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Integrated Screening for Communicable and Non-Communicable Diseases Multimorbidity in Low- and Middle-Income
Evans Duah1,2,3,4, Nyeleti Chauke1, Smangaliso Morerwa5
1Centre for Development and Implementation of Point-of-Care Diagnostics (CPOC-Dx), School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Abstract:
Multimorbidity is a growing public health challenge in low- and middle-income countries (LMICs), where resource-limited and fragmented health systems impede coordinated disease detection and management. Integrated screening offers a promising strategy to improve early detection of communicable and non-communicable diseases. We mapped the current evidence on integrated screening in LMICs, examining models, strategies, diseases, diagnostic tools and contextual factors that affect implementation and sustainability. A comprehensive search was conducted using the following electronic databases: PubMed, Scopus, Web of Science, ProQuest and EBSCOhost following the PRISMA-ScR guidelines. Two independent reviewers screened and extracted data, with a third reviewer resolving any discrepancies. The methodological quality of the study was appraised using the Mixed Methods Appraisal Tool (MMAT, Version 2018). Results were synthesized thematically and presented narratively. Out of 5380 studies screened, 17 were included, spanning 2012-2025 across 12 countries (13 conducted in Africa, 3 in South Asia and 1 in Latin America). They assessed communicable and non-communicable conditions, including HIV, TB, diabetes, hypertension and cardiovascular disease. Integrated screening was delivered via facility-based, mobile, community and community health worker-led models across primary healthcare and community settings. Five themes emerged: implementation in community and healthcare facilities; role of point-of-care diagnostics; health system preparedness and workflow alignment; staffing and workforce support; and factors influencing sustainability. Integrated multimorbidity screening in LMICs is feasible and improves detection, diagnosis and care when supported by trained staff, task shifting, community health workers and point-of-care diagnostics. Sustainable scale-up needs national alignment, funding and resource mobilization for equitable access.