Delivery Models of Diabetic Retinopathy Services in Low and Middle-income Countries: A scoping review protocol

Background Diabetic retinopathy(DR) is among the leading causes of blindness worldwide, including in low- and middle-income countries (LMICs) where the majority of people living with diabetes (PLWD) reside. The World Health Organisation (WHO) endorses DR screening along with timely treatment of those identified with treatable disease as a cost-effective intervention for the prevention of blindness from DR. Although this has been demonstrated to be successful in some high income countries, the service delivery models may not be practical for LMICs due to limited access to screening and treatment services. This scoping review aims to identify, map, and assess the available evidence on DR service delivery models for LMICs. Methods We will search MEDLINE, Embase, Global Health and CENTRAL on the Cochrane Library along with grey literature, to identify relevant publications in all languages reporting on DR service delivery models in LMICs. We will include studies of all designs and technical reports published since the year 2000, where the publication describes the set-up for DR service delivery in terms of one or more of the following aspects of delivery; screening, diagnosis, treatment, follow-up, referral to specialist ophthalmic care and linkage with general diabetes care. We will map current practices and identify gaps in the literature by analysing the included studies. Two reviewers will screen search results independently and data extraction will also be carried out by two reviewers and any discrepancies will be resolved through discussion or arbitration with a third reviewer. The results of the search and the study inclusion process will be presented using the PRISMA-ScR flow diagram and a narrative synthesis will be used to report the results. Discussion This scoping review will provide an overview of DR service delivery models in LMICs, synthesising findings from different countries. The review will offer insights into the components of the DR service delivery models and the extent of the evidence on the effectiveness of the models. The results will be of interest to policymakers planning on optimising DR services or conducting research aimed at reducing the burden of DR in LMICs. Scoping review registration OSF: https://doi.org/10.17605/OSF.IO/E4YX5