Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review

Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review Oluwabunmi Ogungbe , Samira Barbara Jabakhanji , Roopa Mehta , John McCaffrey , David Byrne , Sinéad Hurley , Lori Rosman , Eyram Cyril Bansah , Folahan Ibukun , Irene Afua Quarshie , Katherine Lord , Yidan Lu , Yunzhi Wang , Asma Rayani , Hairong Liu , Ann Joseph , Alejandro Escobosa , Ivy Nyamuame , Jieun Lee , Ning Meng , Ibrahim Jehanzeb , Temitope Akinyemi , Shoichiro Nohara , Mauro F. F. Mediano , Yvette Yeboah-Kordieh , Cecilia de Sousa , Juliana Farhat , Renato Bandeira de Mello , Tara Taeed , Lawrence J. Appel , Sonia Y. Angell , Edward W. Gregg , Kunihiro Matsushita doi: https://doi.org/10.1101/2024.04.17.24305997 Oluwabunmi Ogungbe 1 Johns Hopkins University School of Nursing , Baltimore, Maryland, USA 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Samira Barbara Jabakhanji 3 School of Population Health, RCSI University of Medicine and Health Sciences , Dublin, Ireland 4 Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Roopa Mehta 5 Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición , Salvador Zubirán, México City, México MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site John McCaffrey 3 School of Population Health, RCSI University of Medicine and Health Sciences , Dublin, Ireland MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site David Byrne 3 School of Population Health, RCSI University of Medicine and Health Sciences , Dublin, Ireland PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sinéad Hurley 3 School of Population Health, RCSI University of Medicine and Health Sciences , Dublin, Ireland PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lori Rosman 6 Welch Medical Library, School of Medicine, Johns Hopkins University , Baltimore, Maryland, USA MLS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Eyram Cyril Bansah 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 8 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Folahan Ibukun 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 8 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Irene Afua Quarshie 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 9 Johns Hopkins Carey Business School , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Katherine Lord 10 Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yidan Lu 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yunzhi Wang 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Asma Rayani 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 8 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, Maryland, USA MBBS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hairong Liu 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ann Joseph 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alejandro Escobosa 11 Krieger School of Arts and Sciences, Johns Hopkins University , Baltimore, Maryland, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ivy Nyamuame 12 Department of Radiology, University of Medical Sciences , Havana, Cuba 13 Department of Radiology, Ho Teaching Hospital, Volta Regional Hospital , Ghana MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jieun Lee 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ning Meng 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MHS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ibrahim Jehanzeb 11 Krieger School of Arts and Sciences, Johns Hopkins University , Baltimore, Maryland, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Temitope Akinyemi 14 Department of Internal Medicine, Rutgers/Community Medical Center , Toms River, New Jersey, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shoichiro Nohara 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mauro F. F. Mediano 15 Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation , Rio de Janeiro, RJ, Brazil 16 Department of Research and Education, National Institute of Cardiology , Rio de Janeiro, RJ, Brazil PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yvette Yeboah-Kordieh 17 Department of Internal Medicine , MedStar Health, Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Cecilia de Sousa 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Juliana Farhat 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Renato Bandeira de Mello 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 18 Department of Internal Medicine, Federal University of Rio Grande do Sul , Brazil MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Tara Taeed 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lawrence J. Appel 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 8 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sonia Y. Angell 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 19 Department of Medicine, Columbia University Medical Center , New York, NY 10032, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Edward W. Gregg 3 School of Population Health, RCSI University of Medicine and Health Sciences , Dublin, Ireland PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kunihiro Matsushita 7 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA 8 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University , Baltimore, Maryland, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: kuni.matsushita{at}jhu.edu Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Summary Background The COVID-19 pandemic disrupted care for non-communicable diseases globally. This study synthesizes evidence on disruptions to primary care, focusing on hypertension and diabetes care and mitigation approaches taken during the pandemic in Latin America and the Caribbean (LAC). Methods We conducted a scoping review, searching nine electronic databases for studies from January 2020 to December 2022 on COVID-19-related primary care disruptions and interventions, including studies on hospital-based interventions given their relevance to the pandemic response in LAC. We adapted the Primary Health Care Performance Initiative framework to develop our search strategy and synthesize data. For studies reporting interventions, we included studies conducted outside of LAC. Findings Of 33,510 references screened, 388 studies were included (259 reported disruptions in LAC, 61 interventions in LAC, 63 interventions outside LAC, and five interventions from countries within and outside LAC), with three-quarters presenting data from Brazil, Argentina, Mexico, and Peru; few studies focused on rural areas. Additionally, the few studies that adequately quantified care disruptions reported a reduction in hypertension and diabetes control during the pandemic (e.g., hypertension control rate decreased from 68% to 55% in Mexico). Frequently reported causes of disruption included burnout and mental health challenges among healthcare workers (with disproportionate effects by type of worker), reduced medication supplies, and reduced frequency of clinic visits by patients (e.g., due to financial constraints). The most reported interventions included remote care strategies (e.g., smartphone applications, virtual meeting platforms) and mental health programs for healthcare workers. Remote care strategies were deemed feasible for care delivery, triaging, and clinical support for non-physicians. Patients were generally satisfied with telemedicine, whereas providers had mixed perceptions. Robust evidence on the effectiveness of remote care strategies for diabetes and hypertension care was unavailable in LAC. Interpretation Hypertension and diabetes control appeared to worsen in LAC during the pandemic. Major reported causes of care disruptions were workforce issues, reduced medication supply, and changes in patient perceptions of seeking and receiving primary healthcare. Remote care strategies were feasible for various purposes and were well received by patients. However, the lack of data on intervention effectiveness underscores the importance of strengthening research capacity to generate robust evidence during future pandemics. Developing resilient healthcare systems able to provide care for hypertension and diabetes during future pandemics will depend on investment in the healthcare workforce, medical supply chain, health data and research infrastructure, and technology readiness. Funding This work was supported by funding from the World Bank to Johns Hopkins Bloomberg School of Public Health and RCSI University of Medicine and Health Sciences. Additional support to RCSI was provided by Science Foundation Ireland, Converge Programme, grant number 22/RP/10091. Panel: Research in context Evidence before this study While evidence on health system impacts of the COVID-19 pandemic and potential interventions has been emerging rapidly, comprehensive syntheses in Latin America and the Caribbean (LAC) were unavailable. Added value of this study Drawing from 388 studies on primary care disruptions in LAC and corresponding interventions in and outside of LAC, this scoping review describes pandemic disruptions and mitigation interventions for diabetes and hypertension care from 2020 to 2022. Differences were identified in the volume of studies describing care disruptions and interventions by country/geography, and by the domain of primary care provision. Most publications were from Brazil, Mexico, Argentina, Peru, and urban settings. Most disruptions were identified in the workforce, medication supplies, and patient perceptions of care. Mitigation responses predominantly included remote care strategies and mental health programs for the health workforce; however, robust data for their effectiveness in LAC were unavailable. Implications based upon the available evidence This scoping review shows that action is needed to strengthen healthcare systems and their resilience in LAC. Research gaps remain in many countries and healthcare domains, a major gap being the lack of studies investigating intervention effectiveness. To provide care for persons with hypertension and diabetes during the next pandemic, countries in LAC should invest in the healthcare workforce, health data and research infrastructure, and technology readiness. 1 Introduction The COVID-19 pandemic disrupted care for non-communicable diseases (NCDs) like hypertension and diabetes around the world. A negative impact on the management of these conditions in Latin America and the Caribbean (LAC) was likely, as the region has some of the highest rates of chronic diseases globally, and a need for improvements to NCD care delivery was recognized before the pandemic. 1 – 3 4 In 2021, Pan American Health Organization (PAHO) surveys across LAC found disruptions in the delivery of about half of essential healthcare services, including hypertension and diabetes management and prescriptions. 5 A study using household surveys in 14 LAC countries found that healthcare disruption was highest at the beginning of the pandemic in May-June 2020, with an average of 20.4% of households reporting disruption, and declined to 2.9% by May-July 2021. 6 Furthermore, a qualitative study with health system decision-makers in 8 LAC countries found that the main mitigation strategies focused on telemedicine, community-based care, expansion of hospital capacity and health workforce, and public-private collaborations. However, the magnitude of care disruptions and recovery approaches have yet to be systematically characterized. 7 We conducted a scoping review to answer two research questions: 1) To what extent were diabetes and hypertension care in the LAC region disrupted during the COVID-19 pandemic? and 2) Which interventions were shown to mitigate, reverse, or support the recovery of diabetes and hypertension care disruptions due to the pandemic? Our main focus was diabetes and hypertension since they are leading causes of mortality worldwide and often considered pathfinders for reforming primary care systems. Based on findings from the present scoping review, we provide potential actions to strengthen healthcare systems capable of providing care during future pandemics. 2 Methods This scoping review adheres to the PRISMA Extension for Scoping Reviews ( appendix 1 pp 1-2 ). 8 Before commencing this review, we modified the Primary Health Care Performance Initiative (PHCPI) Framework and used it to organize our analysis. The PHCPI Framework includes various domains (e.g., service delivery) and sub-domains (e.g., facility organization and management) of healthcare provision ( appendix 1 pp 3 ). We have published our study protocol 9 and summarized key review components below and in Table 1 . View this table: View inline View popup Download powerpoint Table 1. Scoping review stages and description. 2.1 Search strategy and information sources Guided by the Population, Concept, and Context (PCC) framework and the modified PHCPI Framework ( appendix 1 pp 3-4 ), we iteratively developed the search strategy ( appendix 1 pp 5-6 ) with an information specialist (L.R.). While the PHCPI framework focuses on primary care, we also included studies on hospital-based interventions, given their relevance to the pandemic response in LAC. We searched MEDLINE via PubMed, CINAHL, Global Health, Embase, Cochrane, Scopus, Web of Science, and LILACS (Latin American and Caribbean Health Sciences Literature) from January 1, 2020, until December 12, 2022. The World Bank, PAHO, and four content experts from Barbados, Brazil, Mexico, and Peru recommended grey literature. 2.2 Study selection and eligibility After removing duplication, 10 , 11 two reviewers independently screened each title/abstract against specified criteria and reviewed potentially eligible full-text publications using Covidence® software. Conflicts were resolved by a third reviewer or team consensus. For the eligibility ( appendix 1 pp 3 ), the population of interest is all adults eligible for screening or receiving diabetes or hypertension care and children with diabetes or hypertension. The concept is a disruption to the delivery of primary care services and mitigation, reversal, or recovery of those services where interruptions occur. While prioritizing diabetes and hypertension care, we also included literature on other primary care services. The context is LAC during the COVID-19 pandemic. For literature on interventions, we also included studies conducted outside LAC since their results may inform healthcare reform in LAC. Original studies, reports, and reviews with systematic search strategies in English, Spanish, or Portuguese were included. 2.3 Data extraction A data extraction and quality assessment template was developed and embedded in Covidence® to record study information and to map studies according to the modified PHCPI Framework ( appendix 1 pp 7-8). Two independent reviewers extracted data and assessed study quality, and a third reviewer contributed to establishing consensus when needed. Studies were assessed for quality using the Mixed Methods Assessment Tool (MMAT), 12 due to the heterogeneity of study designs represented. 2.4 Data synthesis We synthesized study findings narratively. As telemedicine was the most common type of intervention identified, we categorized findings by feasibility and utilization, acceptability and satisfaction, and effectiveness. 14 MMAT results were displayed in a traffic plot using the robvis tool ( appendix 1 pp 9-23 ). 13 2.5 Developing a list of potential actions Together with PAHO, we established a panel of content experts from LAC. We shared preliminary study findings with the panel, World Bank, and PAHO representatives and received initial feedback in May/June 2023. Using the final scoping review findings, we developed a list of potential actions and refined these based on feedback from the expert panel, World Bank, and PAHO. 2.6 Reflexivity Our team includes authors who currently or have previously worked in LAC countries (RM, KL, AJ, AE, IN, TA, MFFM, CS, JF, RBM, SYA), as well as senior researchers with experience in international collaborations (KM, EWG, LJA, SYA). We approached this study with the intention of equitable inclusion of researchers with contextual knowledge of the region ( appendix 2 ). 15 2.7 Role of the funding source This project was supported by the World Bank, and additional support to investigators was provided by Science Foundation Ireland. The expert panel was supported by PAHO. Although the World Bank, PAHO, and the expert panel had opportunities to review relevant materials and provide feedback, the content of the present study is solely the responsibility of the authors and may not represent the views of the World Bank, PAHO, Science Foundation Ireland, or the expert panel members. 3 Results Our search identified 49,954 records ( Figure 1 ). After removing 16,441 duplicates, 33,510 titles/abstracts were screened for eligibility, and 1,511 remained for full-text review. Of these, 388 studies were included in this review, 259 reporting care disruptions in LAC and 129 exploring interventions within and outside LAC ( Table 2 , appendix 1 pp 24 ). Of the 388 studies, most studies were from Brazil (n=169), Argentina (n=45), Mexico (n=44), and Peru (n=35); 59% (n=228) were written in English only ( Figure 2 , Table 2 ). Download figure Open in new tab Figure 1. Selection of eligible studies, PRISMA flowchart 1 . Download figure Open in new tab Figure 2. Geographical representation of included studies within Latin America and the Caribbean (LAC) on (A) disruptions to primary care; (B) interventions to mitigate disruptions. View this table: View inline View popup Table 2. Characteristics of included studies. 3.1 Overview of studies on care disruption in LAC Of 259 studies, 126 were from Brazil, 22 from Argentina, 22 from Mexico, and 19 from Peru ( appendix 1 pp 25 ). Where indicated, most studies described disruptions to primary care services in urban (n=92) or mixed urban and rural settings (n=69) and in public (n=94) or mixed public and private healthcare settings (n=69). Only five studies explicitly studied data in rural areas and only eight in private healthcare settings. Cross-sectional studies (n=155) constituted the most common design, followed by qualitative (n=28) and cohort studies (n=20). Diabetes was explored in 41 studies (16%), and hypertension in 26 studies (10%) ( Table 2 , appendix 1 pp 26 ). Each sub-domain of the PHCPI Framework was represented in at least 20 papers ( Figure 3 , appendix 1 pp. 27-36 ). In the System or Inputs domains, workforce was studied most (n=138), followed by facility infrastructure (n=104), governance and leadership (n=68), and drugs and supplies (n=47). Within the Service Delivery domain, access to primary care services and availability of services were most frequently studied (n=83), followed by patient perceptions of seeking and receiving primary healthcare and facility organization (n=51). In the Outputs domain, key process measures were studied most (n=121), followed by hypertension or diabetes treatment and control (n=57). Within the Outcomes domain, resilience was addressed most (n=148), followed by responsiveness to people (n=69). However, the coverage of domains and subdomains in Figure 3 does not necessarily reflect the level of evidence for each due to variations in quality and objectivity of data ( Figures e2-e6, Tables e5 & e7 ). Download figure Open in new tab Download figure Open in new tab Figure 3. Domains of primary care services addressed in Latin America and the Caribbean (LAC) and Non-LAC countries, by disease area. 3.1.1 Magnitude of disruptions to diabetes and hypertension care Few studies provided quantitative data on treatment or control rates of diabetes and hypertension compared to periods before the pandemic. A Chilean study examined national clinical data from sites implementing the World Health Organization HEARTS Technical Package 16 and reported a 12% and a 14% reduction in treatment and control rates of hypertension, respectively, in 2021 vs. 2017-2019. Similarly, social security data representing more than half of Mexico’s population 17 demonstrated a decrease in hypertension control rates from 68% to 55%. This same investigation showed a reduction in diabetes control rates, from 36% to 26% during the pandemic. Decreases in hypertension and diabetes screening, including its complications, were also reported. 18 , 19 In Brazil, there was a decrease in guideline-recommended screening examinations among patients with type 1 diabetes from 23% pre-pandemic to under 4% in 2022. 20 Decreasing clinic visits for diabetes and hypertension management were also reported in Chile, Haiti, and Mexico. 21 3.1.2 Major disrupted subdomains 3.1.2.1 Workforce Mental Health of Healthcare Workers 115 papers reported workforce-related mental health outcomes. Increases in burnout, anxiety, depression, and insomnia among doctors, nurses, and other healthcare staff were described in several countries. 22 – 27 Administrative data from Brazil showed a 17% increase in psychiatric sick leave during the pandemic. 28 Another Brazilian study noted a 39% increase in mental health absenteeism among 32,691 hospital workers. 29 Nursing assistants and other frontline workers were disproportionately impacted compared to physicians and nurses. 30 – 32 Contributing factors included lack of personal protective equipment (PPE), increased patient volume due to COVID-19, disruptions to workflow, social isolation, and perception of insufficient organizational and governmental support. 22 , 33 – 37 A Colombian study reported that workers with an increased workload due to COVID-19 had ∼2 times higher odds of anxiety and depression compared to those without workload changes. 32 Increased negative health behaviors, including smoking, alcohol use, and reduced physical activity, were also reported among healthcare workers. 38 Changes in Work Environment During the pandemic, changes to the work environment and conditions were reported. 39 – 42 In Brazil, increases in physician income were noted at public facilities, whereas income was reduced in the private sector. 40 A Brazilian study showed increases in job availabilities for registered nurses (14%), nurse assistants (9%), physiotherapists (8%), and physicians (5%). 41 A Brazilian survey of 1,609 healthcare workers found that 65% of psychologists were working remotely, while only 20% of dentists were doing so. 42 Moreover, while opportunities for early assumption of clinical responsibilities among young doctors in Brazil arose during the pandemic, challenges related to support and social integration of early career physicians were noted. 43 3.1.2.2 Medication and essential supplies In a 2020 survey of 40 diabetes organizations in 18 LAC countries, approximately two-thirds of respondents reported shortages of diabetes medications and a lack of critical supplies, such as syringes/needles and glucose strips. Only 37% of the respondents reported that a policy had been introduced to allow for the multi-month delivery of diabetes medications and supplies at home or dispensaries for two-to three months. 44 In Peru, availability of essential medicines like losartan and metformin declined initially, but rebounded in primary care, exceeding pre-pandemic levels. Recovery appeared lower, however, in secondary and tertiary care facilities. 45 Lack of PPE and other essential supplies were also reported in some studies. 30 , 40 – 42 3.1.2.3 Access and availability of relevant services Several studies highlighted substantial reductions in preventive and screening services, routine check-ups, and outpatient care in general. 50 – 54 For example, a Brazilian study reported a 77% drop in pap smears and a 43% decrease in mammograms in 2020-2021 compared to pre-pandemic levels. Significant declines in essential health services were reported in Mexico, including screenings (26-96% decrease), outpatient visits (9-40% decrease), and maternal health appointments (5-33% decrease). 17 Outpatient services and elective procedures were also impacted, with decreases ranging from 46-75% across different studies. 55 – 57 Many facilities focused resources on pandemic response, resulting in barriers like long wait times for primary care. 51 , 58 While several studies mentioned reductions in screening services, none specifically reported on screening for new cases of hypertension or diabetes. 3.1.2.4 Governance and leadership The pandemic revealed gaps in governance and leadership across multiple levels of health systems in LAC. 59 – 61 Studies emphasized challenges in coordinating evidence-based responses, managing scarce resources, and confronting healthcare inequities exacerbated by the pandemic. 62 – 66 Significant regional disparities in health workforce availability were also reported. 67 Delays and inconsistencies in healthcare guidelines and policies were reported in Mexico during the initial pandemic stages. 68 One study reported that Brazilian municipalities perceived the municipal pandemic management as inadequate across various facets, including infrastructure, supplies, and communication. 58 3.1.2.5 Patient factors Studies identified patient-level barriers to disease management, including worsened financial situations, fear of COVID-19 infection in clinics, and reduced adherence to medications and lifestyle changes. 58 , 70 , 71 A Mexican study found that over half of patients with self-reported health needs did not seek care because they considered their issue not severe; other reasons were costs and fear of COVID-19 infection. 18 Lifestyle changes also impacted disease management. A study in Brazil found that during the pandemic, eating habits worsened among adults with type 1 diabetes. 72 3.2 Overview of intervention studies Of 129 studies addressing interventions, 61 were carried out in LAC ( Table 2 ) , predominantly in Brazil (n=28), Mexico (n=11), Argentina (n=10), and Colombia (n=8) ( appendix 1 pp 37-53, Figure e11 ). Three studies included several LAC countries, and five included data from both LAC and non-LAC regions. Outside LAC, most interventions were from the United States (n=38) and European countries (n=9), and eight had multi-country representation. In LAC, 30% of studies focused on diabetes (n=18) and 16% on hypertension (n=10) ( Figure 3 ). Other major investigated conditions included mental health (n=12, 20%) and general medical encounters (n=14, 23%). The corresponding numbers in non-LAC countries were as follows: diabetes (n=13, 21%), hypertension (n=6, 10%), mental health (n=9, 14%), and general medical encounters (n=23, 37%). Two main types of interventions were implemented both in and outside LAC: remote care strategies, generally termed “telehealth” or “telemedicine” (LAC: n=43, 71%; non-LAC countries: n=52, 83%, appendix 1 pp 55-62 ), and mental healthcare (LAC: n=12, 20%; non-LAC countries: n=8, 13%, appendix 1 pp 63-64 ). Other interventions involved drug access and prescriptions, behavioral interventions, policy, diet, funding, screening campaigns, and team-based care. Interventions targeted either patients or healthcare workers. 3.3 Remote care strategies within LAC Of the 43 studies in LAC, half were cross-sectional descriptive studies (n=20); only three were randomized controlled trials (RCTs). 73 – 75 Remote care was applied across numerous conditions, including 11 studies on diabetes and 5 on hypertension. Remote care was predominantly offered in tertiary care settings (n=27; primary care: n=7) delivered during real-time synchronous encounters (n=35). Technologies ranged from telephone calls (n=20) to smartphone applications and virtual meeting platforms such as WhatsApp (n=22), Zoom, and Microsoft Teams (n=13). Studies evaluated various aspects of remote care implementation: feasibility and utilization (n=31), healthcare provider or patient acceptance and satisfaction (n=14), and some level of intervention effectiveness (n=19). 3.3.1 Feasibility and utilization 3.3.1.1 Healthcare delivery and clinical education Studies reported feasibility based on the number of teleconsultations completed. In Mexico, a primary-care diabetes clinic 76 and a large hospital-based study 77 perceived phone calls, text messaging, and video calls helpful for safe continuity of care and monitoring prescription needs among patients with diabetes or hypertension. In Brazil, telephone calls and text messages permitted monitoring of adherence among patients with type 1 diabetes. 78 Additionally, WhatsApp messages, audio, and video calls improved patients’ access in remote communities. 68 A cross-sectional analysis of an ongoing randomized trial in Guatemala 80 reported on the success of telephone calls for verifying delivery of anti-hypertensive medication (e.g., 73% in the intervention group vs. 51% in the control group). Remote healthcare strategies were also used for patient education. In Colombia, web-based video conferencing was used to train patients with type 1 diabetes who were switching from regular insulin pumps to a hybrid closed-loop system. 83 In Brazil, telephone calls by nurses providing education on hypertension treatment and COVID-19 guidance helped avoid unnecessary emergency room visits. 84 3.3.1.2 Triaging and clinical support A Brazilian study concluded that teleophthalmology for patients with diabetes was a feasible low-cost strategy to increase diabetic retinopathy screening in remote areas. 86 Similarly, in Peru, teleophthalmology was used to identify patients requiring face-to-face visits. 87 Other examples included WhatsApp video calls to triage for respiratory symptoms, 88 telephone consultations to triage primary care patients to specialty care, 89 and a remote medical advice program triaging patients requiring in-person hospital evaluation. 77 Another study from Mexico implemented teleconsultations to provide remote neurology support. 90 Over 95% of the 304 teleconsultations conducted by neurology residents successfully addressed neurological issues without needing an in-person evaluation. 3.3.2 Acceptance and satisfaction 3.3.2.1 Acceptance and satisfaction - patients In Argentina, 92 patients in a cardiology clinic rated virtual visits highly (e.g., easy to carry out and not inferior to face-to-face visits). Similar findings were reported among primary care and hospital-based patients in Chile. 93 In 56,560 web-based video consultations in Colombia, 94 patients’ satisfaction was excellent at 84%. Acceptance also was high (>∼85%) among neurology patients 90 and patients with diabetes. 76 Some studies reported that patients accepted virtual visits because of the pandemic, but generally preferred in-person visits. 84 , 96 3.3.2.2 Acceptance and satisfaction – healthcare workers A Brazilian study 97 found that while only 19% of providers had used telemedicine pre-pandemic, 83% reported engaging in telemedicine training, and 64% used telemedicine to provide care during the pandemic. However, perceptions of telehealth among healthcare professionals were mixed; in Chile, one study 93 reported that 62% of medical providers felt their clinical skills were challenged on video visits. 3.3.3 Effectiveness Of 19 studies aiming to evaluate effectiveness, most did not quantify disease outcomes or lacked control/comparator groups. Furthermore, some studies were small (e.g., <50 participants). None conducted a health economic assessment. Diabetes In a Colombian study using video conferences for monitoring and training 91 patients with type 1 diabetes, there were significant improvements in percent of time in glucose control range (77% to 82%) comparing pre- and post-intervention. 83 An observational study in Brazil carried out telephone monitoring of 237 patients with type 2 diabetes 78 and reported a small but statistically significant reduction in HbA1c (7.9% vs. 7.7%, p=0.004). However, a study 100 (n=143) that used telephone calls and text messages to send blood glucose values, check insulin doses, and periodically monitor for acute complications in patients with type 1 diabetes observed worsening of HbA1c in 46% of patients. A Brazilian center 101 (n=747) assessed a telemedicine program without specific training and found hospitalization rates increased by ∼50%. In contrast, a pre-post study from the Dominican Republic 102 used WhatsApp and telephone calls to monitor 946 dialysis patients and observed decreased hospitalization and a 2% COVID-19 diagnosis rate over a 3-month follow-up period. Hypertension A Chilean study used video calls from a mobile device to facilitate communication between the emergency department and a remote neurologist for rapid thrombolytic decision-making for stroke. Time from arrival to decision for thrombolytic administration was significantly reduced (median 5 [IQR 3–8] vs. 6 [IQR 4–10] minutes, p=0.016) compared to pre-implementation. 103 A study from Guatemala used an integrated intervention approach, including patient health coaching and home blood pressure monitoring in rural communities, and reported fewer problems with antihypertensive medication availability. 80 3.3.4 Team-based care strategies in LAC Two RCTs within LAC utilized multi-professional team-based approaches for delivering remote interventions. An RCT (n=91) in Brazil found that a 16-week multi-professional remote intervention, including weekly telephone calls and educational materials, significantly reduced the prevalence of positive screening for mental health disorders (37.0% vs. 57.8%, p=0.04) and diabetes-related emotional distress (21.7% vs. 42.2%, p=0.03) compared to standard care among adults with type 2 diabetes. 75 Another RCT (n=47) evaluated the effects of a 16-week multi-professional remote intervention with a nurse compared to an in-person multi-professional intervention without a nurse on body composition parameters among obese adults in Brazil. 73 The remote intervention group had significant decreases in waist circumference (p<0.001) and blood glucose (p=0.014) compared to in-person care. 3.3.5 Remote care strategies outside the LAC region We identified additional insights regarding intervention effectiveness in studies from countries outside LAC. For example, remote diabetes care delivered by primary care physicians in the USA achieved better medication adherence compared to non-physician providers (83% vs 77%). 104 Additionally, HbA1c control rate of remote and in-person care was similar in urban settings (63% vs 65%), but lower in rural areas (56% vs 63%). 105 – 107 Other studies indicated that rural areas face more barriers to engagement with virtual care options than urban areas. 108 – 110 In contrast, some studies found that telemedicine increased access and utilization for rural residents and other underserved populations in Canada, 106 Saudi Arabia, 91 and other countries. 92 Other barriers included insufficient technological literacy or skills and discomfort with remote monitoring devices. 111 Furthermore, internet availability, costs, reimbursement considerations, privacy or data concerns, and practice workflow challenges emerged as common themes. 111 One Australian study reported initial cost increases to the Medicare Benefits Schedule for general practitioner consultations after expansion of public telehealth coverage (pre-pandemic: $545 million per month; March 2020 – December 2021: $592 million per month; p=0.0001). After this initial increase, there was no significant change in costs. 105 3.4 Mental health support for providers in LAC In Uruguay, 98 an online mindfulness program reported improved stress scores among 15 healthcare workers. A brief remote cognitive behavioral therapy intervention decreased anxiety and depression symptoms in 26 Mexican healthcare workers, though time constraints and workload impeded participation. 112 In Brazil, 99 a program providing mental health support for 395 hospital-based healthcare workers showed that workers appreciated the support and connectedness from the virtual interventions. An RCT (n=120) in Brazil showed that oral cannabidiol (CBD) plus standard care vs standard care alone reduced emotional exhaustion over a month. CBD also reduced anxiety and depression symptoms, but five serious adverse events occurred in the CBD group. 74 3.5 Mental health support for providers outside LAC An RCT in Turkey showed reduced stress and work-related strain and improved psychological well-being among 52 nurses after mindfulness-based breathing and music therapy. 113 Similarly, a mindfulness-based course lowered workforce distress, emotional exhaustion, fear of COVID-19, and physical stress symptoms, including sleep difficulties in Italy. 114 In France, a psychological support hotline was rapidly implemented to provide support for hospital workers during the COVID-19 outbreak. After 26 days, the hotline had received 149 calls, helped assess symptoms, and referred staff to additional psychosocial support. 115 3.6 Other interventions 3.6.1 Interventions within LAC A digital COVID-19 screening protocol among over 500 healthcare workers in Mexico promoted workforce wellness and NCD prevention and control by identifying previously undiagnosed hypertension, diabetes, and obesity. 57 , 82 A 10-month medication home delivery program through partnerships with local pharmacies for over 800 older adults in Brazil resulted in 25% fewer in-person visits to the pharmacy. Among the program users, 67% and 21% received medications for hypertension and diabetes, respectively, and 92% of users considered the program satisfactory. 116 3.6.2 Interventions outside LAC In the USA, an analysis of electronic health records for 2,479 cardiometabolic patients showed that pharmacist-led medication review interventions (e.g., simplifying complex regimes) helped conserve supplies, reduce staff exposure, and maintain patient safety. 117 In Portugal, a cross-sectional study of 603 patients found that community pharmacies taking on dispensing of typically hospital-only medications improved therapy adherence and lowered patient travel and absenteeism. 118 In Saudi Arabia, a prospective interventional study delivered pharmacy-based education to 54 patients with diabetes, which improved disease knowledge, self-care, medication adherence, and diabetes control compared to usual care. 119 In the USA, a community-based participatory approach providing online lifestyle education to 105 participants in underserved communities significantly improved health behaviors, self-reported health, and mental health scores. 120 Integration of diabetes screening into routine COVID-19 testing facilities for 923 low-income individuals in a cross-sectional study identified high rates of previously undiagnosed diabetes and connected patients to follow-up care. 121 Similarly, an RCT using non-clinical patient coaches increased cancer screening rates among 119 patients compared to usual care. 3.7 Recommended Actions Based on the findings from this scoping review and feedback from the World Bank, PAHO, and our expert panel, we list potential actions relevant to LAC in Table 3 . While their relevance will vary across LAC countries, they aim to contribute to strengthening data infrastructure to evaluate care disruptions in real-time and improve the resilience and equity of healthcare systems. View this table: View inline View popup Download powerpoint Table 3. Recommended actions based on review findings. 4 Discussion Our scoping review of 388 articles found some evidence that hypertension and diabetes care services in LAC were disrupted during the COVID-19 pandemic and indicated potential pathways that may explain these disruptions. Workforce (including the mental health of healthcare workers) and medication supplies were the most frequently reported disrupted in LAC. Disruptions to the healthcare environment were exacerbated at the patient level, resulting in adverse lifestyle changes, financial constraints, and fear of contracting COVID-19. Our review also identified several promising mitigating interventions. Remote care strategies, including telemedicine (e.g., telephone calls, text messaging, video conferences), teleophthalmology, medication home delivery programs, and mental health care of healthcare workers were the two most studied interventions in LAC. Remote care strategies facilitated healthcare service delivery, clinical support of healthcare workers, and patient education, and they appeared feasible and acceptable. However, knowledge gaps remain in long-term benefits and cost-effectiveness of remote care in LAC. Findings reveal a breadth of innovations from several countries to mitigate pandemic disruptions, but rigorous evaluation is needed, particularly on sustainability and integration within health systems. Given the number of studies identified in our scoping review, it was surprising that only a few evaluated changes in hypertension or diabetes control during the pandemic. This was likely a product of limited capacity for immediate assessment of relevant data in care delivery settings and the redirection of staff and system’s focus on the COVID response. Introducing data infrastructure and sufficient workforce capacity to allow for NCD treatment and control surveillance and data analysis in real-time could address these gaps. Our review revealed substantial pandemic impacts on health workforces across LAC (e.g., burnout and mental distress), with disproportionate effects on some types of workers, e.g., worse for nurse assistants compared to physicians. 35 It is natural for healthcare systems to focus on patient needs, but functional healthcare systems require a healthy workforce. Relevant also in non-LAC countries, 31 this scoping review signaled several areas LAC countries could consider for strategies to improve the well-being of healthcare workers, such as monitoring provider distress, workload redistribution with task sharing policies, and increasing access to mental health resources. 35 Dedicated efforts will also be required to build robust emergency response capacities, such as developing rosters of retired workers to be mobilized for emergencies and policies enabling extended task-shifting across provider cadres in emergencies. 124 While medication shortages occurred initially in some settings, supplies rebounded quickly in others, contrasting with more prolonged global supply chain disruptions. 125 These differences may be related to domestic pharmaceutical production capacity and supply chain resilience. Countries like Brazil reported pronounced insulin shortages, 128 while Peru’s rebound aligned with policies fortifying local manufacturing after past shortages. 45 Diversifying import sources, localized production and patient-centered delivery models can help countries prepare supply chains to withstand future crises. Cross-national regional collaborations on sourcing, stockpiling, and distribution may also be highly effective. The pandemic introduced several unique circumstances leading to changes in patient behavior potentially detrimental to hypertension and diabetes management. For example, fear of COVID-19 infection posed a major barrier to care-seeking. Patients also faced intensified financial constraints and occupational disruptions (e.g., unemployment), that may have impacted care-seeking and self-management. 130 Studies also revealed worsening mental health, diet, and health behaviors during lockdowns - all likely exacerbating existing illness. Remote care addressed some of these patient-level factors and indeed emerged as an adaptive strategy, as detailed below. Most studies in LAC suggested that remote care strategies helped maintain continuity and access across a spectrum of clinical care needs. More specifically, telehealth enabled remote monitoring for clinical decision-making and helped reduce potential COVID-19 exposure. Patient acceptance was generally high, whereas provider acceptance was lower, highlighting the need for more telemedicine training in medical education. Although a few studies reported that telehealth performs comparably to in-person primary care, 76 , 101 , 131 the evidence remains limited regarding its clinical effectiveness, cost-effectiveness, and long-term sustainability. 132 , 133 Also, structural barriers around health literacy and digital skills (particularly among elderly patients), insufficient availability of technology, limited infrastructure, and suboptimal connectivity (particularly in rural and poorer regions) can be issues. There may also be cost-related barriers (e.g., out-of-pocket costs). 71 , 80 , 134 These findings highlight the value of patient-centered telehealth in addressing these structural barriers. 110 While global collaborations can accelerate learnings on how to optimize remote care strategies, optimal design (e.g., telehealth modalities like video conferences) of remote care and evaluation frameworks tailored to LAC contexts will be essential for scaling up remote care models in the region. 135 4.1 Proposed modification to the conceptual framework After completing this scoping review, we perceived screening and lab testing in the ‘service delivery’ domain as closely linked to the domain of “outputs,” along with other diagnostic tests (e.g., imaging). Regarding patient factors, our initial conceptual framework only specified patient perception, whereas other patient-related elements (e.g., patient financial situation) are relevant. Thus, we propose modifying our conceptual framework for future studies, as depicted in Figure 4 . Download figure Open in new tab Figure 4. Second modification of the Primary Health Care Performance Initiative Conceptual Framework based on scoping review findings. 4.2 Limitations Despite its comprehensiveness and rigor, the present scoping review has limitations. First, the limited data on interventions likely reflect the challenges of conducting rigorous research during the COVID-19 pandemic, especially in settings with limited research and data infrastructure, as well as the timing of our study (i.e., <3 years into the pandemic). Second, as noted above, grey literature was not systematically searched. Third, we did not consider the timing of included studies with the spread of COVID-19 across specific LAC countries. Finally, the review was restricted to studies published in English, Spanish, or Portuguese, while a few LAC countries have other languages as their primary language. 5 Conclusions This review revealed concerning disruptions to essential NCD services, including diabetes and hypertension care across LAC. Workforce capacity and well-being, medication supplies, and patient perception were most reported as sources of the disruption. While this review identified promising strategies for adapting service delivery, predominantly remote care strategies, gaps remain in their cost-effectiveness and sustainability in the region. Our findings offer crucial insights that may inform health leaders in building resilient, equitable NCD care in LAC. Contributors The scope of the review was conceived by the Pan American Health Organization and the World Bank. The concept sheet and study plan were developed by SYA, EWG, and KM, shared with PAHO and The World Bank, and revised as needed. OO, SBJ, RM, SA, EG, KM, LR, and DB iteratively developed the search strategy. Literature screening and data abstraction were conducted by OO, SBJ, RM, JM, DB, SH, ECB, FI, IAQ, KL, YL, YW, AR, HL, AN, AE, IN, JL, NM, IJ, TA, SN, MFFM, YYK, CS, JF, RBD, and TT; LA, SYA, EWG, KM provided input and oversight during the stages of the review process. Data adjudication and synthesis were undertaken by OO, SBJ, RM, JM, ECB, FL, AR, JL, NM, and IB, with input and iterative discussion with SYA, EWG, and KM. Tables, figures, and maps were developed by OO, SBJ, RM, JM, DB, SH, ECB, FI, IAQ, KL, AR, JL, NM, IJ, YYK, CS, JF, and RBD. OO, SBJ, RM, SYA, EWG, and KM drafted the first iteration of the manuscript and made substantial contributions to the critical review, editing, and revision. All authors approved the final version of the manuscript. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Data sharing Researchers wishing to undertake additional analyses of the data or access original estimates are invited to contact the corresponding author (OO). The study protocol and analysis plan are available. Declaration of interests We established a working consortium of investigators and policymakers from John Hopkins University, the Royal College of Surgeons in Ireland, the World Bank, the Pan American Health Organization, and experts from the LAC region. All other authors declare no competing interests. Data Availability All data produced in the present work are contained in the manuscript. Acknowledgments This project was supported by the World Bank. We appreciate the opportunity to contribute to this synthesis of published literature. We thank individuals from the World Bank: Cristian A Herrera, Rialda Kovacevic, Francisca Corona Ravest, and Pan-America Health Organization (PAHO): Anselm Hennis, Silvana Luciani, Roberta Caixeta, who provided support in various ways. We thank our Regional Expert Committee members selected by PAHO, who assisted in locating grey literature and interpretation and contextualization of findings, providing both early and later input: Carlos A. Aguilar-Salinas (Mexico), Jaime Miranda (Peru although currently in Australia), Kenneth Connell (Barbados), Maria Inês Schmidt (Brazil). Footnotes ↵ # Co-first ↵ † Co-last References ↵ Hennis AJM , Coates A , Del Pino S , et al. COVID-19 and inequities in the Americas: lessons learned and implications for essential health services . Rev Panam Salud Publica Pan Am J Public Health 2021 ; 45 : e130 . OpenUrl Hambleton IR , Caixeta R , Jeyaseelan SM , Luciani S , Hennis AJM . The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data . Lancet Reg Health – Am 2023 ; 21 . DOI: 10.1016/j.lana.2023.100483 . OpenUrl CrossRef ↵ Msemburi W , Karlinsky A , Knutson V , Aleshin-Guendel S , Chatterji S , Wakefield J . The WHO estimates of excess mortality associated with the COVID-19 pandemic . Nature 2023 ; 613 : 130 – 7 . OpenUrl ↵ Hartmann-Boyce J , Highton P , Rees K , et al. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review . Lancet Diabetes Endocrinol 2024 ; 12 : 132 – 48 . OpenUrl ↵ World Health Organization (WHO). Second round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic. January-March 2021 . 2021 https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS-continuity-survey-2021.1 (accessed Dec 26, 2023 ). ↵ Herrera CA , Kerr AC , Dayton JM , Kakietek JJ . Healthcare service disruption in 14 Latin American and Caribbean countries during the COVID-19 pandemic: Analysis of household phone surveys, 2020-2021 . J Glob Health 2023 ; 13 : 06023 . OpenUrl ↵ Herrera CA , Juárez-Ramírez C , Reyes-Morales H , et al. COVID-19 Disruption To Routine Health Care Services: How 8 Latin American And Caribbean Countries Responded: The study examines disruption to routine health care services brought about by the COVID-19 pandemic in eight Latin American and Caribbean countries . Health Aff (Millwood) 2023 ; 42 : 1667 – 74 . OpenUrl ↵ The Primary Health Care Performance Initiative. The PHCPI conceptual framework . https://improvingphc.org/phcpi-conceptual-framework (accessed Dec 26, 2023). ↵ Jabakhanji SB , Ogungbe O , Angell SY , et al. Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol . BMJ Open 2024 ; 14 : e074443 . OpenUrl Abstract / FREE Full Text ↵ Covidence systematic review software . www.covidence.org . ↵ The EndNote Team. EndNote . 2013 . ↵ Q.N. Hong , S. Fàbregues , G. Bartlett , et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers . ↵ McGuinness LA , Higgins JPT . Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments . Res Synth Methods 2021 ; 12 : 55 – 61 . OpenUrl PubMed ↵ Moschonis G , Siopis G , Jung J , et al. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials . Lancet Digit Health 2023 ; 5 : e125 – 43 . OpenUrl CrossRef ↵ Morton B , Vercueil A , Masekela R , et al. Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships . Anaesthesia 2022 ; 77 : 264 – 76 . OpenUrl CrossRef PubMed ↵ Barake F , Paccot M , Rivera M , Neira C , Reyes V , Escobar MC . Chile’s public healthcare sector hypertension control rates before and during the pandemic and HEARTS implementation . Rev Panam Salud Publica 2022 ; 46 : e126 . OpenUrl ↵ Doubova SV , Leslie HH , Kruk ME , Pérez-Cuevas R , Arsenault C . Disruption in essential health services in Mexico during COVID-19: an interrupted time series analysis of health information system data . BMJ Glob Health 2021 ; 6 . DOI: 10.1136/bmjgh-2021-006204 . OpenUrl Abstract / FREE Full Text ↵ Colchero MA , Gómez R , Pineda-Antúnez CJ , Bautista-Arredondo SA . Health care utilization during the Covid-pandemic in Mexico: the cascade of care . Salud Publica Mex 2021 ; 63 : 743 – 50 . OpenUrl ↵ Carro GV , Carlucci EM , Torterola I , Breppe P , Ticona Ortiz MÁ , Palomino Pallarez JE . Diabetic foot and COVID-19. Medical consultation and severity of lesions compared to 2019 . Med BAires 2020 ; 80 : 30 – 4 . OpenUrl ↵ Foppa L , Alessi J , Nemetz B , de Matos R , Telo GH , Schaan BD . Quality of care in patients with type 1 diabetes during the COVID-19 pandemic: a cohort study from Southern Brazil . Diabetol Metab Syndr 2022 ; 14 : 75 . ↵ Arsenault C , Gage A , Kim MK , et al. COVID-19 and resilience of healthcare systems in ten countries . Nat Med 2022 ; 28 : 1314 – 24 . OpenUrl CrossRef PubMed ↵ Silvera Carminati AE , Prol Misura SM , Gallardo Denis YV . Situación de carga física y mental en enfermería de Uruguay durante la pandemia Covid 19 . Rev Urug Enferm 2022 ; 17 : 1 – 20 . OpenUrl Bonilla-Sierra P , Manrique GA , Hidalgo-Andrade P , Ruisoto P . Psychological Inflexibility and Loneliness Mediate the Impact of Stress on Anxiety and Depression Symptoms in Healthcare Students and Early-Career Professionals During COVID-19 . Front Psychol 2021 ; 12 : 729171 . Cortés-Álvarez NY , Vuelvas-Olmos CR . COVID 19: Psychological Effects and Associated Factors in Mexican Nurses . Disaster Med Public Health Prep 2022 ; 16 : 1377 – 83 . OpenUrl Gir E , Baptista CJ , Reis RK , Menegueti MG , Pillon SC , de Oliveira ESAC . Increased use of psychoactive substances among Brazilian health care professionals during the COVID-19 pandemic . Arch Psychiatr Nurs 2022 ; 41 : 359 – 67 . OpenUrl Mota IA , Oliveira Sobrinho GD , Morais IPS , Dantas TF . Impact of COVID-19 on eating habits, physical activity and sleep in Brazilian healthcare professionals . Arq Neuropsiquiatr 2021 ; 79 : 429 – 36 . OpenUrl ↵ Scatularo CE , Battioni L , Bellia S , et al. Psychophysical impact of the covid-19 pandemic on healthcare workers in argentina. The imppacts-sac.20 survey . Rev Argent Cardiol 2021 ; 89 : 196 – 202 . OpenUrl ↵ Marconi AM , Myers U , Retamar AM , Freddi IJ , Chiarelli J , Zamora R . Increase in use of psychiatric sick leave during COVID-19 pandemic by healthcare workers in a municipality in Argentina . Rev Bras Med Trab 2022 ; 20 : 36 – 44 . OpenUrl ↵ Barros-Areal AF , Albuquerque CP , Silva NM , et al. Impact of COVID-19 on the mental health of public university hospital workers in Brazil: A cohort-based analysis of 32,691 workers . PLoS One 2022 ; 17 : e0269318 . OpenUrl ↵ Dos Santos MA , Pereira FH , De Souza Caliari J , Oliveira HC , Ceolim MF , Andrechuk CRS . Sleep and Professional Burnout in Nurses, Nursing Technicians, and Nursing Assistants During the COVID-19 Pandemic . J Nurs Res Lippincott Williams Wilkins 2022 ; 30 : e218 – e218 . OpenUrl ↵ Lotta G , Fernandez M , Correa M . The vulnerabilities of the Brazilian health workforce during health emergencies: analysing personal feelings, access to resources and work dynamics during the COVID-19 pandemic. (Special Issue: Global health and health workforce development: education, ma . Int J Health Plann Manage 2021 ; 36 : 42 – 57 . OpenUrl PubMed ↵ Llop-Gironés A , Vračar A , Llop-Gironés G , et al. Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic? Hum Resour Health 2021 ; 19 : 112 . ↵ Peñaranda A , García E , Pérez-Herrera LC , et al. Effect of the COVID-19 pandemic on the mental health, daily and occupational activities among health professionals in Colombia: a national study . BMC Psychiatry 2022 ; 22 : 682 . Osorio-Martínez ML , Malca-Casavilca M , Condor-Rojas Y , Becerra-Bravo MA , Ruiz Ramirez E . [Factors associated with the development of stress, anxiety and depression in the context of COVID-19 pandemic in Peruvian healthcare facilities] . Arch Prev Riesgos Labor 2022 ; 25 : 271 – 84 . OpenUrl ↵ Franco JA , Leví P. Feelings , Stress, and Adaptation Strategies of Nurses against COVID-19 in Guayaquil . Invest Educ Enferm 2020 ; 38 . DOI: 10.17533/udea.iee.v38n3e07 . OpenUrl CrossRef Juarez-Garcia A , Camacho-Avila A , Garcia-Rivas J , Gutierrez-Ramos O . Psychosocial factors and mental health in Mexican healthcare workers during the COVID-19 pandemic . Salud Ment 2021 ; 44 : 229 – 40 . OpenUrl ↵ Zipf AL , Polifroni EC , Beck CT . The experience of the nurse during the COVID-19 pandemic: A global meta-synthesis in the year of the nurse . J Nurs Sch 2022 ; 54 : 92 – 103 . OpenUrl ↵ Bazán PR , Azevedo Neto RM , Dias JA , et al. COVID-19 information exposure in digital media and implications for employees in the health care sector: findings from an online survey . Einstein Sao Paulo 2020 ; 18 : eAO6127 . OpenUrl ↵ Cotrin P , Moura W , Gambardela-Tkacz CM , et al. Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey . Inquiry 2020 ; 57 : 46958020963711 . ↵ de Oliveira B , Andrietta LS , Reis RS , et al. The Impact of the COVID-19 Pandemic on Physicians’ Working Hours and Earnings in São Paulo and Maranhão States , Brazil. Int J Env Res Public Health 2022 ; 19 . DOI: 10.3390/ijerph191610085 . OpenUrl CrossRef ↵ Bigoni A , Malik AM , Tasca R , et al. Brazil’s health system functionality amidst of the COVID-19 pandemic: An analysis of resilience . Lancet Reg Health Am 2022 ; 10 : 100222 . ↵ Campos J , Martins BG , Campos LA , de Fátima Valadão-Dias F , Marôco J . Symptoms related to mental disorder in healthcare workers during the COVID-19 pandemic in Brazil . Int Arch Occup Env Health 2021 ; 94 : 1023 – 32 . OpenUrl ↵ Montagna E , Donohoe J , Zaia V , et al. Transition to clinical practice during the COVID-19 pandemic: A qualitative study of young doctors’ experiences in Brazil and Ireland . BMJ Open 2021 ; 11 . DOI: 10.1136/bmjopen-2021-053423 . OpenUrl Abstract / FREE Full Text ↵ Barone MTU , Villarroel D , de Luca PV , et al. COVID-19 impact on people with diabetes in South and Central America (SACA region) . Diabetes Res Clin Pr 2020 ; 166 : 108301 . ↵ Tenorio-Mucha J , Lazo-Porras M , Zafra J , Ewen M , Beran D . Using government data to understand the use and availability of medicines for hypertension and diabetes: lessons from Peru . J Pharm Policy Pr 2022 ; 15 : 86 . Velasquez Montenegro AD , Dávila Uriarte M , Valladares-Garrido MJ. Factores asociados a la no adherencia al tratamiento antihipertensivo en un hospital del seguro social de Chiclayo durante el período de emergencia sanitaria por COVID-19 . Rev Cuerpo Méd Hosp Nac Almanzor Aguinaga Asenjo 2022 ; 15 : 11 – 8 . OpenUrl Cassarino I , Rijo J , Trombotti M , Nozar F , Viroga S . Impact of the COVID-19 pandemic on the time between the detection of premalignant lesions of the cervix and their treatment . Rev Medica Urug 2022 ; 38 . DOI: 10.29193/RMU.38.3.2 . OpenUrl CrossRef Macêdo Queiroz A , Reis de Sousa A , Carneiro Moreira W , et al. The novel COVID-19: impacts on nursing professionals’ mental health? Acta Paul Enferm 2021 ; 34 : 1 – 9 . OpenUrl Ribeiro AAD , Oliveira MVD , Furtado B , de Freitas GF . Impacts of the COVID-19 pandemic on Brazilian nurses’ lives, health and work . Acta Paul Enferm 2022 ; 35 : 8 . ↵ de Degani GL , Duarte L , Ismael J , Martinez L , López F . The impact of the COVID-19 pandemic on cancer care in the public health subsector, province of Santa Fe, Argentina . Ecancermedicalscience 2021 ; 15 : 1270 . OpenUrl ↵ Duarte MBO , Argenton JLP , Carvalheira JBC. Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis . JCO Glob Oncol 2022 ; 8 : e2100371 . OpenUrl Lopez-Huamanrayme E , Salsavilca-Macavilca E , Taype-Rondan A . Impact of the COVID-19 pandemic on outpatient endocrinology consultation and teleconsultation in a Peruvian hospital . Rev Cuerpo Medico Hosp Nac Almanzor Aguinaga Asenjo 2022 ; 15 . DOI: 10.35434/rcmhnaaa.2022.153.1407 . OpenUrl CrossRef Rojas-Zumaran V , Walttuoni-Picón E , Campos-Siccha G , Cruz-Gonzales G , Huiza-Espinoza L , Moya-Salazar J. Decline of cytology-based cervical cancer screening for COVID-19: a single-center Peruvian experience . Medwave 2022 ; 22 : e2589 . OpenUrl ↵ Tachibana BMT , Ribeiro RLM , Federicci É EF , et al. The delay of breast cancer diagnosis during the COVID-19 pandemic in São Paulo, Brazil . Einstein Sao Paulo 2021 ; 19 : eAO6721 . OpenUrl ↵ Horta BL , Silveira MF , Barros AJD , et al. COVID-19 and outpatient care: a nationwide household survey . Cad Saude Publica 2022 ; 38 : e00194121 . OpenUrl Bozovich GE , Alves De Lima A , Fosco M , et al. [Collateral damage of COVID-19 pandemic in private healthcare centres of Argentina] . Med B Aires 2020 ; 80 Suppl 3 : 37 – 41 . OpenUrl ↵ Dimperio H , Gagliardi J , Zoni R , et al. Resultados de la Encuesta COVID-19. Impacto en la atención cardiovascular del Registro Nacional de Infarto ARGEN IAM-ST . Rev Argent Cardiol 2020 ; 88 : 222 – 30 . OpenUrl ↵ Duarte LS , Shirassu MM , Atobe JH , Moraes MA de, Bernal RTI. Continuidade da atenção às doenças crônicas no estado de São Paulo durante a pandemia de Covid-19 . Saúde Debate 2021 ; 45 : 68 – 81 . OpenUrl ↵ Mamani-Benito O , Esteban RFC , Ventura-León J , Caycho-Rodríguez T , Solís RF , Shocosh DHB . Effect of concern about COVID-19 on professional self-efficacy, psychological distress, anxiety, and depression in Peruvian health personnel . Salud Ment 2021 ; 44 : 215 – 20 . OpenUrl Medina Guillen LF , Quintanilla Ferrufino GJ , Juárez Pérez I , Asfura JS . Occupational exposure to covid-19 in healthcare workers from Latin America, may 2020 . Rev Cientif Cienc Med 2020 ; 23 : 207 – 13 . OpenUrl ↵ Antiporta DA , Bruni A . Emerging mental health challenges, strategies, and opportunities in the context of the COVID-19 pandemic: Perspectives from South American decision-makers . Rev Panam Salud Publica 2020 ; 44 : e154 . OpenUrl ↵ Villalobos Dintrans P , Maddaleno M , Granizo Román Y , et al. [Disruption of health services for pregnant women, newborns, children, adolescents, and women during the COVID-19 pandemic: ISLAC 2020 ProjectInterrupção dos serviços de saúde para grávidas, recém-nascidos, crianças, adolescentes e mulheres durante a pand . Rev Panam Salud Publica 2021 ; 45 : e140 . OpenUrl Zafra-Tanaka JH , Najarro L , Tenorio-Mucha J , et al. COVID-19’s impact on type 1 diabetes management: A mixed-methods study exploring the Peruvian experience . Int J Health Plann Manage 2022 . DOI: 10.1002/hpm.3536 . OpenUrl CrossRef Villain P , Carvalho AL , Lucas E , et al. Cross-sectional survey of the impact of the COVID-19 pandemic on cancer screening programs in selected low-and middle-income countries: Study from the IARC COVID-19 impact study group . Int J Cancer 2021 ; 149 : 97 – 107 . OpenUrl CrossRef PubMed Steinman M , de Sousa JHB , Tustumi F , Wolosker N . The burden of the pandemic on the non-SARS-CoV-2 emergencies: A multicenter study . Am J Emerg Med 2021 ; 42 : 9 – 14 . OpenUrl ↵ Luciani S , Agurto I , Caixeta R , Hennis A . Prioritizing noncommunicable diseases in the Americas region in the era of COVID-19 . Rev Panam Salud PublicaPan Am J Public Health 2022 ; 46 . DOI: 10.26633/RPSP.2022.83 . OpenUrl CrossRef ↵ Santos AL dos , Manzano M , Krein A . Heterogeneity in the distribution of health professionals in Brazil and the COVID-19 pandemic. (Desenvolvimento, saude e mudanca estrutural: o complexo economico-industrial da saude 4.0 no contexto da Covid-19.) [Portuguese] . Cad Desenvolv 2021 ; 16 : 197 – 219 . OpenUrl ↵ Bautista-González E , Werner-Sunderland J , Pérez-Duarte Mendiola P , et al. Health-care guidelines and policies during the COVID-19 pandemic in Mexico: A case of health-inequalities . Health Policy Open 2021 ; 2 : 100025 . Santos TBS , Andrade LR , Vieira SL , et al. Hospital contingency in coping with COVID-19 in Brazil: governmental problems and alternatives . Cien Saude Colet 2021 ; 26 : 1407 – 18 . OpenUrl ↵ de Pádua Borges R , Avila GO , Ritter AC , et al. Healthcare of pregnant women with diabetes during the COVID-19 pandemic: a Southern Brazilian cross-sectional panel data . J Perinat Med 2022 . DOI: 10.1515/jpm-2022-0177 . OpenUrl CrossRef ↵ Braghieri HA , Correia M de A , Carvalho JF de , et al. Impacto da pandemia da COVID-19 sobre o tratamento medicamentoso dos pacientes com doença arterial periférica: um estudo observacional transversal . J Vasc Bras 2021 ; 20 : e20210021 – e20210021 . OpenUrl ↵ Oliveira GB de , Alessi J , Erthal IN , et al. Healthy lifestyle gone bad: effect of the COVID-19 pandemic on the daily habits of children and adolescents with type 1 diabetes . Arch Endocrinol Metab Online 2022 ; 66 : 345 – 54 . OpenUrl ↵ Christinelli HCB , Westphal G , Costa MAR , Okawa RTP , Nardo Junior N , Fernandes CAM . Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial . Rev Bras Enferm 2022 ; 75 : e20210059 – e20210059 . OpenUrl ↵ Crippa JAS , Zuardi AW , Guimarães FS , et al. Efficacy and Safety of Cannabidiol Plus Standard Care vs Standard Care Alone for the Treatment of Emotional Exhaustion and Burnout Among Frontline Health Care Workers During the COVID-19 Pandemic: A Randomized Clinical Trial . JAMA Netw Open 2021 ; 4 : e2120603 . OpenUrl ↵ Alessi J , de Oliveira GB , Franco DW , et al. Telehealth strategy to mitigate the negative psychological impact of the COVID-19 pandemic on type 2 diabetes: A randomized controlled trial . Acta Diabetol 2021 ; 58 : 899 – 909 . OpenUrl ↵ Silva-Tinoco R , Torre-Saldaña V de la. La imperiosa necesidad de telemedicina en la atención de diabetes durante la pandemia de COVID-19 . Un estudio de abordaje integral. Gac Méd Méx 2021 ; 157 : 323 – 6 . OpenUrl ↵ Mendoz RL , Moreno GYC , Martinez Arredondo HA , et al. Remote Healthcare Program in Mexico in the Context of the COVID-19 Pandemic . Heal Inf Res 2022 ; 28 : 152 – 9 . OpenUrl ↵ de Mattos Matheus AS , Cabizuca CA , Tannus LRM , et al. Telemonitoring type 1 diabetes patients during the COVID-19 pandemic in Brazil: was it useful? Arch Endocrinol Metab 2021 ; 65 : 105 – 11 . OpenUrl Castro FAG de , Santos AO dos , Reis GVL , Viveiros LB , Torres MH , Oliveira Junior PP de . Rural telemedicine and COVID-19: expanding access where distance was already the rule . Rev Bras Med Fam E Comunidade 2020 ; 15 . DOI: 10.5712/rbmfc15(42)2484 . OpenUrl CrossRef ↵ Hernández-Galdamez D , Mansilla K , Peralta AL , et al. Monitoring Study Participants and Implementation with Phone Calls to Support Hypertension Control During the COVID-19 Pandemic: The Case of a Multicomponent Intervention Trial in Guatemala . Glob Heart 2021 ; 16 : 77 . Aquino E , Rodrigues DLG , Batista CEA , et al. Teleconsultations in neurology in a universal health system amid COVID-19: a descriptive study . Rev Assoc Med Bras 1992 2022; 68 : 1376 – 82 . OpenUrl ↵ Ortiz Contreras J , Quiroz Carreño JM , Neira Contreras R , et al. Sistematización de iniciativas en salud sexual y reproductiva según criterios de buenas prácticas en repuesta a la pandemia COVID-19 en la atención primaria en Chile . Medwave 2022 ; 22 : e002555 – e002555 . OpenUrl ↵ Gómez AM , Henao D , Parra D , et al. Virtual training on the hybrid close loop system in people with type 1 diabetes (T1D) during the COVID-19 pandemic . Diabetes Metab Syndr 2021 ; 15 : 243 – 7 . OpenUrl ↵ Correia DM da S , Pimentel ACE , Costa LBD da , et al. Teleorientação a hipertensos resistentes durante a pandemia por COVID-19: uma ação inovadora na enfermagem . Enferm Foco Brasília 2020 ; 11 : 179 – 84 . OpenUrl Santa-Cruz J , Moran L , Tovar M , et al. Mobilizing digital technology to implement a population-based psychological support response during the COVID-19 pandemic in Lima, Peru . Glob Ment Health ;: 11 . ↵ Queiroz MS , de Carvalho JX , Bortoto SF , et al. Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera . Acta Diabetol 2020 ; 57 : 1493 – 9 . OpenUrl ↵ Huancahuari Ayala G , Roman-Benate JF , Hernandez Peña A , Ticse Aguirre R . Teleorientation in the ophthalmology service in a public hospital from May to August 2020 during the COVID-19 pandemic in Peru . Acta Medica Peru 2022 ; 39 : 120 – 7 . OpenUrl ↵ Carneiro AC , de Pinho GS , Belo JV , et al. Outcomes of telemedicine care during the COVID-19 pandemic: Experience from an intervention program designed for vulnerable population in Brazil . J Telemed Telecare 2022 ;: 1357633X 221089151. ↵ Sperling S , Andretta CRL , Basso J , et al. Telehealth for Supporting Referrals to Specialized Care During COVID-19 . Telemed J E Health 2022 ; 28 : 544 – 50 . OpenUrl ↵ Domínguez-Moreno R , García-Grimshaw M , Chávez-Martínez OA , et al. Global & Community Health: Implementation of and Patient Satisfaction With the First Neurologic Telemedicine Program in Mexico During COVID-19 . Neurology 2021 ; 97 : 293 – 6 . OpenUrl ↵ Scheffer M , Cassenote A , de Britto EAM , Russo G. The multiple uses of telemedicine during the pandemic: the evidence from a cross-sectional survey of medical doctors in Brazil . Glob Health 2022 ; 18 : 81 . OpenUrl ↵ Burgos LM , Benzadón M , Candiello A , et al. Telehealth in Heart Failure Care during COVID-19 Pandemic Lockdown in Argentina . Int J Heart Fail 2020 ; 2 : 247 – 53 . OpenUrl ↵ Garcia-Huidobro D , Rivera S , Valderrama Chang S , Bravo P , Capurro D . System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation . J Med Internet Res 2020 ; 22 : e22146 . OpenUrl ↵ Escobar MF , Henao JF , Prieto D , et al. Teleconsultation for outpatient care of patients during the Covid-19 pandemic at a University Hospital in Colombia . Int J Med Inf 2021 ; 155 : 104589 . OpenUrl León-Vargas F , Martin C , Garcia-Jaramillo M , et al. Is a cloud-based platform useful for diabetes management in Colombia? The Tidepool experience . Comput Methods Programs Biomed 2021 ; 208 : 106205 . ↵ Loza CA , Baez G , Valverdi R , et al. A qualitative study on the elderly and accessibility to health services during the COVID-19 lockdown in Buenos Aires, Argentina - Part 2 . Medwave 2021 ; 21 : e8192 . OpenUrl ↵ Aquino E , Domingues RB , Mantese CE , Fantini F , Nitrini R , Prado GFD . Telemedicine use among neurologists before and during COVID-19 pandemic . Arq Neuropsiquiatr 2021 ; 79 : 658 – 64 . OpenUrl ↵ Castellano GS , Tarasenko YN . An on-line mindfulness-based stress reduction program for health workers in Uruguay amidst the COVID-19 pandemic April 2020 . Psychiatry Res 2022 ; 313 . DOI: 10.1016/j.psychres.2022.114599 . OpenUrl CrossRef ↵ Fukuti P , Uchôa CLM , Mazzoco MF , et al. COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned . Clin Sao Paulo 2021 ; 76 : e2631 . OpenUrl ↵ Santana YE , Liberatore RDRJ . Teleconsultation for pediatric patients with type 1 diabetes mellitus during the COVID-19 pandemic: experience of a university hospital in Brazil . J Pediatr Rio J 2022 ; 98 : 587 – 9 . OpenUrl ↵ Tabuti NIM , Pellizzari C , Carrascossi H , et al. Impact of telemedicine on metabolic control and hospitalization of peritoneal dialysis patients during the COVID-19 pandemic: a national multicentric cohort study . J Bras Nefrol 2022 . DOI: 10.1590/2175-8239-jbn-2021-0113 . OpenUrl CrossRef ↵ Polanco E , Aquey M , Collado J , et al. A COVID-19 pandemic-specific, structured care process for peritoneal dialysis patients facilitated by telemedicine: Therapy continuity, prevention, and complications management . Ther Apher Dial 2021 ; 25 : 970 – 8 . OpenUrl ↵ Delfino C , Mazzon E , Cavada G , et al. A Chilean Experience of Telestroke in a COVID-19 Pandemic Year . Cerebrovasc Dis 2022 ; 51 : 690 – 4 . OpenUrl ↵ Baughman DJ , Jabbarpour Y , Westfall JM , et al. Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System . JAMA Netw Open 2022 ; 5 : e2233267 . OpenUrl ↵ De Guzman KR , Snoswell CL , Caffery LJ , Wallis KA , Smith AC . Costs to the Medicare Benefits Schedule for general practitioner consultations: A time-series analysis . J Telemed Telecare 2022 ; 28 : 726 – 32 . OpenUrl ↵ Ryan BL , Brown JB , Freeman TR , et al. Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews . BMC Prim Care 2022 ; 23 : 300 . ↵ Lee LC , Farwig P , Kirk L , Mitchell VD , Sabatino JA , Barnes KD . Impact of pharmacist intervention on anticoagulation management and risk for potential COVID-19 exposure during the COVID-19 pandemic . Thromb Res 2022 ; 217 : 52 – 6 . OpenUrl ↵ Vieira Silva CRD , Lopes RH , de Goes Bay O Jr , et al. Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review . JMIR Hum Factors 2022 ; 9 . DOI: 10.2196/35380 . OpenUrl CrossRef PubMed Adepoju OE , Chae M , Liaw W , Angelocci T , Millard P , Matuk-Villazon O . Transition to telemedicine and its impact on missed appointments in community-based clinics . Ann Med 2022 ; 54 : 98 – 107 . OpenUrl ↵ Chang JE , Lai AY , Gupta A , Nguyen AM , Berry CA , Shelley DR . Rapid Transition to Telehealth and the Digital Divide: Implications for Primary Care Access and Equity in a Post-COVID Era . Milbank Q 2021 ; 99 : 340 – 68 . OpenUrl CrossRef PubMed ↵ Kruse C , Heinemann K . Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review . J Med Internet Res 2022 ; 24 . DOI: 10.2196/31752 . OpenUrl CrossRef ↵ Robles R , Ascencio L , Díaz D , et al. Implementation Science of Telepsychotherapy for Anxiety, Depression, and Somatization in Health Care Workers Dealing with COVID-19 . Telemed J E Health 2022 . DOI: 10.1089/tmj.2022.0155 . OpenUrl CrossRef ↵ Yıldırım D , Çiriş Yıldız C . The Effect of Mindfulness-Based Breathing and Music Therapy Practice on Nurses’ Stress, Work-Related Strain, and Psychological Well-being During the COVID-19 Pandemic: A Randomized Controlled Trial . Holist Nurs Pract 2022 ; 36 : 156 – 65 . OpenUrl PubMed ↵ Marotta M , Gorini F , Parlanti A , Berti S , Vassalle C . Effect of Mindfulness-Based Stress Reduction on the Well-Being, Burnout and Stress of Italian Healthcare Professionals during the COVID-19 Pandemic . J Clin Med 2022 ; 11 . DOI: 10.3390/jcm11113136 . OpenUrl CrossRef ↵ Geoffroy PA , Le Goanvic V , Sabbagh O , et al. Psychological Support System for Hospital Workers During the Covid-19 Outbreak: Rapid Design and Implementation of the Covid-Psy Hotline . Front Psychiatry 2020 ; 11 . DOI: 10.3389/fpsyt.2020.00511 . OpenUrl CrossRef ↵ Alves JS , Gonçalves AMS , Bittencourt MN , Alves VM , Mendes DT , Nóbrega M . Psychopathological symptoms and work status of Southeastern Brazilian nursing in the context of COVID-19 . Rev Lat Am Enferm 2022 ; 30 : e3518 . OpenUrl ↵ Burgess LH , Cooper MK , Wiggins EH , et al. Utilizing Pharmacists to Optimize Medication Management Strategies During the COVID-19 Pandemic . J Pharm Pract 2022 ; 35 : 184 – 9 . OpenUrl ↵ Murteira R , Romano S , Teixeira I , Galante H , Sousa S , Teixeira Rodrigues A . POSA247 Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies during COVID-19 Pandemic: A Single-Arm, Before-and-After Study . Value Health 2022 ; 25 : S157 . ↵ Khan YH , Alzarea AI , Alotaibi NH , et al. Evaluation of Impact of a Pharmacist-Led Educational Campaign on Disease Knowledge, Practices and Medication Adherence for Type-2 Diabetic Patients: A Prospective Pre-and Post-Analysis . Int J Env Res Public Health 2022 ; 19 : 12 . OpenUrl ↵ Iglesias A , Ambrose A , Coronel-Mockler S , et al. Impact of transitioning to virtual delivery of a cardiovascular health improvement program for Latinos during the COVID-19 pandemic . BMC Public Health 2022 ; 22 : 1935 . OpenUrl ↵ Kerkhoff AD , Rojas S , Black D , et al. Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program . JAMA Netw Open 2022 ; 5 : e2214163 . OpenUrl Meghani A , Shreya H , Priyanka D , Bennett S . Public sector engagement of private healthcare providers during the COVID-19 pandemic in Uttar Pradesh , India. PLoS Glob Public Health 2022 ; 2 . DOI: 10.1371/journal.pgph.0000750 . OpenUrl CrossRef Sepucha KR , Valentine KD , Atlas SJ , et al. Getting patients back for routine colorectal cancer screening: Randomized controlled trial of a shared decision-making intervention . Cancer Med 2022 . DOI: 10.1002/cam4.5172 . OpenUrl CrossRef ↵ World Health Organization . Working for Health 2022 -2030 Action Plan . Geneva , 2022 https://creativecommons.org/licenses/by-nc-sa/3.0/igo/ ) (accessed Jan 29, 2024). ↵ Bown CP , Bollyky TJ . How COVID-19 vaccine supply chains emerged in the midst of a pandemic . World Econ 2022 ; 45 : 468 – 522 . OpenUrl Luciani S , Caixeta R , Chavez C , Ondarsuhu D , Hennis A . What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region . BMJ Open 2023 ; 13 : e070085 . OpenUrl Abstract / FREE Full Text Gadsden T , Downey LE , Vilas VDR , Peiris D , Jan S . The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: A systematic review . Lancet Reg Health - Southeast Asia 2022 ; 1 . DOI: 10.1016/j.lansea.2022.04.006 . OpenUrl CrossRef PubMed ↵ Ugliara Barone MT , Harnik SB , Chaluppe M , et al. Decentralized COVID-19 measures in Brazil were ineffective to protect people with diabetes . Diabetes Metab Syndr 2020 ; 14 : 1973 – 8 . OpenUrl PubMed Rawaf S , Quezada Yamamoto H , Rawaf D . Unlocking towns and cities: COVID-19 exit strategy . East Mediterr Health J Rev Sante Mediterr Orient Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 2020 ; 26 : 499 – 502 . OpenUrl ↵ Filip R , Gheorghita Puscaselu R , Anchidin-Norocel L , Dimian M , Savage WK . Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems . J Pers Med 2022 ; 12 . DOI: 10.3390/jpm12081295 . OpenUrl CrossRef ↵ Garelli F , Fushimi E , Rosales N , et al. Non-hybrid glycemic control of type 1 diabetes ambulatory patients . RIAI - Rev Iberoam Autom Inf Ind 2022 ; 19 : 318 – 29 . OpenUrl ↵ Snoswell CL , Taylor ML , Comans TA , Smith AC , Gray LC , Caffery LJ . Determining if Telehealth Can Reduce Health System Costs: Scoping Review . J Med Internet Res 2020 ; 22 : e17298 . OpenUrl CrossRef ↵ Scott Kruse C , Karem P , Shifflett K , Vegi L , Ravi K , Brooks M . Evaluating barriers to adopting telemedicine worldwide: A systematic review . J Telemed Telecare 2018 ; 24 : 4 – 12 . OpenUrl CrossRef PubMed ↵ Macinko J , Woolley NO , Seixas BV , Andrade FB , Lima-Costa MF . Health care seeking due to COVID-19 related symptoms and health care cancellations among older Brazilian adults: the ELSI-COVID-19 initiative . Cad Saude Publica 2020 ; 36 Suppl 3 : e00181920 . OpenUrl ↵ Economic Commission for Latin America and the Caribbean (ECLAC). A digital path for sustainable development in Latin America and the Caribbean. Santiago , 2022 https://repositorio.cepal.org/server/api/core/bitstreams/71eb91ed-b241-41c8-9463-d1eaa3b12932/content (accessed Jan 29, 2024 ). Ribeiro PCC, Alvarenga MAS, Azevedo TG de , et al. Impactos do avanço da pandemia de COVID-19 na saúde mental de profissionais de saúde . Psico Porto Alegre 2021 ; 52 . https://revistaseletronicas.pucrs.br/ojs/index.php/revistapsico/article/view/41302/27119 . Primholdt Christensen N , Skou KE , Boe Danbjørg D . Health Care Professionals’ Experiences With the Use of Video Consultation: Qualitative Study . JMIR Form Res 2021 ; 5 : e27094 . OpenUrl Legido-Quigley H , Mateos-García JT , Campos VR , Gea-Sánchez M , Muntaner C , McKee M . The resilience of the Spanish health system against the COVID-19 pandemic . Lancet Public Health 2020 ; 5 : e251 – 2 . OpenUrl View the discussion thread. Back to top Previous Next Posted April 19, 2024. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review Oluwabunmi Ogungbe , Samira Barbara Jabakhanji , Roopa Mehta , John McCaffrey , David Byrne , Sinéad Hurley , Lori Rosman , Eyram Cyril Bansah , Folahan Ibukun , Irene Afua Quarshie , Katherine Lord , Yidan Lu , Yunzhi Wang , Asma Rayani , Hairong Liu , Ann Joseph , Alejandro Escobosa , Ivy Nyamuame , Jieun Lee , Ning Meng , Ibrahim Jehanzeb , Temitope Akinyemi , Shoichiro Nohara , Mauro F. F. Mediano , Yvette Yeboah-Kordieh , Cecilia de Sousa , Juliana Farhat , Renato Bandeira de Mello , Tara Taeed , Lawrence J. Appel , Sonia Y. Angell , Edward W. Gregg , Kunihiro Matsushita medRxiv 2024.04.17.24305997; doi: https://doi.org/10.1101/2024.04.17.24305997 Share This Article: Copy Citation Tools Disruption to diabetes and hypertension care during the COVID-19 pandemic in Latin America and the Caribbean and mitigation approaches: A Scoping Review Oluwabunmi Ogungbe , Samira Barbara Jabakhanji , Roopa Mehta , John McCaffrey , David Byrne , Sinéad Hurley , Lori Rosman , Eyram Cyril Bansah , Folahan Ibukun , Irene Afua Quarshie , Katherine Lord , Yidan Lu , Yunzhi Wang , Asma Rayani , Hairong Liu , Ann Joseph , Alejandro Escobosa , Ivy Nyamuame , Jieun Lee , Ning Meng , Ibrahim Jehanzeb , Temitope Akinyemi , Shoichiro Nohara , Mauro F. F. Mediano , Yvette Yeboah-Kordieh , Cecilia de Sousa , Juliana Farhat , Renato Bandeira de Mello , Tara Taeed , Lawrence J. Appel , Sonia Y. Angell , Edward W. Gregg , Kunihiro Matsushita medRxiv 2024.04.17.24305997; doi: https://doi.org/10.1101/2024.04.17.24305997 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Public and Global Health Subject Areas All Articles Addiction Medicine (574) Allergy and Immunology (865) Anesthesia (304) Cardiovascular Medicine (4462) Dentistry and Oral Medicine (445) Dermatology (383) Emergency Medicine (611) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1517) Epidemiology (15251) Forensic Medicine (31) Gastroenterology (1132) Genetic and Genomic Medicine (6621) Geriatric Medicine (669) Health Economics (1002) Health Informatics (4564) Health Policy (1372) Health Systems and Quality Improvement (1617) Hematology (544) HIV/AIDS (1272) Infectious Diseases (except HIV/AIDS) (15938) Intensive Care and Critical Care Medicine (1107) Medical Education (624) Medical Ethics (147) Nephrology (670) Neurology (6643) Nursing (346) Nutrition (1001) Obstetrics and Gynecology (1149) Occupational and Environmental Health (957) Oncology (3350) Ophthalmology (981) Orthopedics (369) Otolaryngology (421) Pain Medicine (436) Palliative Medicine (130) Pathology (665) Pediatrics (1698) Pharmacology and Therapeutics (694) Primary Care Research (714) Psychiatry and Clinical Psychology (5465) Public and Global Health (9259) Radiology and Imaging (2212) Rehabilitation Medicine and Physical Therapy (1372) Respiratory Medicine (1198) Rheumatology (598) Sexual and Reproductive Health (716) Sports Medicine (533) Surgery (715) Toxicology (100) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a03c5576bd3358f4',t:'MTc4MDEyOTM3NQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();