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. 2023 Dec 15;18(12):e0294979. doi: 10.1371/journal.pone.0294979

Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases (NCDs) among people living with human immunodeficiency virus (PLWH) in low- and middle-income countries (LMICs) in Africa: A scoping review protocol

Abebe Sorsa Badacho 1,2,3,*, Ozayr Harron Mahomed 2,4
Editor: Billy Morara Tsima5
PMCID: PMC10723733  PMID: 38100401

Abstract

Background

Noncommunicable diseases (NCDs) represent a global public health challenge in all population groups, but the prevalence of major NCDs, such as depression, hypercholesterolemia, hypertension, obesity and diabetes, is increasing at a rapid rate among people living with human immunodeficiency virus (PLWH). Studies show that integrated NCDs and human immunodeficiency virus (HIV) services have improved the patient outcome of PLWH with comorbidities with NCDs. It requires a strengthened and sustainable way of diagnosing major NCDs early among PLWH. However, there is limited evidence regarding the barriers to and facilitators of early diagnosis of NCDs (depression, hypercholesterolemia, hypertension, obesity and diabetes) among PLWH in low- and middle-income countries (LMICs). This review will systematically map the literature and describe the barriers and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity and diabetes) among PLWH in LMICs in Africa.

Methods

The methodology presented by Arksey and O’Malley and the recommendation set out by Levac and colleagues will be used. PubMed, MEDLINE with full text via the EBSCO host, Google Scholar, Science Direct and Scopus will be used for a comprehensive search for data extraction. The search will be conducted using keywords, Boolean terms, and Medical Subject Headings (MeSH). All studies with eligible titles will be exported to the EndNote citation manager for deduplication and imported to Rayyan software for screening. Two reviewers will independently screen abstracts, and the preferred reporting items for systematic review and meta-analysis extension to scoping review (PRISMA-Sc) guidelines will be used to guide the search in conducting the scoping review. We will perform descriptive data analysis for quantitative studies, NVivo software version 12 will be used for qualitative studies, and thematic content analysis will be carried out. This scoping review will include studies that included PLWH with those diagnosed with major NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) in LMICs in Africa.

Discussion

This scoping review will highlight evidence mapping on barriers and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH LMICs in Africa.

Scoping Review Registration: registered on Open Science Framework (https://osf.io/xvtwd/).

Introduction

Globally approximately 40 million people are living with human immunodeficiency virus (PLWH [1, 2]. The number of PLWHs has increased by more than 10 million since 2010 [2]. Sub-Saharan African countries are home to more than two-thirds (67%) of PLWHs [1, 2].

More than 28 million people currently access antiretroviral therapy (ART), more than 20 million increments from 7.8 access in 2010 [2]. Increased access to ART services has halted an estimated 12.1 million acquired immunodeficiency syndrome (AIDS) human immunodeficiency virus (HIV) related deaths since 2010 [3]. PLWHs across the globe now live longer due to improvements in and expanded access to ART [4–7].

Noncommunicable diseases (NCDs) represent a global public health challenge in all populations, leading to the deaths of more than 41 million people each year (accounting for 71% of deaths globally) [8]. Along with increased life expectancy, NCD susceptibility comes with an increased burden of NCDs [9]. Moreover, exposure to ART increases the risk of hyperlipidemia and diabetes; HIV inflammatory effects, ART drug side effects, and the risk associated with increasing age can be a risk for NCD for PLWH [10]. Studies have shown a higher incidence of NCDs among PLWH than HIV-negative patients [11]. Some HIV medicines can increase blood glucose levels and diabetes [10].

A systematic review and meta-analysis of studies conducted in low- and middle-income countries (LMICs) showed pooled estimates for the prevalence of NCDs among PLWH; the prevalence of depression, hypercholesterolemia, hypertension, andobesity was 24.4%, 22.2%, 21.2%, and 7.8%, respectively, and diabetes ranged from 1.3–18% [12]. There is a substantial burden of comorbid NCDs among PLWH in LMICs [13]. Quality of health and life gains made against HIV/AIDS are now under threat as NCDs are significantly increasing among PLWH in LMICs [14, 15]; the comorbidity of HIV and NCDs threatens to reduce global mortality due to HIV [16]. A growing number of PLWH over 50 are at higher risk for developing chronic NCDs [17].

Improved life expectancy, increased vulnerability and epidemiological transition of diseases brought a substantial burden of NCDs among PLWH in LMICs. Consequently, PLWH may now need regular screening for early detection and management of NCDs [18, 19].

However, LMICs struggle to manage growing chronic NCDs. There have been calls for the integration of HIV and NCD services to increase efficiency and improve coverage of NCD care, although evidence of effectiveness remains unclear [20]. The increasing burden of comorbidity of HIV infection and NCDs requires a focus on healthcare services providing care for chronic multimorbidities in an integrated manner [21]. Furthermore, the demands of PLWHs with multimorbidities are significant since they are more prone to care fragmentation due to the participation of several health providers [22]. Thus, the multimorbidity of non-HIV NCDs in PLWHs has highlighted the importance of improving NCD care in this population [23]. With the growing burden of NCDs and infectious diseases in both the general population and among PLWH, healthcare systems must be strengthened for early detection and management of NCDs and making services accessible.

Strengthening and sustaining NCD services in resource-limited settings in primary healthcare is a need focus. However, there is a lack of evidence on the barriers to and facilitators of diagnosing major NCDs among PLWH. Therefore, the current study will systematically map the literature and describe the evidence on the barriers to and facilitators of the diagnosis of major NCDs, focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes for PLWH in LMICs.

Methods

This proposed scoping review will be conducted based on the framework outlined by Arksey and O’Malley [24]. It will follow five steps: step 1: Identifying the research question, step 2: Searching relevant studies, step 3: selecting appropriate studies, step 4: Charting the data, and step 5: collating, summarizing, and reporting results. The optional step 6, consultation with relevant stakeholders, has been excluded from this review. Incorporating recommendations made by Levac and colleagues [25] will be considered. A scoping study approach enables systematically searching for literature, selecting and examining literature, knowledge synthesis and mapping concepts, and the range of evidence to address an exploratory research question [24].

The Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR) proposed by Tricco et al. [26] PRISMA-SCR provides a reporting guideline containing 20 essential items and two optional items that should be included in scoping reviews [26]. This guideline also facilitates methodological transparency and acceptance of research findings [26]. This protocol has been registered prospectively on the open science Frameworks (https://osf.io/xvtwd/)

Step 1: Identifying the research question

This scoping review seeks to answer the following questions: what evidence exists on barriers and facilitators of diagnosing major NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes in LMICs? We used the people concept and context (PCC) framework approach to identify the question (Table 1).

Table 1. PCC (people, concept and context) used to identify review questions.

People Studies include People living with HIV
Concept Barriers to the diagnosis of NCDs focusing on depression hypercholesterolemia, hypertension, obesity and diabetes, Routine Screening, early detection of depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH Facilitators of diagnosing NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes in LMICs among PLWH
Context Low- and middle-income countries in Africa (developing countries, Africa)
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The sub questions will include the following:

  1. What are the barriers to diagnosing NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH in LMICs in Africa?

  2. What are the facilitators of diagnosing NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH in LMICs in Africa?

Step 2. Identifying relevant studies

Information sources

The authors will conduct a comprehensive systematic search within the following databases for a comprehensive search: PubMed, MEDLINE with full text via EBSCO host, Google Scholar, Science Direct and Scopus. The study will use a complete search strategy that employs medical subject headings (MeSH) and keywords. The Boolean terms (AND and OR) will be used to separate keywords, and Medical Subject Headings terms (MeSH) will be conducted in advanced searching of articles. A secondary search of relevant articles from reference lists of included studies using a snowball approach will also be undertaken. All studies with eligible titles will be exported to the EndNote citation manager for deduplication and imported to Rayyan software for systematic review for screening [27]. Two reviewers will independently screen the titles and abstracts based on eligibility criteria, and the third author will be involved in resolving disagreements between the two authors. The PRISMA-Sc guidelines will be used to guide the search in conducting the scoping review. The PRISMA-Sc flow diagram will account for all relevant sources of evidence during screening.

We will perform descriptive data analysis for quantitative studies. The thematic analysis will be carried out using Nvivo version 12 for qualitative studies.

This study will include studies on barriers to and facilitators of NCDs diagnosis, focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH in LMICs in Africa.

During the search, we will use the following search terms:

“diagnosis of depression among people living with HIV”, “diagnosis of hypercholesterolemia among people living with HIV”, “diagnosis of hypertension among people living with HIV obesity”, “diagnosis of obesity among people living with HIV”, “diagnosis of diabetes people living with HIV”, “access to depression care services among people living with HIV”, “access to hypertension care services among people living with HIV”, “access to diabetes care services among people living with HIV”, “access to depression care services among people living with HIV in low—and middle—income countries in Africa/low resource setting” “access to diabetes care services for people living with HIV in low-and-middle-income countries in Africa/low -resource settings”, “access to depression intervention services among people living with HIV in low- and middle- income countries in Africa/low-resource setting”, “access to obesity intervention services among people living with HIV in low- and middle-income countries in Africa/low-resource setting”, “access to hypertension care services for people living with HIV in low-and-middle-income countries in Africa/low-resource settings”, “diabetes intervention for people living with HIV in low- and middle-income countries in Africa/low-resource settings”; hypertension intervention for people living with HIV in low- and middle-income countries in Africa/low-resource settings”.

A sample search strategy was used (Table 2).

Table 2. The sample search strategy used to identify relevant articles using keywords.
S.No Search strategy Database used Number of articles
1 (Barriers OR Challenges OR influence OR facilitators OR Opportunities OR Enablers) AND (Diagnosis OR access OR early detection OR Screening OR Treating OR management) AND (Noncommunicable disease OR depression OR hypercholesterolemia OR obesity OR diabetes) AND (People Living with Human Immunodeficiency virus OR AIDS OR PLWH OR PLHIV OR HIV OR People Living with HIV OR Human Living HIV) AND (“Low-and middle-income countries” OR Africa OR “developing countries” OR “low resource settings”) PubMed 1617
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Step 3. Study selection

The screening process will start with at least two review authors independently assessing the titles and abstracts. Full-text articles will be retrieved for all the titles and abstracts that potentially meet the eligibility criteria. At least two review authors will again independently assess the full-text articles to decide which studies to include in the review. The third author will be involved in solving disagreements between the two authors.

Eligibility criteria

This scoping review will consist of the following eligibility criteria to include articles in this scoping review:

  • Studies involving People Living with HIV

  • Studies that report evidence on the diagnosis of NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH.

  • Studies conducted in low- and middle-income countries in Africa.

  • All study designs (interventional, observational, mixed study, qualitative and qualitative designs).

  • English language publications

  • We decided to include studies published between 2013 and 2023 in this scoping review to get recent evidence on NCD, since the World Health Assembly adopted Global NCD Action Plan in 2013 [28].

This scoping review will exclude.

  • Articles published in languages other than English will be excluded because of time, funding challenges, and lack of language resources and language skills in the review team to deal with non-English studies and access to non-English specialized databases.

  • Study settings other than low- and middle-income countries other than Africa.

  • Studies conducted in high-income countries.

  • Studies that focus on the diagnosis of NCD other than depression, hypercholesterolemia, hypertension, obesity and diabetes among PLWH.

Selection process

The primary author will conduct a thorough title screening using electronic databases guided by eligibility criteria. All relevant articles will be imported into an EndNote library to remove duplicates of articles. Then articles will be uploaded to Rayyan software and shared with the review team for the next stage of the study screening and selection process. Eligibility criteria will be used to develop a screening tool for abstract and full-text screening phases. Two reviewers will independently conduct abstract and full-text screening phases and group them to include categories. Discrepancies in abstract screening will be addressed through discussion by the review team until a consensus is reached. Assistance from the University of KwaZulu-Natal library services will be sought. The PRISMA-Sc flow diagram [29] will be adopted to report the screening results (Fig 1).

Fig 1. PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases, registers and other sources.

Fig 1

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From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 10.1136/bmj.n71.

Step 4: Charting the data

A Google form will be developed for data extraction and piloted to ensure accuracy. All relevant data from the included articles will be extracted after thoroughly reading the full texts. Inductive and deductive hybrid approaches will be used to extract data from the included studies for coding and theme development [30]. The data extraction form will consist of the study’s title, author and year of publication, study setting, aims and objectives, country, study design, study participants, type of NCDs, findings relevant to the question (barriers and facilitators of diagnosis of depression, hypercholesterolemia, hypertension, obesity and diabetes), conclusion and recommendations. The data extraction form will be continuously updated to capture all relevant data to answer the review question.

Step 5: Collating, summarizing, and reporting the results

According to Arksey and O’Malley [24], scoping reviews require thematic frameworks to present narrative accounts of selected literature. The extracted data will be exposed to thematic analysis, and relevant themes and subthemes relating to the study objectives will be developed. In this review, we will use the five steps of thematic analysis recommended by Braun and Clarke [31]. The first step will be data familiarization; the two authors will read through all papers that meet the inclusion criteria in detail. In the second step, initial thematic codes will be inductively generated. The third step will transform the initial codes into emergent themes. In the fourth step, the themes will be reviewed iteratively way to encapsulate all the themes emerging from the entire data set. The fifth will be ensure that the thematic analysis is comprehensive and congruent. NVivo version 12 will be used to assist in thematic data analysis.

Step 6: Methodological quality appraisal

Although critical appraisal of evidence sources is not mandatory in scoping reviews, the methodological quality of evidence will be assessed using mixed methods appraisal tools [32].

Discussion

We anticipate that this scoping review will highlight evidence mapping on barriers and facilitators affecting the diagnosis of major NCDs (depression, hypercholesterolemia, hypertension, obesity and diabetes) among PLWH in LMICs. This review will contribute evidence for strengthening and sustaining early diagnosis of hypertension and diabetes among people living with HIV in primary health care facilities. The results of the study will be presented in a tabular form according to the aims of this scoping review. The strengths and limitations of this scoping review method will be detailed. This scoping review may explore different barriers and facilitators of diagnosing NCDs among PLWH and input for strengthened and sustained NCD services for integrated NCD-HIV services in primary health care resource-limited settings for early detection of NCD among PLWH.

Supporting information

S1 Data

(XLSX)

Click here for additional data file. (10.6KB, xlsx)
S1 Checklist. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

(PDF)

Click here for additional data file. (548.8KB, pdf)

Acknowledgments

The authors intend to acknowledge the University of Kwazulu Natal, South Africa, Health Economics and AIDS research division (HEARD) for giving a PhD scholarship to the primary author. Additionally, the author intends to acknowledge Nontobeko Precious Sikhosana, a professional Librarian University of Kwazulu Natal, for her professional contribution to search strategies. This scoping review is part of a large-scale study of a PhD project on strengthening ng and sustaining health services for the diagnosis of hypertension and diabetes among PLWH in primary health centres. This scoping review will contribute to a PhD degree award for the primary author.

Abbreviations

MMAT

Mixed methods appraisal tools

PRISMA

Preferred Reporting Items for Systematic Review and Meta-Analysis

PRISMA-SCR

Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews

Data Availability

No datasets were generated or analyzed during the current study. All relevant data from this study will be made available upon study completion.

Funding Statement

The author(s) received no specific funding for this work.

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Decision Letter 0

Desmond Kuupiel

27 Jul 2023

PONE-D-22-28972Mapping evidence on barriers and facilitators of diagnosing hypertension and diabetes among People Living with Human Immune virus (PLWH):  A scoping review protocolPLOS ONE

Dear Dr. Badacho,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: No

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thanks for the opportunity to review this manuscript. The authors detail a scoping review protocol on mapping the evidence of barriers and facilitators of diagnosing hypertension and diabetes among PLWH. The review was well written and studied an important topic. Below are minor suggestions to help improve the manuscript:

- Given your objectives/ research questions within the abstract and methodology, it might be more transparent to add “low resource settings” or “low and middle income countries” within your title.

- On Line 159, it details the “introduction of Art in most developing countries”. Could you please elaborate on this?

- Since you mentioned the use of deductive coding (in addition to inducting coding), it might help to utilize existing frameworks to organize some of the barriers & facilitator themes – e.g. socio-ecological model; or mapping behaviour related facilitators/ barriers to the behaviour change wheel. However, this might be a decision.

Reviewer #2: Reviewer’s Comments

The reviewer would like to thank the author/s for their attempt.

Though this article has the potential to make a significant impact with regards to PLHIV and hypertension and diabetes, the quality of the article is poor. One gets the idea that it was not proof-read and just put together and submitted hoping that the reviewers would edit and fix for the authors.

There are too many spelling and grammatical errors which negate the value in the study.

I believe that at this stage it should be rejected. The authors can then revisit and revise and bring up to publishable standard.

Abstract

The entire abstract needs to be proof-read and revised. Several typo and grammatical errors are evident across the abstract. The acronyms are unnecessarily repeated.

HIV (human immunodeficiency virus) – immune human immune deficiency virus

Low-and middle-income

However, there is limited evidence regarding the barriers and facilitators early diagnosis of hypertension and diabetes among people living with the human immune virus (PLWH) in Low and middle income countries (LMIC).

Non-communicable

Is highly rising – does not read well. Could substitute with is increasing/ is increasing at a rapid rate/in on the increase

Sentence needs to be revised as an denotes singular, yet services is plural.

Studies show an integrated non-communicable disease (NCD), and human immune deficiency virus (HIV) services improved the patient outcome of People living with human immune virus (PLWH) comorbidities with non-communicable diseases (NCDs).

une virus (PLWH) low resource settings. Word missing.

Non-communicable diseases (NCDs) represent a global public health challenge in all population groups, but the prevalence of hypertension and diabetes is highly rising among people living with HIV (PLWH). Studies show an integrated non-communicable disease (NCD), and human immune deficiency virus (HIV) services improved the patient outcome of People living with human immune virus (PLWH) comorbidities with non-communicable diseases (NCDs). It requires a strengthened and sustainable way of diagnosing hypertension and diabetes early among People living with the human immune virus (PLWH). However, there is limited evidence regarding the barriers and facilitators early diagnosis of hypertension and diabetes among people living with the human immune virus (PLWH) in Low and middle income countries (LMIC). This review will systematically map literature and describe the barriers and facilitators of diagnosing of non communicable diseases among people living with the human immune virus (PLWH) low resource settings.

Non-communicable diseases (NCDs) represent a global public health challenge in all

population groups, but the prevalence of hypertension and diabetes is highly rising

among people living with HIV (PLWH).

Methods

This study will include people living with HIV diagnosed with common non-communicable diseases focusing on hypertension and diabetes (word/s missing) resource limited setting.

Discussion

There are inconsistencies in this paper as in the Methods section the focus is on common NCDs and in the discussion the focus is on

This study will include people living with HIV diagnosed with common non-communicable diseases focusing on hypertension and diabetes (word/s missing) resource limited setting.

This scoping review will highlight evidence mapping on barriers and facilitators of

diagnosing major Noncommunicable diseases (hypertension and diabetes) among

people living with the human immune virus (PLWH).

Main document

Globally around 40 million people are living with human immune deficiency virus (HIV), and 48 sub-Saharan Africa is home to more than two-thirds (67%) [1, 2]; the number has increased by 49 more than 10 million since 2010 globally[2].

Line 52 Acquired immune deficiency syndrome (AIDS)-related deaths - HIV (human immunodeficiency virus)

Pg 3 Line 63: Inconsistencies in spelling: Earlier in the abstract Low and middle income countries now low- and middle-income

From the onset the author/s have stated that hypertension and diabetes were the common and major NCDS, however, the stats quoted show that depression (24.4%), hypercholesterolemia (22.2%) are in fact higher than hypertension (21.2%) and diabetes (1.3-18%). This renders the rationale for this scoping review problematic.

Pg 4 A systematic review and meta-analysis of studies conducted in low- and middle-income

64 countries (LMICs) showed pooled estimates for the prevalence of NCDs among PLWH; the prevalence of hypertension, hypercholesterolemia, obesity, depression were 21.2%, 22.2%, 7.8%, 24.4%, respectively, and diabetes ranges from 1.3–18%[12

Pg 4 line 69: use of the signifies a word is missing after positive

among the HIV positive [14, 15];

Could delete the - HIV infected people, HIV positive people, HIV positive patients, HIV-seropositive patients.

Line 80: Spelling - with multi-morbidity are considerable

primary health care (PHC)

Methods

Line 96/7: (1) Identify the research question (2) Searching relevant studies(3)

selecting the studies (4) Charting the data (5) collating, summarizing, and reporting results and (6) consulting with relevant stakeholders to inform or validate findings.

Line 110-112: major NCDs (hypertension and diabetes among PLWH) in the

112 Low and middle income countries .

Context – Needs unpacking – There many LMIC globally. Will this scoping review only focus on LMIC countries in Africa?

Context - Low and middle income countries (developing countries, Africa)

Line 119: What are the barriers of diagnosing hypertension and diabetes among PLWH in (LMIC) Low and middle income countries?

Line 120/1 2. What are the facilitators of diagnosing hypertension and diabetes among PLWH in (LMIC) Low and middle income countries?

Line 133: based on the eligibility criteria

Lines 134-6 The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-Sc) guidelines will be used to guide the search in conducting the scoping review. The PRISMA preferred reporting items for systematic review and meta-analysis flow diagram will account for all relevant sources of evidence during screening.

Line 136/7: We will perform a descriptive data analysis for quantitative studies, and NVIVO

software V.11 for qualitative studies and thematic analysis. will be carried out.

Step 3. Study selection

Words are missing and there are different size fonts in this section.

Line 150: meet the defined eligibility criteria

Studies that report evidence on the diagnosis of NCDs

Studies conducted in low and middle income countries

Line 157: English language publications – Please provide justification for the inclusion of English language publications only.

Line 158-159: Different size fonts. ART should be in capitals.

Studies published between 2003 to June 2022 will be included in the review because the first introduction of Art in most developing countries in 2003[28]

Line 164: Studies carried out in high income countries

Line 166: The Primary author – Why capital letter

Selection process

Line 167: Missing word. an EndNote library

It is unclear if there are 3 reviewers or two. This needs to be unpacked so that any reader will understand how many people are in the research team.

Sometimes researcher/s uses PRISMA and in other instances PRISMA-Sc. I appeal to them to be consistent.

Line 192: Spelling - Figure 1. PRISA 2020

The author/s should double check that they are using the correct PRISA 2020 flow diagram for new systematic reviews

Step 5: Collating, summarizing, and reporting the results

Missing word/s -Lines 204/5: According to Arksey and O’Malley[24] scoping review requires thematic framework to present narrative account of selected literature.

According to Arksey and O’Malley[24] a scoping review requires a thematic framework to present the narrative account of selected literature.

According to Arksey and O’Malley[24] scoping reviews require thematic frameworks to present narrative accounts of selected literature.

Lines 209-213: The author/s state who the first author is (AB) and his role however, who will perform the subsequent roles is unclear. This is linked to my earlier comment on the selection process. There are missing words and spelling and grammatical errors.

the first author (AB) will read through all papers that met the inclusion criteria in detail. In the second step,initial thematic codes will be inductively generated. The third step will transform the initial codes into emergent themes. In the fourth step, the themes will be reviewed in an iterative way to encapsulate all the themes emerging from the entire data set. The fifth will be ensureing that the thematic analysis is comprehensive and congruent. NVivo version12 will be used to assist in thematicdata analysis

Line 215/6 - Step 6: Methodological quality appraisal

Critical appraisal of evidence sources is not mandatory in scoping review, but the

methodological quality will be assessed using mixed methods appraisal tools[32].

Critical appraisal of evidence sources is not mandatory in a scoping review, but the methodological quality will be assessed using mixed methods appraisal tools[32].

Though critical appraisal of evidence sources is not mandatory in scoping reviews, the methodological quality of evidence will be assessed using mixed methods appraisal tools[32].

Discussion

Line 218-221 – are repetitive

We anticipate that this scoping review will highlight evidence mapping on the diagnosis of hypertension and diabetes among PLWH. The barriers and facilitators of diagnosing non communicable disease focusing on hypertension and or diabetes will be identified. This review will contribute evidence for strengthening and sustaining early diagnosis of hypertension and diabetes among people living with HIV in primary care facilities.

…will map evidence on the barriers and facilitators affecting the diagnosing of NCD such as hypertension and diabetes among PLHIV.

Lines 223/4: Line needs to be revised as it does not read well.

The strength and limitations of our scoping review method credibility of the results will be detailed.

References: Reference list and intext references should be checked.

organizatio WH; 2021.

Nations U: 2020 Global AIDS Update Seizing the moment Tackling entrenched

inequalities to end epidemics. In.; 2020.

12. !!! INVALID CITATION !!! [12].

**********

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

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<quillbot-extension-portal></quillbot-extension-portal>

PLoS One. 2023 Dec 15;18(12):e0294979. doi: 10.1371/journal.pone.0294979.r002

Author response to Decision Letter 0

2 Aug 2023

August 2, 2023

PONE-D-22-28972

Mapping evidence on barriers and facilitators of diagnosing hypertension and diabetes among People Living with Human Immune virus (PLWH): A scoping review protocol

PLOS ONE

Subject: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s).

Editors comment Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

Authors response: Dear editor; Thank you so much for your kind review and time to improve the manuscript. We have revised our manuscript according to PLOS ONE’s style requirements.

2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

Authors response: Dear editor; Thank you so much. No data were generated for this scoping review protocol.

3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

Authors response: Dear editor, Thank you so much for supporting information files for this scoping review protocol at the end.

Reviewers' comments:

Reviewer's Responses to Questions

Point-to-point response to reviewer and editor comment.

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

Authors' response: Dear Reviewers, thank you for your kind review and time in evaluating our manuscript. We revised the manuscript that identify and justify the research question. Kindly see the revised manuscript.

________________________________________

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: No

Authors response: Dear Reviewers, thank you for your kind review and time to improve the manuscript. In the revised manuscript, we described methods in detail that answer a research question.

________________________________________

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

Authors response: Dear Reviewers, thank you for your kind review and time to improve the manuscript. We tried to describe the methodology as feasible and in sufficient detail to make the work replicable. Please kindly look at the revised manuscript.

________________________________________

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Authors' response: Dear Reviewers, thank you so much. In this scoping review protocol, all supportive information is available with the manuscript, and no data is generated in the current stage.

________________________________________

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

________________________________________

Authors' response: Dear Reviewers, thank you so much. We revised and edited the language and corrected grammatical and typographical errors using professional language editors.

6. Review Comments to the Author

Reviewer #1 Comment: Thanks for the opportunity to review this manuscript. The authors detail a scoping review protocol on mapping the evidence of barriers and facilitators of diagnosing hypertension and diabetes among PLWH. The review was well-written and studied an important topic. Below are minor suggestions to help improve the manuscript:

Authors response: Dear Reviewer, thank you for your kind review and time to improve the manuscript.

Reviewer #1 Comment: Given your objectives/ research questions within the abstract and methodology, it might be more transparent to add “low resource settings” or “low and middle-income countries” within your title.

Authors response: Dear Reviewer, thank you so much. We revised the title to “Mapping evidence on barriers to and facilitators of diagnosing noncommunicable diseases (NCDs) among people living with human immunodeficiency virus (PLWH) in low- and middle-income countries (LMICs) in Africa: A scoping review protocol.”

Reviewer #1 Comment: On Line 159, it details the “introduction of Art in most developing countries”. Could you please elaborate on this?

Authors response: Dear Reviewer, thank you so much. We have revised the manuscript. We decided to include studies published between 2013 and 2023 in this scoping review to get recent evidence on NCD since the World Health Assembly adopted Global NCD Action Plan in 2013.

Reviewer #1 Comment: Since you mentioned the use of deductive coding (in addition to inducting coding), it might help to utilize existing frameworks to organize some of the barriers & facilitator themes – e.g. socio-ecological model; or mapping behaviour related facilitators/ barriers to the behaviour change wheel. However, this might be a decision.

Authors response: Dear Reviewer, thank you so much for your critical comment. We have not decided to use a framework for deductive coding.

Reviewer #2: Reviewer’s Comments

The reviewer would like to thank the author/s for their attempt.

Though this article has the potential to make a significant impact with regards to PLHIV and hypertension and diabetes, the quality of the article is poor. One gets the idea that it was not proof-read and just put together and submitted hoping that the reviewers would edit and fix for the authors.

There are too many spelling and grammatical errors which negate the value in the study.

I believe that at this stage it should be rejected. The authors can then revisit and revise and bring up to publishable standard.

Authors response: Dear Reviewer, thank you so much for your kind review and time in reviewing the manuscript and constructive feedback to improve the manuscript. We appreciate your critical insights.

Reviewer #2: Reviewer’s Comments Abstract

The entire abstract needs to be proof-read and revised. Several typo and grammatical errors are evident across the abstract. The acronyms are unnecessarily repeated.

Authors response: Dear Reviewer, thank you so much. We revised the abstract and addressed the grammatical and editorial errors according to your suggestions. Please see the track changes on the abstract.

Reviewer #2: Reviewer’s Comments HIV (human immunodeficiency virus) – immune human immune deficiency virus

Low-and middle-income

Authors response: Dear Reviewer, thank you so much. We revised it to HIV (human immunodeficiency virus).

Reviewer #2: Reviewer’s Comments However, there is limited evidence regarding the barriers and facilitators early diagnosis of hypertension and diabetes among people living with the human immune virus (PLWH) in Low and middle income countries (LMIC).

Authors response: Dear Reviewer thank you so much. We revised the statement as “However, there is limited evidence regarding the barriers and facilitators of early diagnosis of NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in low- and middle- income countries (LMICs).

Reviewer #2: Reviewer’s Comments : Non-communicable Is highly rising – does not read well. Could substitute with is increasing/ is increasing at a rapid rate/in on the increase

Authors response: Dear Reviewer, thank you so much. We revised as substituting increasing at a rapid rate.

Reviewer #2: Reviewer’s Comments : Sentence needs to be revised as an denotes singular, yet services is plural.

Studies show an integrated non-communicable disease (NCD), and human immune deficiency virus (HIV) services improved the patient outcome of People living with human immune virus (PLWH) comorbidities with non-communicable diseases (NCDs).

Authors response: Dear Reviewer, thank you so much. We revised it according to your comments.

Reviewer #2: Reviewer’s Comments : une virus (PLWH) low resource settings. Word missing.

Authors response: Dear Reviewer, thank you so much. We revised the sentences as This review will systematically map the literature and describe the barriers to and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in LMICs in Africa.

Reviewer #2: Reviewer’s Comments: Non-communicable diseases (NCDs) represent a global public health challenge in all population groups, but the prevalence of hypertension and diabetes is highly rising among people living with HIV (PLWH). Studies show an integrated non-communicable disease (NCD), and human immune deficiency virus (HIV) services improved the patient outcome of People living with human immune virus (PLWH) comorbidities with non-communicable diseases (NCDs). It requires a strengthened and sustainable way of diagnosing hypertension and diabetes early among People living with the human immune virus (PLWH). However, there is limited evidence regarding the barriers and facilitators early diagnosis of hypertension and diabetes among people living with the human immune virus (PLWH) in Low and middle income countries (LMIC). This review will systematically map literature and describe the barriers and facilitators of diagnosing of non communicable diseases among people living with the human immune virus (PLWH) low resource settings.

Non-communicable diseases (NCDs) represent a global public health challenge in all

population groups, but the prevalence of hypertension and diabetes is highly rising

among people living with HIV (PLWH).

Authors response: Dear Reviewer, thank you so much. We revised as

Noncommunicable diseases (NCDs) represent a global public health challenge in all population groups, but the prevalence of major NCDs such as depression, hypercholesterolemia, hypertension, obesity and diabetes are increasing at a rapid rate among people living with human immunodeficiency virus (PLWH). Studies show that integrated NCDs and human immunodeficiency virus (HIV) services have improved the patient outcome of PLWH comorbidities with NCDs. It requires a strengthened and sustainable way of diagnosing major NCDs early among PLWH. However, there is limited evidence regarding the barriers and facilitators of early diagnosis of NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in low- and middle-income countries (LMIC). This review will systematically map the literature and describe the barriers and facilitators of diagnosing major NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in LMICs in Africa.

Reviewer #2: Reviewer’s Comments:

Methods

This study will include people living with HIV diagnosed with common non-communicable diseases focusing on hypertension and diabetes (word/s missing) resource limited setting.

Authors response: Dear Reviewer, thank you so much. We revised it as “This scoping review will include studies that included PLWH with those diagnosed with major NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) in LMICs in Africa.”

Reviewer #2: Reviewer’s Comments:

Discussion

There are inconsistencies in this paper as in the Methods section the focus is on common NCDs and in the discussion the focus is on

This study will include people living with HIV diagnosed with common non-communicable diseases focusing on hypertension and diabetes (word/s missing) resource limited setting.

This scoping review will highlight evidence mapping on barriers and facilitators of

diagnosing major Noncommunicable diseases (hypertension and diabetes) among

people living with the human immune virus (PLWH).

Authors response: Dear Reviewer, thank you so much for your kind review. We have addressed the comments; accordingly, please see the track changes in the manuscript of the abstract section. This scoping review will highlight evidence mapping on barriers and facilitators of diagnosing NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in LMICs in Africa.

Reviewer #2: Reviewer’s Comments:

Main document

Globally around 40 million people are living with human immune deficiency virus (HIV), and 48 sub-Saharan Africa is home to more than two-thirds (67%) [1, 2]; the number has increased by 49 more than 10 million since 2010 globally[2].

Authors response: Dear Reviewer, thank you so much for your kind review. We have addressed the comments; accordingly, Please see the track changes. Globally around 40 million people are living with human immunodeficiency virus (PLWH), globally (1, 2). The number PLWH have increased by more than 10 million since 2010 (2). Sub-Saharan African countries are home to more than two-thirds (67%) of PLWH (1, 2).

Reviewer #2: Reviewer’s Comments:

Line 52 Acquired immune deficiency syndrome (AIDS)-related deaths - HIV (human immunodeficiency virus)

Authors response: Dear Reviewer, thank you so much for your kind review. We have addressed the comments, revised as acquired immunodeficiency syndrome (AIDS)- related deaths - human immunodeficiency virus (HIV).

Reviewer #2: Reviewer’s Comments:

Pg 3 Line 63: Inconsistencies in spelling: Earlier in the abstract Low and middle income countries now low- and middle-income

Authors response: Dear Reviewer, thank you so much for your kind review. We have addressed the comments and used low- and middle-income (LMICs) throughout the manuscript for consistency.

Reviewer #2: Reviewer’s Comments: From the onset the author/s have stated that hypertension and diabetes were the common and major NCDS, however, the stats quoted show that depression (24.4%), hypercholesterolemia (22.2%) are in fact higher than hypertension (21.2%) and diabetes (1.3-18%). This renders the rationale for this scoping review problematic.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly. We included major NCDs such as depression, hypercholesterolemia, hypertension, obesity and diabetes in our scoping review. Please see the track changes in the manuscript.

Reviewer #2: Reviewer’s Comments: Pg 4 A systematic review and meta-analysis of studies conducted in low- and middle-income

64 countries (LMICs) showed pooled estimates for the prevalence of NCDs among PLWH; the prevalence of hypertension, hypercholesterolemia, obesity, depression were 21.2%, 22.2%, 7.8%, 24.4%, respectively, and diabetes ranges from 1.3–18%[12

Authors response: Dear Reviewer, thank you for your constructive insight. We have decided to include major NCDs such as depression, hypercholesterolemia, hypertension, obesity and diabetes in our scoping review.

Reviewer #2: Reviewer’s Comments: Pg 4 line 69: use of the signifies a word is missing after positive among the HIV-positive [14, 15];

Authors response: Dear Reviewer, thank you so much. We revised the sentence as “Quality of health and life gains made against HIV/AIDS are now under threat as NCDs are significantly increasing among PLWH in LMICs”

Reviewer #2: Reviewer’s Comments: Could delete the - HIV infected people, HIV positive people, HIV positive patients, HIV-seropositive patients.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly, and editorial errors are fixed.

Reviewer #2: Reviewer’s Comments: Line 80: Spelling - with multi-morbidity are considerable

primary health care (PHC)

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly, and editorial errors have been fixed. Please see the track changes in the manuscript.

Reviewer #2: Reviewer’s Comments: Methods

Line 96/7: (1) Identify the research question (2) Searching relevant studies(3)

selecting the studies (4) Charting the data (5) collating, summarizing, and reporting results and (6) consulting with relevant stakeholders to inform or validate findings.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly, and editorial errors have been fixed. Please see the track changes in the manuscript.

Reviewer #2: Reviewer’s Comments: Line 110-112: major NCDs (hypertension and diabetes among PLWH) in the 112 Low and middle income countries .

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed comments accordingly and revised them as “major NCDs focusing on depression, hypercholesterolemia, hypertension, obesity and diabetes in LMICs.”

Reviewer #2: Reviewer’s Comments: Context – Needs unpacking – There many LMIC globally. Will this scoping review only focus on LMIC countries in Africa?

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly. This scoping review will focus on LMIC countries in Africa.

Reviewer #2: Reviewer’s Comments: Context - Low and middle income countries in Africa (developing countries, Africa)

Line 119: What are the barriers of diagnosing hypertension and diabetes among PLWH in (LMIC) Low and middle income countries?

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly. We have revised it as What are the barriers to diagnosing depression, hypercholesterolemia, hypertension, obesity, and among PLWH in LMICs in Africa?

Reviewer #2: Reviewer’s Comments: Line 120/1 2. What are the facilitators of diagnosing hypertension and diabetes among PLWH in (LMIC) Low and middle income countries?

Authors response: Dear Reviewer, thank you for your constructive insight. We have addressed the comments accordingly. We have revised it as What are the facilitators to diagnosing depression, hypercholesterolemia, hypertension, obesity, and among PLWH in LMICs in Africa?

Reviewer #2: Reviewer’s Comments: Line 133: based on the eligibility criteria

Authors response: Dear Reviewer, thank you so much for your constructive insight. We revised the eligibility criteria.

Reviewer #2: Reviewer’s Comments: Lines 134-6 The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-Sc) guidelines will be used to guide the search in conducting the scoping review. The PRISMA preferred reporting items for systematic review and meta-analysis flow diagram will account for all relevant sources of evidence during screening.

Authors response: Dear Reviewer, thank you for your constructive insight. We have addressed the comments accordingly.

Reviewer #2: Reviewer’s Comments: Line 136/7: We will perform a descriptive data analysis for quantitative studies, and NVIVO

software V.11 for qualitative studies and thematic analysis. will be carried out.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly. We will perform descriptive data analysis for quantitative studies. The thematic analysis will be carried out using NVivo version 12 for qualitative studies.

Reviewer #2: Reviewer’s Comments: Step 3. Study selection

Words are missing and there are different size fonts in this section.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We revised.

Reviewer #2: Reviewer’s Comments: Line 150: meet the defined eligibility criteria

Authors response: Dear Reviewer, thank you so much for your constructive insight. We revised.

Reviewer #2: Reviewer’s Comments: Studies that report evidence on the diagnosis of NCDs

Studies conducted in low and middle income countries

Line 157: English language publications – Please provide justification for the inclusion of English language publications only.

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have addressed the comments accordingly. Articles published in languages other than English will be excluded because of cost, time, funding challenges, lack of language resources, and language skills in the review team to deal with non-English studies and access to specialized databases.

Reviewer #2: Reviewer’s Comments: Line 158-159: Different size fonts. ART should be in capitals.

Authors response: Dear Reviewer, thank you so much. We revised and fixed errors.

Reviewer #2: Reviewer’s Comments: Studies published between 2003 to June 2022 will be included in the review because the first introduction of Art in most developing countries in 2003[28]

Authors response: Dear Reviewer, thank you so much for your constructive insight. We have revised. We decided to include studies published between 2013 and 2023 in this scoping review to get recent evidence on NCD, since the World Health Assembly adopted Global NCD Action Plan in 2013.

Reviewer #2: Reviewer’s Comments: Line 164: Studies carried out in high income countries

Authors response: Dear Reviewer, thank you so much. We have addressed the comments accordingly and revised them as studies conducted in high-income countries will be excluded.

Reviewer #2: Reviewer’s Comments: Line 166: The Primary author – Why capital letter

Authors response: Dear Reviewer thank you so much. We revised as “primary author.”

Reviewer #2: Reviewer’s Comments: Selection process

Line 167: Missing word. an EndNote library

Authors response: Dear Reviewer, thank you so much. We revised accordingly.

Reviewer #2: Reviewer’s Comments: It is unclear if there are 3 reviewers or two. This needs to be unpacked so that any reader will understand how many people are in the research team.

Authors response: Dear Reviewer, thank you so much. We proposed three reviewers review the scoping reveiew.

Reviewer #2: Reviewer’s Comments: Sometimes researcher/s uses PRISMA and in other instances PRISMA-Sc. I appeal to them to be consistent.

Authors response: Dear Reviewer, thank you so much. We have revised and used the PRISMA-Sc in this manuscript and the PRISMA diagram.

Reviewer #2: Reviewer’s Comments: Line 192: Spelling - Figure 1. PRISA 2020

The author/s should double check that they are using the correct PRISA 2020 flow diagram for new systematic reviews

Authors response: Dear Reviewer, thank you so much. We have revised as PRISMA diagram.

Reviewer #2: Reviewer’s Comments: Step 5: Collating, summarizing, and reporting the results

Missing word/s -Lines 204/5: According to Arksey and O’Malley[24] scoping review requires thematic framework to present narrative account of selected literature.

According to Arksey and O’Malley[24] a scoping review requires a thematic framework to present the narrative account of selected literature.

According to Arksey and O’Malley[24] scoping reviews require thematic frameworks to present narrative accounts of selected literature.

Authors response: Dear Reviewer, thank you so much. We have revised according to your suggestion as “According to Arksey and O’Malley [24] scoping reviews require thematic frameworks to present narrative accounts of selected literature.”

Reviewer #2: Reviewer’s Comments: Lines 209-213: The author/s state who the first author is (AB) and his role however, who will perform the subsequent roles is unclear. This is linked to my earlier comment on the selection process. There are missing words and spelling and grammatical errors. the first author (AB) will read through all papers that met the inclusion criteria in detail. In the second step,initial thematic codes will be inductively generated. The third step will transform the initial codes into emergent themes. In the fourth step, the themes will be reviewed in an iterative way to encapsulate all the themes emerging from the entire data set. The fifth will be ensureing that the thematic analysis is comprehensive and congruent. NVivo version12 will be used to assist in thematicdata analysis

Authors response: Dear Reviewer thank you so much; we revised.

Reviewer #2: Reviewer’s Comments: Line 215/6 - Step 6: Methodological quality appraisal

Critical appraisal of evidence sources is not mandatory in scoping review, but the

methodological quality will be assessed using mixed methods appraisal tools[32]. Critical appraisal of evidence sources is not mandatory in a scoping review, but the methodological quality will be assessed using mixed methods appraisal tools[32].

Though critical appraisal of evidence sources is not mandatory in scoping reviews, the methodological quality of evidence will be assessed using mixed methods appraisal tools[32].

Authors response: Dear Reviewer, thank you so much. We have revised according to your suggestion as “Though critical appraisal of evidence sources is not mandatory in scoping reviews, the methodological quality of evidence will be assessed using mixed methods appraisal tools[32].”

Reviewer #2: Reviewer’s Comments: Discussion

Line 218-221 – are repetitive

We anticipate that this scoping review will highlight evidence mapping on the diagnosis of hypertension and diabetes among PLWH. The barriers and facilitators of diagnosing non communicable disease focusing on hypertension and or diabetes will be identified. This review will contribute evidence for strengthening and sustaining early diagnosis of hypertension and diabetes among people living with HIV in primary care facilities.

…will map evidence on the barriers and facilitators affecting the diagnosing of NCD such as hypertension and diabetes among PLHIV.

Authors response: Dear Reviewer, thank you so much. We have revised it according to your suggestion. Please see the track change in the manuscript. as “We anticipate that this scoping review will highlight evidence mapping on barriers to and facilitators affecting the diagnosis of major NCDs (depression, hypercholesterolemia, hypertension, obesity, and diabetes) among PLWH in LMICs.”

Reviewer #2: Reviewer’s Comments: Lines 223/4: Line needs to be revised as it does not read well.

The strength and limitations of our scoping review method credibility of the results will be detailed.

Authors response: Dear Reviewer, thank you so much. We have revised it according to your suggestion. Please see the track change in the manuscript.

Reviewer #2: Reviewer’s Comments: References: Reference list and intext references should be checked. organizatio WH; 2021.

Nations U: 2020 Global AIDS Update Seizing the moment Tackling entrenched

inequalities to end epidemics. In.; 2020.

12. !!! INVALID CITATION !!! [12].

Authors response: Dear Reviewer, thank you so much. We have revised it according to your suggestion and fixed errors in the references. Please see the track change in the manuscript.

Attachment

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Decision Letter 1

Billy Morara Tsima

14 Nov 2023

Mapping evidence on barriers to and facilitators of diagnosing  noncommunicable diseases (NCDs) among people living with human immunodeficiency virus (PLWH) in low- and middle -income countries (LMICs) in Africa: A scoping review protocol

PONE-D-22-28972R1

Dear Dr.Badacho,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Billy Morara Tsima, MD MSc

Academic Editor

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Additional Editor Comments (optional):

Reviewers' comments:

Acceptance letter

Billy Morara Tsima

20 Nov 2023

PONE-D-22-28972R1

Mapping evidence on barriers to and facilitators of diagnosing  noncommunicable diseases (NCDs) among people living with human immunodeficiency virus (PLWH) in low- and middle-income countries (LMICs) in Africa: A scoping review protocol

Dear Dr. Badacho:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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on behalf of

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Academic Editor

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Associated Data

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    Supplementary Materials

    S1 Data

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    S1 Checklist. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

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    Attachment

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    Data Availability Statement

    No datasets were generated or analyzed during the current study. All relevant data from this study will be made available upon study completion.

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