Impact of the COVID-19 pandemic on the HIV care continuum: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this systematic review is to synthesize evidence on the impact of the COVID-19 pandemic on the HIV care continuum for persons living with or at risk of living with HIV. INTRODUCTION: The COVID-19 pandemic affected the self-management and care of people living with HIV. Self-regulation to acquire recurring treatment for HIV is essential for managing symptoms as well as viral suppression. Therefore, this review will systematically appraise and synthesize primary literature on the impact of the COVID-19 pandemic on all phases of the HCC for people living with, or at risk of acquiring, HIV. INCLUSION CRITERIA: This systematic review will include quantitative, qualitative, and mixed methods studies. The search will be limited to studies reporting findings from March 2020. Selected studies must focus on one or more steps of the HIV care continuum, which are diagnosis of HIV infection, linkage to care, retention in care, adherence to antiretroviral therapy, and viral suppression. There are no age, gender, or geographic location restrictions for this review. Studies that examined the impact on other diseases as well as HIV will be included only if the data for HIV can be extracted separately. METHODS: The JBI methodology for convergent integrated mixed methods systematic reviews will guide this review. The following databases will be searched: MEDLINE (Ovid), CINAHL (EBSCOhost), CAB Direct, and Embase. Articles will be screened by 2 independent reviewers. In the case of a disagreement between reviewers, a third independent reviewer will resolve the conflict. Articles will be appraised for methodological quality and their data extracted using an original extraction tool created for the study's purpose. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021285677.

Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd.

PURPOSE: Many academic medical organizations issued statements in response to demand for collective action against racial injustices and police brutality following the murder of George Floyd in May 2020. These statements may offer insight into how medical schools and national organizations were reflecting on and responding to these incidents. The authors sought to empirically examine the initial statements published by academic medical organizations in response to societal concerns about systemic, anti-Black racism. METHOD: The authors searched for initial public statements released by a sample of academic medical organizations in Canada and the United States between May 25 and August 31, 2020. They assembled an archive with a purposive sample of 45 statements, including those issued by 35 medical schools and 10 national organizations. They analyzed the statements using Fairclough's 3-dimensional framework for critical discourse analysis (descriptive, interpretive, explanatory), which is a qualitative approach to systematically analyzing language and how it reflects and shapes social practice. RESULTS: Many statements used formal and analytical language and reflected hierarchical thinking and power differentials between statement producers and consumers. The authors identified several tensions in the statements between explicit messaging and implied ideologies (e.g., self-education vs action to address racism), and they found a lack of critical reflection and commitment to institutional accountability to address anti-Black racism in academic medicine. The authors also found that many statements minimized discussions of racism and de-emphasized anti-Black racism as well as portrayed anti-Black racism as outside the institution and institutional accountability. CONCLUSIONS: This research offers insight into how 45 academic medical organizations initially responded following the murder of George Floyd. Many of these statements included self-exculpatory and nonracist discursive strategies. While these statements may have been well intentioned, organizations must move beyond words to transformative action to abolish institutional racism in academic medicine.