Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol

Eligibility criteria

To specify inclusion criteria, population, concept and context (PCC) were defined (see table 1). The population of interest is all adults for whom guidelines recommend screening or access to diabetes or hypertension care, irrespective of sex or socioeconomic characteristics. Children with diabetes or hypertension were also included. The concept of interest is disruption to the delivery of primary care services, focusing primarily on diabetes and hypertension-related primary care services and management, and mitigation, reversal or recovery of those services where interruptions occurred. The context is the LAC region during the COVID-19 pandemic, including the years 2020–2022. The list of countries in the LAC region was defined according to the United Nations. Individual LAC countries are listed in the search terms (online supplemental appendix 3).

Eligible studies will fall within the PCC defined above. However, we intend to consider inclusion of literature outside the defined population and context if findings are insufficient to achieve our objectives. Specifically, literature that relates to the first research question will be restricted to the defined context of LAC, whereas literature to answer the second research question may include studies outside LAC. For both research questions, literature related to diabetes or hypertension care will be prioritised; however, literature on disruptions or recovery of services typically provided in primary care more broadly (eg, cancer screening) will be included during title/abstract screening and full-text review. Once the full-text review is complete, the number of studies relating to (1) disruption to diabetes care, (2) disruption to hypertension care, (3) recovery of diabetes care and (4) recovery of hypertension care will be assessed. If we do not find enough papers (eg, <50 articles) in each of these four categories for data extraction, we will explore relevant articles more broadly (ie, outside the LAC context or scoping out to other primary care services which may indicate disruptions to diabetes and hypertension care).

Original studies (eg, retrospective or prospective observational studies; clinical trials), reports and reviews with systematic search strategies (eg, systematic reviews, scoping reviews) will be included, whereas narrative literature reviews not using systematic searches will be excluded. Literature will be considered if published in English, Spanish or Portuguese. Studies will be excluded if they do not contain research data on levels of service delivery or effectiveness of interventions. Hence, editorials, commentaries, perspectives/viewpoints, theoretical reflective studies and letters to the editor for other original articles will not be included. Conference abstracts will be excluded.

Of note, studies were not restricted to the primary care setting, but may include any disease prevention or management services typically considered part of primary care; accordingly, studies on community health services or hospital outpatient services may be included, whereas specialist treatment will generally be excluded. Furthermore, when investigating ‘primary care’, this is defined to include all levels of the treatment cascade (awareness, detection, treatment and control); hence studies on prevention, screening and diagnosis will be included. This includes screening for diabetic complications (eg, eye, kidney, foot and heart disease); hence studies reporting referral to specialist care for screening of complications will be included. We will exclude studies with only COVID-19 cases or studies on the efficacy of COVID-19 prevention (eg, vaccination), surveillance, treatment or testing modalities, as this is not the focus of this review. Studies on the association of diabetes, hypertension or any other condition with COVID-19 infection or outcomes will also be excluded. Furthermore, we will exclude studies that primarily present data on dental care, established cancer treatment (not: cancer screening and treatment initiation), long-term and residential care (eg, in nursing homes), palliative care, psychiatry care, psychotherapy and mental health counselling, surgery (except in relation to diabetes/hypertension, as detailed in the next paragraph), acute hospital and emergency care and follow-up of acute conditions (except diabetes/hypertension related), management of substance use disorders and rehabilitation care, as these are not typically provided in primary care.

We will include studies reporting results from tertiary care services for diabetes and hypertension (eg, acute hospitalisation for diabetes-related/hypertension-related complications), as the occurrence of complications may indicate how effectively primary care services managed diabetes and hypertension care. These studies will be included if reporting referral or access to tertiary care or frequency (ie, prevalence and incidence) of complication occurrence, but excluded if reporting on delivery of specialist treatment. For example, findings on adverse cardiovascular event (eg, myocardial infarction, stroke) prevalence may be included if a link to diabetes or hypertension has been made in the study, or a link to primary care provision more generally is mentioned, whereas we will exclude cardiovascular events related to COVID-19 infection, health outcomes of specialist or tertiary care treatment and all other studies on cardiovascular events outside the above definition.

Due to the interest in COVID-19-specific disruptions to care, the review will be limited to literature indexed from 1 January 2020.

Search strategy and information sources

The authors developed the search strategy through an iterative approach, in consultation with an information specialist (LR), and guided by the PCC framework described above. A preliminary list of search terms was collated and further potential search terms were added through discussion within the team. To identify literature in relation to the second research question (mitigation/reversal/recovery interventions), a preliminary PubMed and Google search was conducted; titles, abstracts, index terms and a small number of full texts of retrieved scientific papers and reports were analysed for text words relevant to the search. These potential search terms were entered into PubMed to investigate their relevance to the research questions and approved terms were added to the list of potential search terms. Moreover, various terms from the preliminary list were entered in the MeSH database to identify additional search terms. The collated list of potential search terms was then discussed with the information specialist, who added further search terms in relation to COVID-19 and the LAC region (concept and context) and refined the search strategy.

Second, the preliminary search strategy was piloted to gauge the yield of relevant publications and to test the clarity of inclusion/exclusion criteria for reviewers. Following an initial search via PubMed, 700 articles were randomly chosen and pilot-reviewed by the researchers, and by research assistants who had not participated in the search strategy development, using double review. Based on the pilot review, the preliminary search strategy was discussed and further refined by the research team prior to performing the final search.

The final search strategy includes database-specific terms (MeSH terms) and keywords (see online supplemental appendix 3). For the final search, we will explore the following eight electronic databases: MEDLINE via PubMed, CINAHL, Global Health, Embase, Cochrane, Scopus, Web of Science and a Latin America specific database, LILACS.

Additionally, we will search grey literature and citation lists to identify relevant studies which may have been missed in the database search. For identifying grey literature, we will seek input from the World Bank, PAHO and regional subject experts recommended by PAHO. Cross-referencing will be done during full-text review to identify studies from the citation lists of identified literature reviews and reports.