PRISMA 2020 Checklist: Meta-analysis and Time Series Projection of HPV Prevalence Among Women in Honduras (1990-2023)

PRISMA 2020 Checklist Meta-analysis and Time Series Projection of Human Papillomavirus Prevalence Among Women in Honduras (1990-2023) Salvador Diaz1 (principal), Marissa Montoya1, Arnoldo Zelaya1,2, Jorge Valle1, Carlos Agudelo-Santos3, Marcio Madrid1,2 , Melania Madrid1, Alicia Diaz4, Yolly Molina3, Isaac Zablah1 1 Faculty of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras 2 San Felipe General Hospital, Ministry of Health (SESAL), Tegucigalpa, Honduras 3 Center for Biomedical Imaging Diagnostics Research and Rehabilitation, National Autonomous University of Honduras, Tegucigalpa, Honduras 4 Faculty of Health Sciences, Catholic University of Honduras, Honduras This checklist documents compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Items are numbered according to the PRISMA 2020 statement. Section/Topic Item # Checklist Item Location Reported TITLE Title 1 Identify the report as a systematic review. Title page ABSTRACT Abstract 2 See the PRISMA 2020 for Abstracts checklist. Abstract section INTRODUCTION Rationale 3 Describe the rationale for the review in the context of existing knowledge. Introduction, paragraphs 1-3 Objectives 4 Provide an explicit statement of the objective(s) or question(s) the review addresses. Introduction, final paragraph METHODS Eligibility criteria 5 Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses. Methods: Eligibility criteria section Information sources 6 Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. Methods: Search strategy section - PubMed, Google Scholar, Tz'ibalnaah, SciELO; searched January 2025 Search strategy 7 Present the full search strategies for all databases, registers and websites, including any filters and limits used. Methods: Search strategy section - keywords provided Selection process 8 Specify the methods used to decide Methods: Study selection whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process. section - two independent reviewers; consensus process described Data collection 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used. Methods: Data collection section - standardized extraction form used Data items 10a List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought. Methods: Data collection - HPV prevalence by age groups (15-24, 25-34, 3544, 45-54, 55+) Data items 10b List and define all other variables for which data were sought. Describe any assumptions made about any missing or unclear information. Methods: Data collection - study characteristics, diagnostic methods, sample sizes Study risk of bias 11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently. Methods: Quality assessment section - six quality criteria assessed Effect measures 12 Specify for each outcome the effect measure(s) used in the synthesis or presentation of results. Methods: Statistical analysis - pooled prevalence estimates with 95% CI; rates per 10,000 Synthesis methods 13a Describe the processes used to decide which studies were eligible for each synthesis. Methods: Statistical analysis - random-effects meta-analysis of proportions Synthesis methods 13b Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions. Methods: Population adjustment section - INE census data used for rate calculations Synthesis methods 13c Describe any methods used to tabulate or visually display results of individual studies and syntheses. Results section - forest plots, trend charts, tables Synthesis methods 13d Describe any methods used to synthesize results and provide a Methods: Statistical analysis - random-effects rationale for the choice(s). If metaanalysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used. model; I² statistic; MedCalc software Synthesis methods 13e Describe any methods used to explore possible causes of heterogeneity among study results. Results and Discussion - age-stratified analyses; methodological differences discussed Synthesis methods 13f Describe any sensitivity analyses conducted to assess robustness of the synthesized results. Discussion: Methodological limitations section Reporting bias 14 Describe any methods used to assess risk of bias due to missing results in a synthesis. Discussion: Methodological limitations - publication and selection bias addressed Certainty assessment 15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome. Discussion - heterogeneity analysis (I²=96.8%) and limitations discussion RESULTS Study selection 16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram. Results, paragraph 1; Figure 1 (PRISMA flow diagram) Study selection 16b Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded. Results, paragraph 1 - exclusion reasons: lack of age-stratified data (n=11) Study characteristics 17 Cite each included study and present its characteristics. Results, paragraph 2; Table 1 Risk of bias 18 Present assessments of risk of bias for each included study. Methods: Quality assessment - all studies met basic standards Results of individual studies 19 For all outcomes, present, for each study: (a) summary statistics for each group and (b) an effect estimate and its precision, ideally using structured tables or plots. Results; Tables 2-3; Figure 2 (forest plot) Results of syntheses 20a For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies. Results, paragraphs 2-3; Table 2 Results of syntheses 20b Present results of all statistical syntheses conducted. If metaanalysis was done, present for each the summary estimate and its Results - pooled prevalence 42% (95% CI: 36.1-63.9%); I²=96.8%; Figure 2 precision and measures of statistical heterogeneity. Results of syntheses 20c Present results of all investigations of possible causes of heterogeneity among study results. Results - age-stratified analyses showing divergent trends Results of syntheses 20d Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results. Discussion: Methodological limitations section Reporting biases 21 Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed. Discussion: Methodological limitations - publication bias discussed Certainty of evidence 22 Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed. Discussion - substantial heterogeneity limits certainty; forecast limitations noted DISCUSSION Discussion 23a Provide a general interpretation of the results in the context of other evidence. Discussion sections Discussion 23b Discuss any limitations of the evidence included in the review. Discussion: Methodological limitations section Discussion 23c Discuss any limitations of the review processes used. Discussion: Methodological limitations - limited temporal observations, heterogeneity Discussion 23d Discuss implications of the results for practice, policy, and future research. Discussion: Implications section; Recommendations for future research OTHER INFORMATION Registration 24a Provide registration information for the review, or state that the review was not registered. Methods - not registered (secondary analysis of published data) Registration 24b Indicate where the review protocol can be accessed, or state that a protocol was not prepared. Methods - protocol not prepared Registration 24c Describe and explain any amendments to information provided at registration or in the protocol. Not applicable Support 25 Describe sources of financial or nonfinancial support for the review, and the role of the funders or sponsors. Acknowledgments - UNAH institutional support; Funding Statement Competing 26 Declare any competing interests of Competing Interests interests review authors. statement - none declared Availability of data 27 Report which of the following are publicly available and where they can be found: data extraction forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used. Data Availability section - all data from publicly available studies; code available upon request Notes - This PRISMA 2020 checklist accompanies the systematic review and meta-analysis titled "Meta-analysis and Time Series Projection of Human Papillomavirus Prevalence Among Women in Honduras (1990-2023)". - License: This checklist is released under a CC0 1.0 Universal (CC0 1.0) Public Domain Dedication license. - For questions or clarifications, please contact the corresponding author at [email protected]