are at risk of experiencing the same forms of violence as other women in the population but in a severe form because of their status [17].
There is increasing evidence suggesting that HIVpositive women and probably men in many African countries may be at increased risk of experiencing intimate partner violence (IPV) following disclosure of their status to their partners [3,12,14]. These problems relating to IPV are, however, more likely to be exacerbated in resource-poor settings like Ghana, where discrimination and stigmatization are high [2,3]. HIV-positive couples in such areas are at risk of being ostracized, denied some essential services, criticized, thrown out of their homes, divorced and/or blamed for bringing disease into the family or into the community [15]. Shamu et al. further reported that 40.5% of HIV-positive pregnant women in Zimbabwe experienced IPV after disclosure of their HIV-positive status to their partners. HIV-positive women are at increased risk of experiencing IPV following disclosure of the partner's status to each other [1,10]. The fear of IPV (physical, sexual, psychological and spiritual abuse) may decrease HIV-prevention behaviours [5,8,15] such as disclosure of seropositive status to partners, which may lead to the spread of the infection. It may also prevent HIV-positive couples from staying on lifelong antiretroviral treatment and prevention of mother-to-child transmission [6,7,13]. Violence against HIV-positive women also has a consequential influence on status disclosure, which is vital to HIV prevention and partner support in accessing preventive services [8,9].
Intimate partner violence by men against their partners is one of the most glaring indicators of women's lack of empowerment [3,10]. There is often the need for the collection of both victimization and offending data that question both partners. This would allow for an examination of the association between status compatibilities and intimate partner violence and victimization and perpetration, as well as mutually combative behaviour between intimate partners [11].
There is scarcity of evidence on the most effective ways of reducing IPV and abuse among persons living with HIV (PLWHIV) in most sub-Saharan African countries [14] which are low-and middle-income countries. Therefore, the need to review studies on HIV-positive couples with intimate partner violence to establish gaps and identify where primary research is necessary. Hence, this study will explore evidence of experiences of HIV-positive couples with IPV and the types of violence experiences by HIV-positive couples.

Research objectives
The main aim of the review is to explore evidence of intimate partner violence among human immunodeficiency virus (HIV)-positive couples.
The specific objectives of the study include the following: 1. To review evidence on the types of intimate partner violence among HIV couples 2. To review evidence on the experiences of HIV couples with intimate partner violence The study will provide answers to the following questions: 1. What are the types of intimate partner violence among HIV couples? 2. What are the experiences of HIV couples with intimate partner violence?

Methods/designs
This study protocol was registered and published with the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42017062190.

Search strategy and study selection
This scoping review will involve electronic databases which will include PsycARTICLES (EBSCO), Psy-cINFO (EBSCO), ScienceDirect, PubMed, MEDLINE (EBSCO) and Google Scholar. The search strategy will include all studies that addressed evidence of experiences of HIV-positive couples with partner violence. All peer-reviewed studies and grey literature that addresses the research questions will be selected in the study. Only articles published in English between 2007 and 2018 will be used. The reason for limiting this study to between 2007 and 2018 is due to lack of resources. The literature search results will be uploaded to EndNote X8. The EndNote X8 software will be used to find and remove duplicates. The search will be conducted over 4 months. Keywords search (Table 1) will be combined into a phrase including Boolean (AND, OR) terms, as follows: (intimate partner violence AND HIV/AIDS OR couples OR disclosure OR behaviour OR low and middle income countries).

Criteria for inclusion
Updated records of the number of publications identified during each session of the literature search will be kept using the information.

Data extraction
Numerical summary and thematic analysis will be employed to extract background information from the selected studies. In order to answer the research questions as guided by population, interventions, comparison and outcome (PICOS) ( Table 1), the reviewers will collectively design a data-chronicling form to determine the text words, and themes to include and extract. They will also collectively develop the data-charting form.
➢ Information and data relevant to answer the research questions will be determined by the reviewers collectively ➢ Update recording of data relevant to the study ➢ Relevant data will be extracted from all the eligible studies by two independent reviewers in duplicate Data to be extracted include (i) author (s) names, (ii) year of publication, (iii) study design and/or methodology, (iv) study population, (v) intervention(s), (vi) study setting, (vii) aim of the study, (viii) geographic location of the study and (ix) conclusions.
Information specific to the evidence of experiences of HIV-positive couples with partner violence will be extracted using phases of the literature search for extraction of the most specific literature for the review as seen in Fig. 1 below. ➢ If necessary, a third reviewer will be consulted in order to reach consensus ➢ The researchers will collectively carry out a thematic analysis to extract relevant outcomes using NVivo software

Collating, summarizing and communicating results
The main aim of this review is to scope for existing evidence of the experiences of HIV-positive couples with partner violence and summarize the findings as presented across the articles reviewed. The research team will meet to carry out a thematic analysis of the data collected and provide an overview of all data collected. This process will include the following steps; Study settings Low-and middle-income countries are the focus. Owing to the scarcity of literature on intimate partner violence, we proposed not to limit the scope of this review by study setting. The rationale for this is to have a good number of publications globally for comparison Step 1: Examine the bibliographic details, study designs, number of participants, study setting and funding sources of all included studies Step 2: Results on the evidences of the experiences of human immunodeficiency virus (HIV)-positive couples with partner violence will be coded independently by the authors. All the authors will then come together and interrogate the resultant themes, critically look at their relationship to the set research questions Step 3: The research team will examine the implications for future research, practice and policy based on the main aim of the study

Patient and public involvement
Patients and/or the public were not involved in this study.

Discussion/conclusion
This study will generate evidence that will help to de- We are not aware if there are any empirical studies or reviews that have been done in sub-Saharan African countries that answer the research questions outlined in this protocol. Therefore, this study will include all studies from anywhere in the world that address the population of interest, intervention and any/or all the outcomes listed in Table 1.
Findings from this study will contribute to the body of knowledge on intimate partner violence among HIVpositive individual/couples which will have a positive impact on research, practice and policy. Reduction or elimination of intimate partner violence should help improve the quality of life of HIV-positive couples and increase their life expectancy. The findings from the study will provide an insight on the possible means of reducing IPV and abuse among PLWHIV. The proposed systematic scoping review results will generate findings that will describe the experiences of HIV-positive couples with partner violence, and the types of violence these populations experienced. The findings from this study will help in identifying gaps in literature on the care of the HIV-positive couples with partner violence. It will also enhance HIV prevention that can be used in education, clinical practice and in making public health policies on HIV and AIDS prevention. The gaps identified will help outline areas for preventive strategies to stimulate cordial coexistence among couples in the low-and middle-income countries. However, there is no data on intimate partner violence among HIV-positive couples in low-and middle-income countries. A number of studies have been on HIV and stigmatization among both men and women.