Scoping Review of the Models for Case-Based Health Programs in Africa: Towards Case-Based Surveillance for HIV in Lesotho
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsI have attached my comments.
Comments for author File: 
Comments.pdf
Author Response
Overall, the comments were on using the correct referencing, spelling out acronyms upon the first use, including page number on the reference for quotes and correcting the grammar. I have attached a document with track changes highlighting all the changes.
Author Response File: Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsI am grateful for the opportunity to review this paper. Please find my comments.
TITLE
“ Scoping review of the models for case-based health programs in Africa” What about Lesotho? (For example “ Scoping review of the models for case-based health programs in Africa to understand how to do in Lesotho”)
HIGHLIGHTS
Line 14 :“Having a CBS system will help track disease patterns …” Please describe the acronym “CBS”.
ABSTRACT
-Please write the date of the study.
-The authors did not report how many articles were included in the review. What is the range of years of the included articles? Please include this information.
KEYWORDS
What about Lesotho? Please rewrite the keywords.
INTRODUCTION
Lines 46-48: “The purpose of this scoping review is to identify existing models for case-based surveillance health programs that are available in Africa. The review will aid in informing the development of a case-based surveillance (CBS) of HIV for implementation in Lesotho. Please move this information “ / Lines 137-139: “The summary of the scoping review will include a description of studies; types of models or systems used and lastly challenges and successes.” This information could be moved to the end of the objectives paragraph. Please think about this.
METHOD
-Please include the exclusion criteria in this section.
-Lines 162-163: “For this paper, many articles were reviewed but not all of them were selected for inclusion.” This is part of Result section
-Lines 163-166: “The inclusion criterion focused on articles related to implementation of case-based surveillance for infectious diseases not older than 10 years (2014-2024), documents written in English, and both quantitative and qualitative studies to assess the differences and results when implementing CBS.”
“Articles related to implementation of case-based surveillance for infectious diseases” OR “Articles related to implementation of case-based surveillance for infectious diseases in Africa.” Please include information in the text.
“…documents written in English…” Which kind of documents? Please include this information in the text.
-Lines 172-177: “Out of 537 publications searched, 329 were duplicates and were therefore excluded. Total articles screened were 208 and about 182 were further excluded because of irreverence and outdated as per inclusion criterion of 10 years. There were 43 articles left as included. The 34 articles that were excluded were due to insufficient information, some were focusing on the progress of diseases, not the system and two (2) full articles could not be accessed. Finally, nine (9) were included and analyzed”. This is part of the results. Please, move this information to Results section.
- Please, Figure 1 is a result. Please, remove this information from Method section.
-Lines 223-225: “For critical appraisal of individual sources of evidence, a tool aimed at 223 measuring the quality of the article was developed where a score ranged from 0 to 10 with 224 7 and higher being good quality, 4 to 6 as moderate and 0 to 3 as low quality” Which VALIDATED tool? Please, describe this information in the text.
-Lines 227-233: “The included articles demonstrated high relevance to CBS, excellent comparison and robust methods. Also, there was strong emphasis on digital architecture description and assessment, clear CBS operational models and strong data quality assessment relevant to CBS system strengthening. On the other hand, the articles scored moderate and low quality were as a result of low CBS specificity, moderate depths on CBS functionality and some were just not focused on CBS technical model.”
This is part of the results. Please, move this information to Results section and include the reference numbers of the included articles with “high relevance to CBS, excellent comparison and robust methods” and of the included articles “scored moderate and low quality were as a result of low CBS specificity, moderate depths on CBS functionality and some were just not focused on CBS technical model”
RESULTS
-Line 235. “This section will discuss the description…” OR “This section will DESCRIBE the description”. Please think about this.
242-251: “Of the countries selected, all were in Africa; majority were Southern Africa (four (4)), two (2) in Eastern Africa, one (1) in Western Africa and two (2) in Africa but not specified regions. The individual countries mostly focused on South Africa and Zimbabwe in the Southern African region, Rwanda, Tanzania and Kenya in the Eastern region and Western Cape is represented by Guinea. Other countries outside of Africa were Asia and the Caribbean. There were several methodological approaches used by the studies and these were mixed methods for three (3) studies, one (1) case study, one (1) conceptual Framework, one (1) survey using REDCap, one (1) descriptive cross-sectional study, one (1) combination of in-depth interview and site visit and one (1) combination of desk review, stakeholder meetings and site visits” Please include the reference numbers. For example, initially include the reference number of the articles focused on Southern Africa.
-Table 1 “DHIS2” Please describe this acronym.
-Lines 163-167: “The inclusion criterion focused on articles related to implementation of case-based surveillance for infectious diseases not older than 10 years (2014-2024), documents written in English, and both quantitative and qualitative studies to assess the differences and results when implementing CBS.” However the authors include 1 article about “Trauma cases” (Ohuabunwa EC, Sun J, Jean Juban-yik K, Wallis LA., 2015). Please align the information.
-Line 272: “The section discusses a summary of successes and challenges…” OR “The section DESCRIBES a summary of successes and challenges…” Please think about this.
-3.3.1. Successes
“Many African countries are responding to the WHO’s call of advocating for a person-centered approach of reporting through case-based surveillance as part of HIV patient monitoring guidelines.
- System’s sensitivity was highlighted as critical in most studies to ensure that there is proper and early detection of public health threats.
- Some countries have developed health information systems that are interoperable which allow for secure data sharing and use which results in better care for patients and eliminates duplication.
- A study conducted in Rwanda proved a successful data exchange between multiple systems including EMR, Lab Information System (LIS), CR and DHIS2 tracker demonstrating a 100% match when generating a dataset for the HIV CBS.” Please include the reference number of the studies in each paragraph
-Lines 280-281: “The use of fingerprints and national ID by some countries are steps in the right direction giving hope to uniquely identify patients.” This information is part of Discussion section.
-Lines 285-287: “Although many countries have highlighted inadequate and lack of funding for CBS, a decision to use open sources can bring some stability and continued maintenance of the systems in low-resource settings.” This information is part of Discussion section.
-Lines 291-291: “This research highlighted the CBS implementation gaps which could help Lesotho to avoid when implementing CBS” This information is part of Discussion section.
-3.3.2. Challenges: Please include the reference number of the studies in each paragraph.
-Please include information about : “…needs for development and implementation of a case-based surveillance and to recommend a model that could be relevant for Lesotho.” (Lines 148-149)
-Please summarize the “gaps in the models that could be considered when developing a case-based surveillance for HIV in an African setting.” (Lines 150-151)
DISCUSSION
-Line 306: “This paper is discussing the different models and systems used in different countries” or “This paper is discussing the different models and systems used in different African countries”
-Lines 306-308: “This paper is discussing the different models and systems used in different countries to assess robust case-based health systems for a stable health system and to determine which ones may be appropriate in a low-income country setting like Lesotho.” However, the authors did not describe the current situation of Lesotho to understand how the results of this study could be used. Please describe this in the Introduction section.
-Please align the discussion to the 1.3. Aim and Objectives
“The aim of the study was to review existing models for the case-based health programs in Africa to inform the development and implementation of case-based surveillance of HIV in Lesotho. This was achieved by the following objectives: 1) To identify and describe the existing models for case-based health programs in Africa. 2) To determine successes and challenges to implementation of these models in Africa. 3) To assess the needs for development and implementation of a case-based surveillance and to recommend a model that could be relevant for Lesotho. 4) To identify any gaps in the models that could be considered when developing a case-based surveillance for HIV in an African setting. “
I did not find recommended proposals for Lesotho´s context. Please include this information.
-Line 345: Please describe the acronym “TB”.
-Limitations: Please include the limitations of the study.
CONCLUSION
I did not find recommended proposals for Lesotho´s context. Please include this information.
REFERENCES
-Please, include references from 2025.
Author Response
All the comments were addressed.
TITLE
“ Scoping review of the models for case-based health programs in Africa” What about Lesotho? (For example “ Scoping review of the models for case-based health programs in Africa to understand how to do in Lesotho”) Done. L3
HIGHLIGHTS
Line 14 :“Having a CBS system will help track disease patterns …” Please describe the acronym “CBS”. Done. L14
ABSTRACT
-Please write the date of the study. Done L45
-The authors did not report how many articles were included in the review. What is the range of years of the included articles? Please include this information. Done. L35-37
KEYWORDS
What about Lesotho? Please rewrite the keywords. Done L47
INTRODUCTION
Lines 46-48: “The purpose of this scoping review is to identify existing models for case-based surveillance health programs that are available in Africa. The review will aid in informing the development of a case-based surveillance (CBS) of HIV for implementation in Lesotho. Please move this information “ / Lines 137-139: “The summary of the scoping review will include a description of studies; types of models or systems used and lastly challenges and successes.” This information could be moved to the end of the objectives paragraph. Please think about this. Done. L157-158
METHOD
-Please include the exclusion criteria in this section. Done. 185-187
-Lines 162-163: “For this paper, many articles were reviewed but not all of them were selected for inclusion.” This is part of Result section Done. L223-224
-Lines 163-166: “The inclusion criterion focused on articles related to implementation of case-based surveillance for infectious diseases not older than 10 years (2014-2024), documents written in English, and both quantitative and qualitative studies to assess the differences and results when implementing CBS.”
“Articles related to implementation of case-based surveillance for infectious diseases” OR “Articles related to implementation of case-based surveillance for infectious diseases in Africa.” Please include information in the text. Done L181
“…documents written in English…” Which kind of documents? Please include this information in the text. Done L182
-Lines 172-177: “Out of 537 publications searched, 329 were duplicates and were therefore excluded. Total articles screened were 208 and about 182 were further excluded because of irreverence and outdated as per inclusion criterion of 10 years. There were 43 articles left as included. The 34 articles that were excluded were due to insufficient information, some were focusing on the progress of diseases, not the system and two (2) full articles could not be accessed. Finally, nine (9) were included and analyzed”. This is part of the results. Please, move this information to Results section. Done L225-230
- Please, Figure 1 is a result. Please, remove this information from Method section. Done
-Lines 223-225: “For critical appraisal of individual sources of evidence, a tool aimed at 223 measuring the quality of the article was developed where a score ranged from 0 to 10 with 224 7 and higher being good quality, 4 to 6 as moderate and 0 to 3 as low quality” Which VALIDATED tool? Please, describe this information in the text. Not Validated, this is custom tool developed by the authors.
-Lines 227-233: “The included articles demonstrated high relevance to CBS, excellent comparison and robust methods. Also, there was strong emphasis on digital architecture description and assessment, clear CBS operational models and strong data quality assessment relevant to CBS system strengthening. On the other hand, the articles scored moderate and low quality were as a result of low CBS specificity, moderate depths on CBS functionality and some were just not focused on CBS technical model.”
This is part of the results. Please, move this information to Results section and include the reference numbers of the included articles with “high relevance to CBS, excellent comparison and robust methods” and of the included articles “scored moderate and low quality were as a result of low CBS specificity, moderate depths on CBS functionality and some were just not focused on CBS technical model” Done L231-239
RESULTS
-Line 235. “This section will discuss the description…” OR “This section will DESCRIBE the description”. Please think about this. Incorporated. The other reviewer made a comment on this too.
242-251: “Of the countries selected, all were in Africa; majority were Southern Africa (four (4)), two (2) in Eastern Africa, one (1) in Western Africa and two (2) in Africa but not specified regions. The individual countries mostly focused on South Africa and Zimbabwe in the Southern African region, Rwanda, Tanzania and Kenya in the Eastern region and Western Cape is represented by Guinea. Other countries outside of Africa were Asia and the Caribbean. There were several methodological approaches used by the studies and these were mixed methods for three (3) studies, one (1) case study, one (1) conceptual Framework, one (1) survey using REDCap, one (1) descriptive cross-sectional study, one (1) combination of in-depth interview and site visit and one (1) combination of desk review, stakeholder meetings and site visits” Please include the reference numbers. For example, initially include the reference number of the articles focused on Southern Africa. Done L286-291
-Table 1 “DHIS2” Please describe this acronym. Done Table 1
-Lines 163-167: “The inclusion criterion focused on articles related to implementation of case-based surveillance for infectious diseases not older than 10 years (2014-2024), documents written in English, and both quantitative and qualitative studies to assess the differences and results when implementing CBS.” However the authors include 1 article about “Trauma cases” (Ohuabunwa EC, Sun J, Jean Juban-yik K, Wallis LA., 2015). Please align the information. Done L183-187
-Line 272: “The section discusses a summary of successes and challenges…” OR “The section DESCRIBES a summary of successes and challenges…” Please think about this. Done L319
-3.3.1. Successes
“Many African countries are responding to the WHO’s call of advocating for a person-centered approach of reporting through case-based surveillance as part of HIV patient monitoring guidelines.
- System’s sensitivity was highlighted as critical in most studies to ensure that there is proper and early detection of public health threats.
- Some countries have developed health information systems that are interoperable which allow for secure data sharing and use which results in better care for patients and eliminates duplication.
- A study conducted in Rwanda proved a successful data exchange between multiple systems including EMR, Lab Information System (LIS), CR and DHIS2 tracker demonstrating a 100% match when generating a dataset for the HIV CBS.” Please include the reference number of the studies in each paragraph Done. L325-340
-Lines 280-281: “The use of fingerprints and national ID by some countries are steps in the right direction giving hope to uniquely identify patients.” This information is part of Discussion section. Done L379-381
-Lines 285-287: “Although many countries have highlighted inadequate and lack of funding for CBS, a decision to use open sources can bring some stability and continued maintenance of the systems in low-resource settings.” This information is part of Discussion section. Already discussed
-Lines 291-291: “This research highlighted the CBS implementation gaps which could help Lesotho to avoid when implementing CBS” This information is part of Discussion section. Done L433-435
-3.3.2. Challenges: Please include the reference number of the studies in each paragraph. Done L334-351
-Please include information about : “…needs for development and implementation of a case-based surveillance and to recommend a model that could be relevant for Lesotho.” (Lines 148-149). Done L164
-Please summarize the “gaps in the models that could be considered when developing a case-based surveillance for HIV in an African setting.” (Lines 150-151). Identified challenges already discussed in the Discussion section
DISCUSSION
-Line 306: “This paper is discussing the different models and systems used in different countries” or “This paper is discussing the different models and systems used in different African countries” Done. L358
-Lines 306-308: “This paper is discussing the different models and systems used in different countries to assess robust case-based health systems for a stable health system and to determine which ones may be appropriate in a low-income country setting like Lesotho.” However, the authors did not describe the current situation of Lesotho to understand how the results of this study could be used. Please describe this in the Introduction section. Done L68-74
-Please align the discussion to the 1.3. Aim and Objectives
“The aim of the study was to review existing models for the case-based health programs in Africa to inform the development and implementation of case-based surveillance of HIV in Lesotho. This was achieved by the following objectives: 1) To identify and describe the existing models for case-based health programs in Africa. 2) To determine successes and challenges to implementation of these models in Africa. 3) To assess the needs for development and implementation of a case-based surveillance and to recommend a model that could be relevant for Lesotho. 4) To identify any gaps in the models that could be considered when developing a case-based surveillance for HIV in an African setting. “
I did not find recommended proposals for Lesotho´s context. Please include this information. L449-464
-Line 345: Please describe the acronym “TB”. Done
-Limitations: Please include the limitations of the study. Done. L357-365
CONCLUSION
I did not find recommended proposals for Lesotho´s context. Please include this information. Done. L449-464
REFERENCES
-Please, include references from 2025. We have passed the selection stage. However, we still have some 2025 references such as WPR, 2025.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsCongratulations.
I only have one more suggestion. The recommended proposals for Lesotho’s context described in “conclusion” section are relevant. They could also be clearly described in “discussion” section.
Author Response
Dear reviewer,
We have already added the relevant content to the Discussion section. (Lines 383-396)
Thus, Lesotho can learn from the successes and barriers identified by other countries such as avoiding paper-based systems and those that lack integration between health information systems [10]. On the other hand, the country can learn from Tanzania and South Africa that implemented one national system to limit interoperability issues [4]. Also, the availability of dedicated human resources and training, policies for HIV reporting, data security and confidentiality cannot be over-emphasized [4,5,10,13,15]. It is imperative for Lesotho to have UID which will allow for transfer of patient information across facilities [4]. However, in the absence of a national ID as UID, Lesotho can learn from Rwanda by using the client registry and lining it with demographic information and multiple identifiers to enable linkage across facilities [14]. Lesotho as a low-income African country is prone to infrastructure challenges especially in the rural areas such as internet and consistent power outages. For a stable surveillance system, the country must invest in these and have contingencies such as generators to allow for a smooth implementation of CBS [4].
We confirm that all comments and concerns raised during the review process have been thoroughly addressed. A detailed point-by-point response to the reviewers’ comments is provided above and reflected in the revised manuscript.
