テレメディスンの無視されがちな熱帯病への対応の役割

タイトル: Telemedicine and clinical care for Neglected Tropical Diseases in a post-pandemic world: where are we on the way to mitigate global inequities? A scoping review

概要: BackgroundNeglected Tropical Diseases (NTDs) represent a global public health problem with great socioeconomic impact. Using digital health technologies to provide medical care remotely can be an important strategy for reducing inequalities in access but is challenging in low-and middle-income settings and geographically isolated areas. The objective of the current review was to identify and summarize international evidence on the use of telemedicine for clinical care of patients with NTD around the world based on a scoping review protocol. Methodology/Principal FindingsA total of 422 articles were extracted from the databases MEDLINE/PubMed, Web of Science and Scopus, and after remove 129 duplicates, 285 studies were excluded because they did not meet at least one of the eligibility criteria. A total of 8 articles were included for data collection, published between 2006 and 2023, half of them after 2021 (n=4). Fifty percent of the studies (n=4) were focused on dermatological diseases, like leprosy and leishmaniosis, and the other diseases found were dengue (n=2), trachoma (n=1) and cysticercosis (n=1). Most of telemedicine interventions in NTD took place in South America (n=5), with emphasis on Brazil (n=2). Studies that evaluated the accuracy of remote diagnosis demonstrated good effectiveness for leprosy, trachoma and complications of neurocysticercosis. There was a significant reduction in the need for specialized in-person medical consultations with telemedicine for the care of dengue fever and some dermatological NTDs; and an improvement in the quality of clinical monitoring of cutaneous leishmaniasis using mobile health was related. Conclusions/SignificanceThis scoping review mapped the existing evidence on telemedicine applied at clinical care for NTD. Although we observed a small recent increase in academic research on the theme after COVID-19 pandemic, there is a gap in recommendations for the clinical management of NTDs through telemedicine, especially for synchronous approaches, revealing that this resource is still largely underutilized. Author SummaryNeglected Tropical Diseases (NTDs) represent a global public health problem with great socioeconomic impact. Using digital health technologies to provide medical care remotely can be an important strategy for reducing inequalities. The objective of this scoping review was to identify and summarize international evidence on the use of telemedicine in the clinical care of patients with NTDs. A total of 8 articles were included for data collection as they met all our search criteria, half of them published after 2021 (n=4). Most of the studies took place in Latin America (n=5) and involved Primary Health Care teams (n=5). Studies that evaluated the accuracy of remote diagnosis demonstrated good effectiveness for leprosy, trachoma and complications of neurocysticercosis. There was a reduction in the need for specialized face-to-face medical consultations with telemedicine to treat dengue fever and some dermatological NTDs, and an improvement in the quality of clinical monitoring of cutaneous leishmaniasis through mobile health was reported. Although we have seen a recent small increase in academic research on the topic following the COVID-19 pandemic, there is a gap in recommendations for the clinical management of NTDs through telemedicine, especially for synchronous approaches, revealing that this resource is still largely underutilized.