Conceptualising care pathways for neglected tropical diseases in sub-Saharan Africa: A systematic scoping review

Background: There is a lack of synthesized evidence on how best to support care continuity for neglected tropical diseases (NTDs) in sub-Saharan Africa (SSA). Methods: To identify all SSA NTD care pathways, we conducted a systematic search of six scientific databases from inception to 18 February 2023. All studies were required to include care pathways for NTDs, defined at minimum as having both NTD diagnosis and treatment or referral to treatment for care continuity. Using an iterative approach to establish an understanding of care pathways relevant for NTDs, concept development drew from data extraction of variables relating to study characteristics; approaches to diagnosis, treatment, and referrals as pathway components; barriers to care and strategies for their resolution; and ethical challenges. Findings: Searches returned 2178 studies where after de-duplication and eligibility screening, 164 were systematically reviewed. Medical referrals were used to support care continuity in 62.2% (102/164) of studies, and community health workers played roles in patient care in 22.6% (37/164) of studies. Only 6.7% (11/164) of studies explicitly mapped care pathways, none of which were for NTDs where preventive chemotherapy is the primary management strategy. The majority of studies (82.9%; 136/164) presented unmapped care pathways, which were primarily biomedical research studies that provided diagnosis and/or treatment of NTD patients (66.9%; 91/136). Of biomedical research studies, 36.3% (33/91) described strategies to support continuity of care. While there is no singular care pathway for all NTDs in SSA, we proposed a conceptual framework relevant for implementation of biomedical research. Interpretation: Further research is needed on morbidity management of NTDs typically addressed through mass drug administration in sub-Saharan Africa. To conduct this research, there is a need for guidance on how research sponsors should collaborate with local health systems to enable continuity of care in low-income, NTD-endemic settings.