Organization and Integration of Care in the HIV–Non-Communicable Disease Syndemic: A Rapid Scoping Review
, Pedro Ivo Torquato Ludugerio 1, Gidyenne Christine Bandeira Silva de Medeiros 1, Grasiela Piuvezam 1 and Richardson Augusto Rosendo da Silva 2
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsFirst, I would like to congratulate the authors on this review, which I have had the pleasure of evaluating. I found it to be an excellent piece of work, both in terms of content and structure. I also consider it highly valuable that the strategic role of nursing has been clearly emphasized.
I would like to draw the authors’ attention to the use of acronyms in the title. It would be preferable to avoid them. While the meaning of HIV is universally recognized, the acronym NCD should be written in full, even if it is subsequently abbreviated in the text, as is appropriately done in the introduction [line 57].
In the Materials and Methods section, specifically within the search strategy subsection, it would also be advisable to clarify what the acronym PCC stands for and what it represents [line 110], as this appears to be its first occurrence.
Finally, in the Discussion section, I noted the absence of a paragraph highlighting the strengths of the study, as is done for its limitations. Including such a section would strengthen the manuscript.
Author Response
We appreciate all the suggestions made for improving the study. Below is the response to each item. We are available for further clarification.
I would like to draw the authors’ attention to the use of acronyms in the title. It would be preferable to avoid them. While the meaning of HIV is universally recognized, the acronym NCD should be written in full, even if it is subsequently abbreviated in the text, as is appropriately done in the introduction [line 57].
Response: Title adjusted.
In the Materials and Methods section, specifically within the search strategy subsection, it would also be advisable to clarify what the acronym PCC stands for and what it represents [line 110], as this appears to be its first occurrence.
Response: The acronym was detailed.
Finally, in the Discussion section, I noted the absence of a paragraph highlighting the strengths of the study, as is done for its limitations. Including such a section would strengthen the manuscript.
Response: Section added to the text.
Reviewer 2 Report
Comments and Suggestions for AuthorsDear Authors
The proposed corrections are for improving the manuscript, aiming for greater clarity, consistency, and scientific rigor.
Line 135: Present the specific descriptors related to nursing practice.
Line 151: Justify the definition of the study search time, considering that the research justification is based on recent epidemiological studies.
Line 179: Figure 2 shows the selection of 24 articles. 23 studies were presented in the manuscript.
Line 179: Show the total number of articles found in Figure 2.
Line 179: In the screening of Figure 2, 396 were removed, then 1 report sought retrieval. Include the exclusion in 396 or show the exclusion in the figure.
Line 187: Indicate the location in the main text of the study where this information is presented.
Line 214: Adjust the information for the 23 studies included in Figure 2.
Lines 236 to 240: In the description of the methodological designs, a total of 25 studies are described. Are there any studies that used more than one methodology? Align the information according to Table 1.
Line 281: Explain why study 2 is cited twice in line 7 of Table 3.
Line 494: In the reference, insert the DOI for articles and page numbers for books.
Author Response
We appreciate all the suggestions made for improving the study. Below is the response to each item. We are available for further clarification.
Line 135: Present the specific descriptors related to nursing practice.
Response: The descriptors were inserted into the text.
Line 151: Justify the definition of the study search time, considering that the research justification is based on recent epidemiological studies.
Response: The study considered literature from 2010 onwards, firstly because it is a rapid scoping review, which needs to be carried out within a time constraint. Secondly, as cited in the paragraph's references, the topic of HIV-NCD multimorbidity has been explored in recent decades due to the effectiveness of ARTs, increasing the survival of PLHIV and enabling these people to go through the aging process. Below is the conclusion of Deeks (2013):
“By virtue of the success of ART, HIV has evolved into a chronic disease in which the typical complications of AIDS are no longer the dominant problem in many parts of the world. Rather than dealing with acute and potentially life-threatening complications, clinicians are now confronted with managing a chronic disease that in the absence of a cure will persist for many decades. HIV care requires new skills on the part of the clinical workforce and a reshaping of health-care systems that were initially designed for acute care. Clinicians will still require knowledge of antiretroviral management but will need more expertise in prevention and management of cardiovascular disease and other comorbidities, including many of the complications typically associated with ageing. Biomedical research will need to evolve accordingly. Understanding of why inflammation persists during ART, how it causes morbidity, and how to reverse the process is a high priority for HIV disease, as it is for many other chronic disorders” [13].
Line 179: Figure 2 shows the selection of 24 articles. 23 studies were presented in the manuscript.
Response: Figure 2 has been adjusted.
Line 179: Show the total number of articles found in Figure 2.
Response: Figure 2 has been adjusted.
Line 179: In the screening of Figure 2, 396 were removed, then 1 report sought retrieval. Include the exclusion in 396 or show the exclusion in the figure.
Response: The text has been adjusted.
Line 187: Indicate the location in the main text of the study where this information is presented.
Response: The information was inserted into the text.
Line 214: Adjust the information for the 23 studies included in Figure 2.
Response: Figure 2 and text have been adjusted.
Lines 236 to 240: In the description of the methodological designs, a total of 25 studies are described. Are there any studies that used more than one methodology? Align the information according to Table 1.
Response: The information has been modified in the text.
Line 281: Explain why study 2 is cited twice in line 7 of Table 3.
Response: There are no duplicate studies in Table 3. The authors modified the method of identifying studies to avoid confusion. We are available for further clarification and suggestions for improvement if necessary.
Line 494: In the reference, insert the DOI for articles and page numbers for books.
Response: The DOI was inserted in reference 6.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe topic is relevant to healthcare workers, policymakers, program managers, and people living with HIV. The title reflects the content of the manuscript. The abstract is an adequate summary of the manuscript. The introduction orients the readers to the topic, identifies a literature gap, and states the aim of the review. The materials and methods are clearly discussed to allow for the replication of the study. The presentation of results requires some improvement. The authors discuss their results with help from literature and acknowledge the limitations of their review. The conclusion is based on the findings of the review.
MAJOR REVISIONS
Abstract
- State the databases used in the review.
- Mention the software used for data synthesis
Introduction
- In line 84, the authors state, ‘Unlike previous reviews, ……’ Previous reviews should be cited.
Eligibility criteria
- Did the exclusion criteria include scoping reviews, systematic reviews, meta-analyses, and meta-syntheses? If so, please include them in your exclusion list.
Results
- In section 3.2, the authors state, ‘The 23 included studies were published between 2014 and 2025. 19 of these studies were conducted in sub-Saharan Africa (82,6%), with South Africa accounting for the largest share (n = 7), followed by Tanzania (n = 3), Uganda (n = 2), Zimbabwe (n = 2), and one study each from Ghana, Malawi, Botswana, and Ethiopia.’ The 23 included studies, 19 studies in sub-Saharan Africa, and studies for each country should be added in square brackets. Instead of saying Uganda (n=2), provide the citations of the 2 studies. This should be done throughout the manuscript.
- In line 221, the authors state that one study was cross-sectional. This information should be combined with the information in lines 236-241, and the references of the studies should be provided.
- Wherever the authors mention the included studies, they should properly cite them in square brackets.
- Table 1 should be presented in an orderly fashion. This can either be by reference numbers or countries from the one with the largest number to the ones with the smallest.
- In section 3.3, the authors should reference all the studies correctly in square brackets. Presenting as (study 2) is not correct referencing. And take note of comment 7 for this section too.
- In section 3.4, refer to comment 9.
- There should be subheading 3.5 on patients’ perceptions.
- There should be a table of findings on patients’ perceptions.
- There should be a sub-heading 3.6 on the implications of care. A table of findings should also be included, and the studies that reported on this properly cited.
Discussion
- In line 409, citations are in curved brackets, while in other sections they are in square brackets. The authors should be consistent throughout the manuscript.
Author Response
We appreciate all the suggestions made for improving the study. Below is the response to each item. We are available for further clarification.
Abstract
State the databases used in the review.
Response: The information was inserted into the text.
Mention the software used for data synthesis
Response: The information was inserted into the text.
Introduction
In line 84, the authors state, ‘Unlike previous reviews, ……’ Previous reviews should be cited.
Response: The justification has been reformulated.
Eligibility criteria
Did the exclusion criteria include scoping reviews, systematic reviews, meta-analyses, and meta-syntheses? If so, please include them in your exclusion list.
Response: Information embedded in the text.
Results
In section 3.2, the authors state, ‘The 23 included studies were published between 2014 and 2025. 19 of these studies were conducted in sub-Saharan Africa (82,6%), with South Africa accounting for the largest share (n = 7), followed by Tanzania (n = 3), Uganda (n = 2), Zimbabwe (n = 2), and one study each from Ghana, Malawi, Botswana, and Ethiopia.’ The 23 included studies, 19 studies in sub-Saharan Africa, and studies for each country should be added in square brackets. Instead of saying Uganda (n=2), provide the citations of the 2 studies. This should be done throughout the manuscript.
Response: The references in brackets were cited in the text as requested.
In line 221, the authors state that one study was cross-sectional. This information should be combined with the information in lines 236-241, and the references of the studies should be provided.
Response: The text has been adjusted.
Wherever the authors mention the included studies, they should properly cite them in square brackets.
Response: The references in brackets were cited in the text as requested.
Table 1 should be presented in an orderly fashion. This can either be by reference numbers or countries from the one with the largest number to the ones with the smallest.
Response: The studies are listed in order of reference.
In section 3.3, the authors should reference all the studies correctly in square brackets. Presenting as (study 2) is not correct referencing. And take note of comment 7 for this section too.
Response: Adjusted.
In section 3.4, refer to comment 9.
Response: Adjusted.
There should be subheading 3.5 on patients’ perceptions.
Response: Adjusted.
There should be a table of findings on patients’ perceptions.
Response: Adjusted.
There should be a sub-heading 3.6 on the implications of care. A table of findings should also be included, and the studies that reported on this properly cited.
Response: A new subtopic and a new table have been added.
Discussion
In line 409, citations are in curved brackets, while in other sections they are in square brackets. The authors should be consistent throughout the manuscript.
Response: Adjusted.
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors have addressed all my comments.
