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Effectiveness of task-shifting for the detection of diabetic retinopathy in low- and middle-income countries: a rapid review protocol

  • Bascaran, Covadonga1
  • Mwangi, Nyawira1, 2
  • D’Esposito, Fabrizio3
  • Gordon, Iris1
  • Ulloa, Juan Alberto Lopez4
  • Mdala, Shaffi5
  • Ramke, Jacqueline1, 6
  • Evans, Jennifer R.1
  • Burton, Matthew1, 7
  • 1 London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK , London (United Kingdom)
  • 2 Kenya Medical Training College, Nairobi, Kenya , Nairobi (Kenya)
  • 3 The Fred Hollows Foundation, Melbourne, Australia , Melbourne (Australia)
  • 4 Centro Mexicano de Salud Visual Preventiva, Mexico, DF, Mexico , Mexico (Mexico)
  • 5 Queen Elizabeth Central Hospital, Blantyre, Malawi , Blantyre (Malawi)
  • 6 University of Auckland, Auckland, New Zealand , Auckland (New Zealand)
  • 7 Moorfields Eye Hospital, London, UK , London (United Kingdom)
Published Article
Systematic Reviews
BioMed Central
Publication Date
Jan 04, 2021
DOI: 10.1186/s13643-020-01553-w
Springer Nature


BackgroundDiabetic retinopathy is the most common ocular complication of diabetes and a cause of vision loss in adults. Diabetic retinopathy screening leading to early identification of the disease followed by timely treatment, can prevent vision loss in people living with diabetes. A key barrier to the implementation of screening services in low- and middle-income countries is the low number of ophthalmologists per million population. Interventions that shift screening to non-ophthalmology cadres have been implemented in programmes in low- and middle-income countries and are routinely used in high-income countries. The aim of this rapid review is to summarise the published literature reporting the effectiveness of task-shifting interventions for the detection of diabetic retinopathy by non-ophthalmologists in low- and middle-income countries.MethodsWe will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting task-shifting interventions for diabetic retinopathy detection. The review will include studies published in the last 10 years in the English language. We will include any interventional or observational comparative study measuring outcomes in terms of participation or access to diabetic retinopathy detection services (uptake) and quality of diabetic retinopathy detection services (detection, severity, diagnostic accuracy). For included studies, cost-effectiveness of the task-shifting intervention will also be presented. Two reviewers will screen search results independently. The risk of bias assessment and data extraction will be carried out by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively.DiscussionDifferences in health systems organization, structure and resources will determine the need and success of task-shifting interventions for DR screening. The review will examine how these interventions have been used and/or tested in LMICs. The results will be of interest to policy makers and programme managers tasked with designing and implementing services to prevent and manage diabetes and its complications in similar settings.Systematic review registrationOSF:

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