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. 2024 Jul 25;19(7):e0307656. doi: 10.1371/journal.pone.0307656

Incidence and influencing factors related to social isolation among HIV/AIDS patients: Protocol for a systematic review and meta-analysis

Qiao Wu 1, Jiarong Tan 1,*, Shu Chen 1,*, Jiayi Wang 1, Xiaogang Liao 1, Lingling Jiang 1
Editor: Magdalena Szaflarski2
PMCID: PMC11271913  PMID: 39052562

Abstract

Background

People living with HIV (PLWH) are susceptible to social isolation as a result of stigma and discrimination, which not only diminishes adherence to antiretroviral therapy but also heightens the risks of hospital readmission, depression, and mortality. However, there is currently no systematic review addressing the occurrence and impact of social isolation in individuals with HIV. Therefore, this study undertook a comprehensive systematic review and meta-analysis of existing literature to examine the prevalence and influencing factors associated with social isolation among PLWH.

Methods and analysis

PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Google Scholar, China Science and Technology Journal Database, The China National Knowledge Infrastructure, WanFang Data and Chinese Biomedicine Literature Database will be searched from the establishment of the database to the latest search date. Literature screening, data extraction and literature quality assessment will be done independently by two researchers and results will be cross-referenced. Data analysis will be performed using stata15.1 software. Risk of publication bias will be assessed using Begg’s and Egger’s methods. Heterogeneity between studies will then be assessed using the I2 index and its 95% CI and Q statistics. Sources of heterogeneity will be accounted for by subgroup and sensitivity analyses.

Results

The results may reveal the prevalence of social isolation among PLWH and provide data support for understanding its etiology and prevention.

Conclusion

By systematically reviewing the existing literature on social isolation among PLWH, this study aims to provide a comprehensive understanding of the prevalence of social isolation within this population, elucidate the detrimental effects it poses for people affected by HIV, and effectively inform targeted interventions for high-risk groups. Furthermore, these findings offer valuable insights to support evidence-based decision-making in public health policy.

Systematic review registration

PROSPERO registration number: CRD42024499044

Introduction

Social isolation, also known as social isolation, refers to an individual’s lack of a sense of belonging in society, insufficient contact with others and social contacts, and a fractured or isolated state of interpersonal interactions, which leads to negative physical and/or psychological consequences [1–3]. It is an objective and quantifiable reflection of reduced social network size and paucity of social contact [4].The prevalence of social isolation is increasing in contemporary society [5]. Studies have demonstrated that more than one in ten individuals in the adult population reported social isolation [6] and nearly one-quarter of adults aged 65 years and older are considered socially isolated [7]. While social isolation may be more common in older age groups, it similarly affect younger age groups [8]. Relevant studies have shown that the incidence of social isolation in children with hearing loss is 64.7% [9].

Whereas PLWH may be more vulnerable to social isolation because they experience or perceive stigma and discrimination, which prevents them from building social network relationships [10–12]. Furthermore, HIV infection itself intensifies many normal aging processes and increases the incidence and severity of frailty, which may hinder their participation in social activities and exacerbate social isolation [13, 14]. According to the literature, the prevalence of social isolation in HIV patients can be as high as 48.5% to 59% [15, 16].

Social isolation has serious adverse effects on PLWH, which not only reducing their adherence to treatment, but also increasing their risk of hospitalization, depression and so on [17, 18]. It may even synergise with other immune processes, leading to an increased risk of morbidity and mortality in PLWH [19]. It is clear that social isolation is an important factor affecting the prognosis and quality of life of PLWH, and has become a global public health problem [20].

In addition, few viable interventions have been identified for the social isolation of PLWH [21] so early identification of risk factors associated with social isolation among PLWH, so as to take targeted interventions is an important way to prevent the occurrence of social isolation among PLWH. However, there is less information about social isolation among HIV [17], and there is no systematic retrospective study on the occurrence of social isolation and its associated factors in PLWH. Based on this, the present study was conducted to systematically evaluate the epidemiological status of social isolation in HIV patients and related influencing factors based on a comprehensive search of original studies on the occurrence of social isolation and related influencing factors in PLWH. The aim is to reveal the prevalence of social isolation among PLWH and its related influencing factors, so as to provide data support for further clinical identification of the high-risk group of PLWH in whom social isolation occurs, and to provide a more comprehensive pre-study basis for its etiological study.

Materials and methods

Study registration

This system review will be carried out in accordance with the Preferred Reporting Project (PRISMA-P) statement guidelines (S1 File) for systematic reviews and meta-analysis programs,and has been registered on the system review registration platform Prospero, registration number: CRD42024499044.

Inclusion and exclusion criteria

The inclusion and exclusion criteria in this review were formulated based on the PECOS (Population, Exposure, Comparison, Outcome, and Study design) principles.

PECOS description

Population

People living with HIV.

Exposure

Influential factors of social isolation. Influencing factors are exposures that increase the incidence of social isolation among PLWH, may include: age, gender, marital status, education, cognitive reserve, income, etc.

Comparator

Reference groups were established for each influencing factor in every study, such as the prevalence of social isolation among male and female PLWH, as well as the prevalence of social isolation among married, unmarried, and divorced PLWH.

Outcome

The prevalence of social isolation and its influence factors or determinants among PLWH.

Study type

Observational studies, including cross-sectional, case-control, and cohort designs, that reported on the incidence or risk factors for social isolation among PLWH Will be included.

Inclusion criteria

  1. Participant. We will incorporate studies involving PLWH who have been diagnosed as social isolation according to any recognized diagnostic criteria, such as the Lubben Social Network Scale [22], regardless of gender, age, race, nationality, or occupation.

  2. Type of study. Published prospective or retrospective studies on observational studies (including cross-sectional, cohort and case-control studies) which report on the incidence of social isolation among PLWH and the influence factors.

  3. Type of exposure. Determinants of social isolation.

  4. Types of outcomes. Primary outcome indicators included different population characteristics (gender, age, occupation, education, etc.), the prevalence of social isolation among HIV patients in different regions, and risk factors associated with the occurrence of social isolation among HIV patients.

Secondary outcomes included general characteristics of the patients (region, age, sex, ethnicity), time of investigation, diagnostic criteria, and type of study.

Exclusion criteria

  1. Studies with incomplete information and data that could not be extracted.

  2. Studies reported or published repeatedly in the same study population, excluding lower quality studies.

  3. Studies not in Chinese or English.

  4. Studies for which only the abstract was available and the full text could not be obtained by contacting the authors.

  5. Lower quality studies (AHRQ scores, Newcastle Ottawa scale scores below 3 points).

Data sources and search strategy

The following 10 databases will be searched: English databases (PubMed, EMBASE, Web of Science, The Cochrane Library, CINAHL, Google Scholar), Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang Data, China Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP). The search was conducted from the database establishment to January 2024. In order to improve the sensitivity, we used a combination of subject terms and free text terms to retrieve the literature. Subject terms included: Social Isolation, HIV, Acquired Immunodeficiency Syndrome, Epidemiology, incidence, Risk Factors. The free word included: Social Exclusion, Social Separation, Social segregation, Social seclusion, Social shielding, Social partitioning, Social solitariness, Social aloneness, Human Immunodeficiency Virus, Lymphadenopathy Associated Virus, AIDS, HIV, Epidemiology, frequency, occurrence, outbreaks, prevalence, incidence, Risk Factor, influence, Affecting factor and so on. At the same times we will search the bibliographies of all studies included in the systematic review to ensure that no relevant studies are missed. The specific search strategy employed in this study is outlined in S2 File, taking Pubmed as an illustrative example.

Study selection

Literature screening will follow the following steps:

  1. Use EndNote X9 software to find the duplicates imported after searching, and delete the duplicates among databases and record them after comparing the information of authors, titles, journal names, publication time, keywords, abstracts, etc. one by one.

  2. Two researchers independently and carefully read the titles and abstracts of all the retrieved literature to determine the relevance of the literature to the research questions of the systematic evaluation, exclude obviously irrelevant literature and indicate the reasons for exclusion, and proceed to full-text screening of literature that is not sure of its relevance.

  3. To obtain the full text of the potentially qualified and uncertain literature initially selected, two researchers independently carefully read and evaluate the full text of the literature, extract the relevant information in the literature, determine whether the literature meets the inclusion criteria of systematic evaluation, and decide whether the literature is included.

Note: Throughout the screening of the literature, two researchers were required to independently screen the literature, make comparisons at the end of each step, and seek arbitration from a third researcher in case of disputes.

Data extraction

Data extraction will be carried out according to a pre-designed data extraction form. Data and information management will be carried out using Microsoft Excel 2016.

Two researchers read the full text of the included literature in detail and independently extracted all relevant information from the study, including basic information of the included literature, basic characteristics of the study and risk factors. Check the extracted data, and if there is any disagreement, check the original literature and modify it.

  1. Basic information of the included literature: including the title of the literature, the name of the first author, journal information (journal name, year, volume, issue and page number), research location, extraction time and extraction personnel.

  2. Basic research information: Study type, study time, study country, data collection method (clinical interview or questionnaire), sample size, number of people with social isolation, prevalence rate of social isolation, characteristics of study subjects (including age, gender, income, education level, sexual behavior characteristics, diagnostic criteria for social isolation, etc.), and disease characteristics (diagnosis method of HIV, course of disease, and treatment method) Type, etc.).

  3. The study of risk factors should also extract: The total number of patients in the case group and the control group, the number of positive social isolation, the number of negative social isolation, the mean and standard deviation of risk factors related to the case group and the control group respectively.

The above literature screening process will be carried out according to PRISMA-P [23], as shown in Fig 1.

Fig 1. Flow diagram of study selection process.

Fig 1

Open in a new tab

(n): is the number of articles that will be included at each stage.

Risk of bias and quality assessment

The cross-sectional study will be assessed for literature quality using 11-item instrument recommended by the Agency for Healthcare Research and Quality [24].

Each item was answered with "yes," "no," or unclear. If the answer is "no" or "unclear", the item will receive a score of "0"; If the answer is "yes", the item is scored as "1". The quality of literature was evaluated as follows: low quality = 0~3; Medium quality = 4~7; High quality = 8~11.

Cohort studies and case-control studies were evaluated by the Newcastle-Ottawa scale recommended by the Non-randomized Research Methods Group of the Cochrane Collaboration [25] n. The scale consists of eight items in three aspects: group selection, comparability between groups, and measurement of exposure or outcome. The total score of each item was 1, except for the item of comparability between groups 2 points. The scores of literature quality ranged from 0 to 9. The literature with scores of ≤3, 4–6 and ≥7 were defined as low quality, medium quality and high quality, respectively.

Two researchers independently assessed literature quality and cross-checked their results. In cases where their conclusions differed, consensus was reached through discussion.

Data analysis and assessment of publication bias

Data analysis

The Stata 15.1 software will be used for data analysis.

Ethics and dissemination Heterogeneity between the included studies was judged by Q test (P value) and I2. If I2 was <50% and P of Q test was >0.1, it was considered that there was good homogeneity among the studies. When there was no obvious heterogeneity among the studies, the fixed effect model was used to calculate the pooled incidence of social isolation of HIV patients. Otherwise (P≤0.1 or I2≥50%), it was considered that there was significant heterogeneity among the studies, and the random effects model was used for the combined calculation. If there was significant heterogeneity among the included studies, the following measures would be taken: the data were checked again; Subgroup analysis and other methods were used to explore the sources of heterogeneity; After excluding the studies with abnormal results, the meta-analysis was performed again, and the results were compared with the meta-analysis without abnormal results to explore the impact of the study on the combined effect; The heterogeneity among studies was too obvious, and the source of heterogeneity was explored by subgroup analysis and sensitivity analysis. The inverse variance method or Mantel-Haenszel method was used to calculate the OR or mean difference of the influencing factors of social isolation in HIV patients. If the data from the included studies could not be synthesized quantitatively, a statistical description was conducted.

Publication bias

The funnel plot was visually assessed to detect potential publication bias. In the presence of noticeable asymmetry, it suggests the existence of certain publication bias. Begg’s rank correlation test and Egger’s linear regression method were employed for quantitative evaluation of publication bias in the meta-analysis investigating the incidence of social isolation and its associated influencing factors among PLWH.

Sensitivity analysis was carried out by excluding the studies with small sample size, large weight and high risk of bias one by one, then the meta-analysis was performed again, and the results were compared with the Meta-analysis without excluding abnormal results to explore the impact of the study on the combined effect.

Ethics and dissemination

This study is an overview based on published articles, so there is no need for ethical review. The study will be conducted in accordance with the protocol approved by PROSPERO in January 2024: the database search will commence on January 25, 2024, and the entire review process is anticipated to conclude by June 30, 2025.

This system evaluation will be published in peer-reviewed journals and the review will be circulated in a peer-reviewed journal or conference report.

Results of the study

The results of this study will shed light on the prevalence of social isolation among PLWH by comparing the differences in the incidence of social isolation among PLWH by different population characteristics (gender, age, education, marital status, etc.), by country/region, and by other relevant factors (duration of HIV disease, use of antiretroviral medication, etc.), the differences in the incidence of social isolation in female versus male HIV patients, thus helping to identify the groups at risk for social isolation. This will reveal the prevalence of social isolation among HIV patients, and thus help to identify groups at high risk of social isolation among HIV patients.

At the same time, the results of this study will also reveal the risk factors related to HIV social isolation through Meta-analysis, so as to provide a basis for clinical targeted scientific prevention programs and provide an important reference for the formulation of public health policies.

Discussion

Social isolation is associated with a variety of adverse health outcomes: it not only increases the risk of falls, cognitive decline, coronary heart disease, depression, stroke, etc., but also increases the all-cause mortality of patients [26–30]. However, existing evidence indicates that PLWH are more prone to experiencing social isolation as a result of stigma and discrimination, which can have numerous detrimental effects on their well-being.

Understanding the prevalence of social isolation among PLWH and related influencing factors is an important prerequisite for effective intervention.

However, because of the limitation of sample size, funds and the regional difference is the lack of a representative study of social segregation occurred among people infected with HIV. In addition, no meta-analysis has been conducted on the current status of social isolation and related influencing factors in this population. Therefore, this study compares the social isolation of PLWH patients with different characteristics (such as age, gender, marital status, education level, time of HIV diagnosis, etc.) by meta-analysis, which can not only comprehensively understand the prevalence of social isolation in PLWH, but also explore the related influencing factors of social isolation in PLWH. Important indicators to identify high-risk groups.

Limitations of the study. Firstly, due to the limitation of language factors, only Chinese and English literature was included in this paper, while literature published in other languages was not included in the analysis, which may lead to some bias in the results. Secondly, for the meta-analysis part of the incidence of social isolation in PLWH, there may be a large heterogeneity among the literature due to the limitation of the characteristics of the individual rate Meta-analysis (in order to explore the source of the heterogeneity, subgroup analyses based on factors such as gender, age, and so on will be conducted in this study).

Supporting information

S1 File. PRISMA-P 2015 checklist.

(DOCX)

pone.0307656.s001.docx (25.2KB, docx)
S2 File. Search strategy of Pubmed database.

(DOCX)

pone.0307656.s002.docx (11.8KB, docx)

Data Availability

No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

Funding Statement

The author(s) received no specific funding for this work.

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Decision Letter 0

Magdalena Szaflarski

10 Apr 2024

PONE-D-24-03090Incidence and influencing factors related to social isolation among HIV/AIDS patients: protocol for a systematic review and meta-analysisPLOS ONE

Dear Dr. Tan,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. This study is a useful addition to the current literature regarding social isolation among people living with HIV. The overall design is appropriate. There are several aspects of the paper that need improvement. Specifically, the description of approach and methods needs refinement. For example, the period of the study is not stated, inclusion and exclusion criteria are unclear, and data sources and search strategy need further details. There is also some confusion about the place of results, discussion, and conclusions in the paper. Some reorganization and streamlining there is needed. Please consider and respond to all comments provided by both reviewers, and revise the paper accordingly. Please submit your revised manuscript by May 25 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

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Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

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Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors,

First of all thanks for your manuscript called Incidence and influencing factors related to social isolation among HIV/AIDS patients: protocol for a systematic review and meta-analysis. I found really valuable the contribution of this paper in the field, it is systematic review and meta-analysis to systematically identify and synthesize the existing literature on the occurrence of social isolation in HIV patients and its associated influencing factors. Anyways I have some concerns with the content and hope the feedback can be taken into consideration and will help with the manuscript quality.

Abstract

1.Introduction should not appear in the abstract, and I can suggest to the authors that they draw the research topic in the background. (Line 11-17)

2.Authors should adjust the structure and write background, methods, results and conclusions in the abstract. (Line 11-36)

3.The sentence “This will be the first systematic review......and its associated influencing factors” is the research significance, it does not belong to the research conclusion. (Line 30-32)

Introduction

Introduction need a restructuring to make all the idea clear, I suggest to use the second-level title to separate theoretical concepts from other contents, such as social isolation among PLWH.

Materials and methods

1.The introduction part has indicated the purpose of the study (Line 68-72), and the research method need not repeat the objectives. (Line 74-79) I suggest to keep the former, because data acquisition, data coding, data analysis should be main content in materials and methods section.

2.The authors say that social isolation is a common phenomenon among adults in introduction, for example, “Social isolation is prevalent psychosocial processes among adults.” (Line 12) “Studies have demonstrated that more than one in ten 48 individuals in the adult population reported social isolation and nearly one-quarter 49 of adults.” (Line 48-51) But according to the screening criteria, the population is included in any age. “We will include studies of PLWH who have been diagnosed as social isolation according to any recognized diagnostic criteria, regardless of age.” (Line 88) I suggest that authors add social isolation phenomenon of other age groups in the introduction section for smooth cohesion.

Inclusion and exclusion criteria

1.Author should use as objective a description as possible, “any recognized diagnostic criteria” is too ambiguous, you may give specific examples, like based on some widely used scale. (Line 88)

2. I recommend to add a PICO process just to make the search process more clear. Population, Intervention, Comparison(s) and Outcome (PICO) is usually used for systematic review and meta-analysis of clinical trial study. For the study without Intervention or Comparison(s), it is enough to use P (Population) and O (Outcome) only to formulate a research question. A well-formulated question creates the structure and delineates the approach to defining research objectives. (Line 87-98)

Data sources and Search strategy

1.The selected databases represent the quality of the articles included in the meta-analysis, the authors mainly search several databases containing high quality papers (like Web of Science). In order to retrieve the suitable and substantial quantitative empirical research studies, a systematic and comprehensive search was conducted, we use Google Scholar and so on as a supplementary database. And what is the total number of articles retrieved that met the criteria? (Line 107-110)

2.Literature search should clearly show the screening process of English database and Chinese database with PRISMA flow chart, and the number of articles included in the meta-analysis should be presented according to the screening criteria. (Line 122)

Data extraction

1.The article should focus on the research process and results, and the researcher can divide the division in Contributors. (Line 144)

2.The article is missing a document coding table, which can clearly present the characteristics of the selected literature. (Line 157)

Risk of bias and quality assessment

The article should focus on the research process and results, and the researcher can divide the division in Contributors. (Line 177)

Data analysis and assessment of publication bias

The authors do not present the funnel plot, how the data points are distributed on the funnel plot? What does the distribution show on the funnel plot? (Line 201)

Discussion

The Results section is missing before Discussion, and the Conclusion chapter is missing after Discussion. The Result is an objective presentation of research result. In discussion, authors can write the association and difference between your research results and other studies to further highlight the significance of research, the limitations of research, and suggestions for subsequent studies and so on. Conclusion is a summary of the full text, authors can make a selective summary of the important content. (Line 206)

Minor edits

First letter of “Which” should use lower-case letter. (Line 40)

Reviewer #2: The manuscript appears formulaic. There is no study period. The authors also do not designate the types of studies they will focus on. How will they operationalize social isolation for this study. In addition, to incidence and prevalence they could also look at the impact of social isolation on various outcomes.

**********

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Reviewer #1: No

Reviewer #2: No

**********

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PLoS One. 2024 Jul 25;19(7):e0307656. doi: 10.1371/journal.pone.0307656.r002

Author response to Decision Letter 0

2 Jul 2024

Dear Editors and Reviewers:

We sincerely appreciate your letter and the reviewers' insightful comments on our manuscript titled 'Incidence and influencing factors related to social isolation among HIV/AIDS patients: protocol for a systematic review and meta-analysis.' Your comments and those of the reviewers were highly insightful and enabled us to greatly improve the quality of our manuscript.In the following pages are our point-by-point responses to each of the comments of the reviewers as well as your own comments.

Revisions in the text are shown using yellow highlight for additions, and strikethrough font [example] for deletions.

Below is the opinion of the referees, we make a point by point response to, and points out the revision.

Responds to the reviewer’s comments:

Reviewer #1:

1.Abstract

1.1Comment:Introduction should not appear in the abstract, and I can suggest to the authors that they draw the research topic in the background. (Line 11-17)

1.1Reply:We express our gratitude to the reviewer for bringing this matter to our attention.In accordance with your suggestion,we have adjusted the introduction in the abstract to the research backgroundand enhancing the corresponding content; please refer to lines 11-18 of the revised manuscript.

1.2Comment:Authors should adjust the structure and write background, methods, results and conclusions in the abstract. (Line 11-36)

1.2Reply:We express our gratitude to the reviewer for bringing this matter to our attention. In response, we have restructured the abstract into four sections: background, methods and analysis, results, and conclusions. Furthermore, we have made corresponding revisions in content as well. Please refer to lines 11-39 of the revised manuscript for further details.

1.3Comment:The sentence “This will be the first systematic review......and its associated influencing factors” is the research significance, it does not belong to the research conclusion. (Line 30-32)

1.3Reply:We express our gratitude to the reviewer for bringing this matter to our attention. In response, we have made revisions to the abstract section of the study; kindly refer to lines 34-39 in the revised manuscript.

2.Introduction

2.1Comment:Introduction need a restructuring to make all the idea clear, I suggest to use the second-level title to separate theoretical concepts from other contents, such as social isolation among PLWH.

2.1Reply:We appreciate the reviewer for bringing this to our attention. In response to your suggestion, we have revised the introduction section accordingly.The revised introduction will encompass the following aspects: the definition of social isolation, the prevalence of social isolation, the fact that HIV patients are more likely to be socially isolated due to a variety of reasons (e.g., discrimination and stigma, etc.), the prevalence of social isolation among HIV patients (which can be as high as 48.5% to 59%), and the harms of social isolation to HIV patients, The current status of research on social isolation among HIV patients (no large-scale epidemiologic studies, no meta) and the significance of this study. See lines 43-80 of the revised manuscript for details.

3.Materials and methods

3.1Comment:The introduction part has indicated the purpose of the study (Line 68-72), and the research method need not repeat the objectives. (Line 74-79) I suggest to keep the former, because data acquisition, data coding, data analysis should be main content in materials and methods section.

3.1Reply:We appreciate the reviewer for bringing this to our attention.The purpose of the study has been omitted from the Materials and Methods section in accordance with your suggestion.

3.2Comment:The authors say that social isolation is a common phenomenon among adults in introduction, for example, “Social isolation is prevalent psychosocial processes among adults.” (Line 12) “Studies have demonstrated that more than one in ten 48 individuals in the adult population reported social isolation and nearly one-quarter 49 of adults.” (Line 48-51) But according to the screening criteria, the population is included in any age. “We will include studies of PLWH who have been diagnosed as social isolation according to any recognized diagnostic criteria, regardless of age.” (Line 88) I suggest that authors add social isolation phenomenon of other age groups in the introduction section for smooth cohesion.

3.2Reply:We appreciate the reviewer for bringing this to our attention.According to your suggestion, the following modifications have been made in the introduction: the previous content "social isolation is a common phenomenon in adults" has been revised to "Nowadays, the incidence of social isolation is increasing"; Additional description on the incidence of juvenile social isolation.See lines 41-53 of the revised manuscript for details.

4.Inclusion and exclusion criteria

4.1Comment:Author should use as objective a description as possible, “any recognized diagnostic criteria” is too ambiguous, you may give specific examples, like based on some widely used scale. (Line 88)

4.1Reply：We appreciate the reviewer for bringing this to our attention. According to your suggestion, we have made amendments to the diagnostic criteria for Social isolation and included the widely recognized Lubben Social Network Scale as an illustrative example. For further information, please refer to the revised section 106-107.

4.2Comment:I recommend to add a PICO process just to make the search process more clear. Population, Intervention, Comparison(s) and Outcome (PICO) is usually used for systematic review and meta-analysis of clinical trial study. For the study without Intervention or Comparison(s), it is enough to use P (Population) and O (Outcome) only to formulate a research question. A well-formulated question creates the structure and delineates the approach to defining research objectives. (Line 87-98)

4.2Reply:We appreciate the reviewer for bringing this to our attention. According to your suggestion, we have incorporated the PECOS process into the inclusion and exclusion criteria section. For further details, please refer to the revised line 88-103.

5.Data sources and Search strategy

5.1Comment:The selected databases represent the quality of the articles included in the meta-analysis, the authors mainly search several databases containing high quality papers (like Web of Science). In order to retrieve the suitable and substantial quantitative empirical research studies, a systematic and comprehensive search was conducted, we use Google Scholar and so on as a supplementary database. And what is the total number of articles retrieved that met the criteria? (Line 107-110)

5.1Reply:This study is a protocol of systematic review and meta-analysis. Therefore, there is no comprehensive literature screening at this stage. The current retrieval results show that 10 Chinese and English databases were searched, and a total of 3133 literatures were retrieved, including: CNKI(n=215); WanFang Data(n=175); VIP(n=76); CBM (n=284); Pubmed(n=372); Web of Science(n=461); Embase(n=108); CENTRAL(n=63); The Cochrane Library (n=82); Google Scholar (n=1297).

5.2Comment:Literature search should clearly show the screening process of English database and Chinese database with PRISMA flow chart, and the number of articles included in the meta-analysis should be presented according to the screening criteria. (Line 122)

5.2Reply:We appreciate the reviewer for bringing this to our attention. According to your suggestion, we drew a flow chart of the literature screening process according to PRISMA-P, as shown in Figure 1.

6.Data extraction

6.1Comment:The article should focus on the research process and results, and the researcher can divide the division in Contributors. (Line 144)

6.1Reply:We appreciate the reviewer for bringing this to our attention. According to your suggestion, the role of the investigator in data extraction was removed and only stated in the investigator contributions.

6.2Comment:The article is missing a document coding table, which can clearly present the characteristics of the selected literature. (Line 157)

6.2Reply:We appreciate the reviewer for bringing this to our attention. Because this study is a protocol of systematic review and meta-analysis . At present, there is no specific coding table for the included literature to present the characteristics of the selected literature. The results of the subsequent included literature will be presented in the complete meta-analysis to be published later.

7.Risk of bias and quality assessment

7.1Comment:The article should focus on the research process and results, and the researcher can divide the division in Contributors. (Line 177)

7.1Reply:We appreciate the reviewer for bringing this to our attention. Same with the process of information extraction, according to your advice, we will be the researchers in the risk of bias and the role of quality assessment for deleted, only make notes in the contribution.

8.Data analysis and assessment of publication bias

8.1Comment:The authors do not present the funnel plot, how the data points are distributed on the funnel plot? What does the distribution show on the funnel plot? (Line 201)

8.1Reply:We appreciate the reviewer for bringing this to our attention. This study provides additional instructions on how to determine the existence of publication bias based on the funnel plot. For details, please refer to lines 226-230 of the revised manuscript. However, this study is a systematic review and meta-analysis scheme, and the funnel plot cannot be presented at this stage. The specific publication bias results of this study will be presented in the complete meta-analysis to be published later.

9.Discussion

9.1Comment:The Results section is missing before Discussion, and the Conclusion chapter is missing after Discussion. The Result is an objective presentation of research result. In discussion, authors can write the association and difference between your research results and other studies to further highlight the significance of research, the limitations of research, and suggestions for subsequent studies and so on. Conclusion is a summary of the full text, authors can make a selective summary of the important content. (Line 206)

9.1Reply:We appreciate the reviewer for bringing this to our attention. According to your advice, we increased the results part by the end of the discussion, and to discuss the corresponding modification, such as increasing research possible limitations and further highlights the significance of research. See lines 235-273 of the revised version for details.

Reviewer #2:

1.Comment: The manuscript appears formulaic.

1.Reply:We appreciate the reviewer for bringing this to our attention. Due to the limitation of language level, this study language may be relatively smooth, to a certain extent, we also pay attention to this problem, the follow-up if need we will add the English speakers in the study the researchers, and the language of the article further polished.

2.Comment: There is no study period.

2.Reply:We appreciate the reviewer for bringing this to our attention.According to your suggestion, we have added the study period of the article, please refer to lines 276-278 of the revised manuscript for details.

3.Comment: The authors also do not designate the types of studies they will focus on. How will they operationalize social isolation for this study.

3.Reply:This study focuses on observational studies (including cross-sectional, cohort and case-control studies). The inclusion criteria have been explained in the literature inclusion criteria, and please refer to lines 109-111 of the revised manuscript for details. And according to the recommendations for further clarifications research retrieval process, we added the PECOS process, the study of cover type further illustrates, details please refer to the revised line 103-101.

4.Comment: In addition, to incidence and prevalence they could also look at the impact of social isolation on various outcomes.

4.Reply:According to your suggestion, we have made additional comments, such as comparing the difference in the incidence of social isolation between female and male HIV patients, which can not only reveal the prevalence of social isolation in HIV patients, but also help to identify high-risk groups of social isolation in HIV patients. For details, please refer to lines 236-247 of the revised version.

Responds to the Academic Editor

1.Comment: The period of the study is not stated.

1.Reply: We have added the study period of the article, please refer to lines 276-278 of the revised manuscript for details.

2.Comment: Inclusion and exclusion criteria are unclear.

2.Reply: As recommended, the PECOS process was added to further clarify the inclusion and exclusion criteria, please refer to the revised line 88-103.

3.Comment: Data sources and search strategy need further details.

3.Reply: A flow chart of the literature selection process was drawn according to PRISMA-P to further clarify the details of literature selection.

4.Comment: Here is also some confusion about the place of results, discussion, and conclusions in the paper. Some reorganization and streamlining there is needed. Please consider and respond to all comments provided by both reviewers, and revise the paper accordingly.

4.Reply:According to the suggestions, we reconstructed the results, discussions, and conclusions of the study, please refer to the revised line 235-273.

We would like to thank the referee again for taking the time to review our manuscript.

Yours sincerely

Attachment

Submitted filename: Response to Reviewers.docx

pone.0307656.s003.docx (18.1KB, docx)

Decision Letter 1

Magdalena Szaflarski

10 Jul 2024

Incidence and influencing factors related to social isolation among HIV/AIDS patients: protocol for a systematic review and meta-analysis

PONE-D-24-03090R1

Dear Dr. Tan,

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Additional Editor Comments (optional):

Thank you for your careful responses to the prior critiques and manuscript revision. No additional changes are recommended.

Reviewers' comments:

Acceptance letter

Magdalena Szaflarski

15 Jul 2024

PONE-D-24-03090R1

PLOS ONE

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. PRISMA-P 2015 checklist.

    (DOCX)

    pone.0307656.s001.docx (25.2KB, docx)
    S2 File. Search strategy of Pubmed database.

    (DOCX)

    pone.0307656.s002.docx (11.8KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0307656.s003.docx (18.1KB, docx)

    Data Availability Statement

    No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

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