Kabwama Steven Ndugwa, Wanyenze Rhoda K, Lindgren Helena, Razaz Neda, Ssenkusu John M, Alfvén Tobias
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala, Uganda.
JMIR Res Protoc. 2025 Jan 15;14:e64316. doi: 10.2196/64316.
BACKGROUND: Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies. OBJECTIVE: This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries. METHODS: The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility-level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation-Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries. RESULTS: The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025. CONCLUSIONS: The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies. TRIAL REGISTRATION: PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408967. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/64316.
背景:尽管现有的疾病防范与应对框架为加强应急响应能力提供了指导,但对应急响应期间卫生服务的连续性却鲜有关注。在2014年埃博拉疫情期间,据报告有11325人死于埃博拉病毒,然而,获得医疗服务的中断又导致因麻疹、艾滋病毒/艾滋病、结核病和疟疾额外死亡1万多人。低收入和中等收入国家承担着因艾滋病毒、结核病和疟疾造成的最大疾病负担,而以往对卫生紧急情况的应对表明,艾滋病毒、结核病和疟疾服务的提供可能会受到严重干扰。迄今为止,尚未对在紧急情况下为维持这些服务的提供而实施的干预措施进行系统的综合分析。 目的:本研究旨在综合分析低收入和中等收入国家在公共卫生紧急情况下为维持艾滋病毒/艾滋病、结核病和疟疾服务而实施的干预措施。 方法:该系统评价已在国际前瞻性系统评价登记册中注册。它将包括通过预防艾滋病毒、结核病或疟疾的发生、降低患者的严重程度或促进因在卫生紧急情况期间感染艾滋病毒、结核病或疟疾而丧失的功能恢复,从而改善人类健康的活动。这些活动将包括政策层面(如制定指南)、卫生机构层面(如重新安排服务)和社区层面的干预措施(如社区药物分发)。服务提供将从改善可及性、可得性、利用和覆盖范围方面进行衡量。我们将报告为维持艾滋病毒、结核病或疟疾治疗流程中的服务而采取的任何干预措施。将检索包括MEDLINE、科学引文索引、Embase、Cochrane和全球医学索引在内的同行评审研究数据库。还将检索关于艾滋病毒/艾滋病、结核病或疟疾的全球报告的参考文献列表。我们将使用GRADE-CERQual(推荐分级评估、制定和评价——定性研究综述证据的可信度)方法来报告每篇论文的证据质量。研究信息将在疾病或病症层面(艾滋病毒/艾滋病、结核病和疟疾)、实施层面(政策、卫生机构和社区)以及结果(改善可及性、可得性、利用或覆盖范围)进行综合分析。我们将使用PRISMA(系统评价和荟萃分析的首选报告项目)清单来报告研究结果,并讨论其对加强防范与应对以及加强低收入和中等收入国家卫生系统的意义。 结果:2023年1月至2023年
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