Mapping Global Evidence on HPV and Cervical Cancer Screening Methods, Limitations, and Emerging Point-of-Care Technologies: A Scoping Review Protocol

Mapping Global Evidence on HPV and Cervical Cancer Screening Methods, Limitations, and Emerging Point-of-Care Technologies: A Scoping Review Protocol Felix Jurua1,3*, Steven Odongo2, Bernard Ssentalo Bagaya3, Freddie Bwanga3, David Patrick Kateete3, Robert Downing1, Enock Matovu2, Pontiano Kaleebu1,4, Deogratius Ssemwanga1,4, Hedmon Okella5, Emmanuel Okello6,7, Alison Annet Kinengyere8, Stefan Magez9, Miriam Nakalembe10 1Uganda Virus Research Institute, Entebbe, Uganda 2Department of Biomedical Laboratory Technology and Molecular Biology, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University Kampala, Uganda 3Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health sciences, Makerere University, Kampala, Uganda 4Medical Research Council/ Uganda Virus Research Institute/London School of Hygiene and Tropical Medicine (MRC/UVRI/LSHTM) Uganda Research Unit, Entebbe, Uganda 5Division of Agriculture and Natural Resources, University of California, Hollister, CA, United States 6Veterinary Medicine Teaching and Research Center, School of Veterinary Medicine, University of California, Davis, Tulare, CA, United States 7Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States 8Sir Albert Cook Medical Library, College of Health Sciences, Makerere University, Kampala, Uganda. 9Laboratory of Cellular and Molecular Immunology (CMIM), Brussels Center for Immunology (BCIM), Department of Bioengineering Sciences, Vrije Universiteit Brussel, Belgium 10Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda *Corresponding Author: fjurua@gmail.com ABSTRACT Introduction: Human Papilloma Virus (HPV) is a sexually transmitted agent. HPV is the causative agent of Cervical Cancer (CC) and 5.2% of all cancers globally. Despite the presence of several CC screening tests, there is still limited knowledge on which cost-effective commercial CC screening tests including technologies under Research and Development (R&D) that are currently available for use within Low- and Middle-Income Countries (LMICs). Here, we outline a protocol for a scoping review, aiming at mapping literature on the screening methods for HPV and CC, their limitations and the point of care (POC) tests under R&D. Methods: We will undertake a scoping review of literature on the prevailing HPV and CC screening methods including those under R&D to identify screening gaps. We will search MEDILINE, Web of Science, EMBASE, CINAHL (EBSCO), Google scholar to obtain evidence on the HPV and CC screening methods. We will consider studies published between January 2016 and January 2026. The scoping review will be developed according to Arksey and O’Malley and Levac et al and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Equally searched will be grey literature (dissertations/theses, conference proceedings, websites of global bodies like the WHO, and applicable government reports) publishing evidence on HPV and CC screening among women. Ethics and dissemination No ethical approval is required since no human participants or animals will be part of this study. The results of this Scoping review will be disseminated electronically in peer-reviewed journals, in-print and via conference presentations. Open Science Framework Registration number: Strengths and Limitations of this study • This review will consider females of 25 years and above and may miss data about screening in those less than 25 years of age • This review will consider articles published in English only and may miss information from articles published in other languages • The pipeline for data extraction was generated by highly experienced librarians and therefore robust enough to capture sufficient information about HPV and CC screening • Four leading public health databases (EMBASE, Ovid MEDLINE, WEB OF SCIENCE CINAHL) with extensive information about HPV and CC will be searched to provide sufficient information • This study is anticipated to yield data about existing gaps in HPV and CC screening globally Keywords: Human Papilloma Virus; Cervical Cancer; Screening; Research and Development; Limitations Introduction Human Papillomavirus and Cervical Cancer Human Papillomavirus, a member of the Papillomaviridae family1 is a very diverse virus with over 200 genotypes2. The Alpha-papilloma genera of Firstpapillomavirinea are the most medically important as they cause anogenital, oral mucosa, and head and neck carcinomas. Alpha-papilloma viruses cause 40% of oral cancers3. HPV infection is the most common sexually transmitted infection (STI) worldwide, and most sexually active persons acquire it at some point in their lifetime4,5. Women get infected by men who carry HPV (HPV infection reservoirs), who are a critical source of hrHPV that causes CC6,7. Also, many anogenital as well as upper aero-digestive tract carcinomas, plus their precancerous lesions in men, are currently known to stem from HPV infection that is sexually acquired8,9. Infection with HPV does not always translate into cancer; however, a small percentage (10%) of persistent infections progress to cancer. Following a silent incubation period ranging from 10–20 years, hrHPV transforms the squamous epithelial or glandular cells, leading to invasive CC10,11,12. Oncoprotein E6 targets p53 for breakdown through the ubiquitin pathway, hence averting apoptosis13,14 and allowing continuous replication. On the other hand, E7 oncoprotein breakdown of pRb results in spontaneous entry into the cell cycle S phase15 which subsequently stimulates cell proliferation. The incidence of viral integration increases with the severity of the precancerous lesions of the cervix and in the cervical epithelium, the resulting premalignant alterations or squamous cell dysplasia are together termed cervical intraepithelial neoplasia (CIN). The exfoliated epithelial cells released at the end of the life cycle contain several biomarkers (viral particles, DNA, mRNA, and viral proteins) detectable in cervico-vaginal swabs or urine. The cytopathic effects of the virus on the epithelial cells are also identifiable through cytological methods. Based on the life cycle and carcinogenesis, a number of viral targets have been identified for diagnostic use. These include the genetic regions of L1, E6/E7 DNA, E6/E7 mRNA, viral proteins such as the E6/E7 oncoproteins as well as the antibodies to viral proteins. These HPV diagnostic targets are currently detected through use of both conventional and contemporary methods with several newer tests under R&D. Conventional tests are the traditional or ordinary tests that have existed for a long time and bear long sample to result times (>1hour), require complex laboratory infrastructure as well as highly trained personnel. Examples include; Cobas HPV (Roche Molecular Systems, Inc.), Abbott RealTime High Risk HPV (Abbott GmbH) and Aptima HPV test (Hologic). Conversely, contemporary or modern tests are those newly developed tests that have short sample to result times, little or no need for a complex laboratory and highly trained laboratory staff and are mostly deployable as POC tests. Examples include; Xpert HPV, careHPV Test, OncoE6™ Cervical assay among others. Global Burden of Cervical Cancer According to the WHO, the majority (94%) of global CC-related mortality occurred in LMICs in 202216. A significant variation in national rates of new cases and deaths exists among countries17, possibly explainable by the differing prevalence of hrHPV strains, and disproportionate accessibility to countrywide screening programs18,19. For instance, the top five countries with the highest global age-standardized mortality rate per 100,000 women (ASMR) are all African countries: Eswatini (ASMR 64.3), Malawi (ASMR 54.1), Zambia (ASMR 49.4), Zimbabwe (ASMR 47.9), and Lesotho (ASMR 42.3). On the other side, the five countries with the least global age-standardized rates for mortality per 100,000 women in descending order were: Switzerland (ASMR 1.1), Syrian Arab Republic (ASMR 1.3), Saudi Arabia (ASMR 1.3), Finland (ASMR 1.3), Malta (ASMR 1.4), and Australia (ASMR 1.4)20. A 10-fold difference in the new CC cases and death rates exists, with sub-Saharan Africa (SSA) and Melanesia registering the highest regional rates21. This high burden, especially in SSA, could partially be attributed to the synergistic epidemic comprising HPV and Human Immunodeficiency Virus (HIV) since the risk of developing CC is 6-times greater in HIV positive than in the HIV negative women22. As a result, out of all the cancers, CC accounts for close to 2.4 million years of life lost among females in the age range of 15 and 59. Cervical cancer is also blamed for 22% of the years of life lost in low-income countries (LICs), 10% in middle-income countries (MICs), and 5% in HICs23. As per the WHO predictions, CC attributable deaths will rise to 443,000 annually worldwide by 203024 with >98% taking place in LMICs and the greatest proportion in SSA25. Despite the WHO projections, CC elimination remains difficult because of poor health and social systems, absent basic screening tools besides inadequate CC awareness and education in SSA countries26. Several reviews on HPV/CC screening methods have already been performed by different researchers. For instance, a systematic review and meta-analysis done by Magdi et al 202127 only covered diagnostic accuracy of HPV tests for the screening of CC in low-resource settings. Then Karisani et al 202428 conducted a systematic review and meta-analysis to evaluate the accuracy of screening CC tests as alternative standalone methods. In 2023, Kundrod and the team29 performed a review on CC screening in general. In 2025, Amit et al30 carried out a systematic review and meta-analysis to evaluate different CC screening methods for women living with HIV while excluding those without HIV. In 2025, Ruchika Gupta et al31 conducted an updated and comprehensive summary of the sensitivity and specificity of three HPV POC tests (careHPV™, oncoE6™ cervical test, Xpert® HPV) to guide resource-constrained countries for their implementation in CC screening. However, the rest of the POC tests were not included and significant inter-study heterogeneity that could be attributed to the HPV prevalence in the populations included in these studies was noted. They also reported the publication bias among the studies on careHPV™ and oncoE6® cervical test and those on physician-collected samples for Xpert® HPV assay. Jennifer Pillay et al32 in 2021 undertook a systematic review to inform an update to recommendations by the Canadian Task Force on Preventive Health Care which was only limited to Canada. As indicated, several studies have been conducted to identify gaps in HPV and CC screening. However, no existing review has simultaneously: compared i) all HPV/CC screening methods, ii) synthesised limitations iii) mapped emerging POC technologies globally. There is a need to map existing evidence on the HPV and CC screening methods, their limitations and the POC tests for HPV that are still under R&D by synthesising both quantitative and qualitative data as well as studies that employ a mixed-methods approach. Therefore, the purpose of this scoping review is to map the literature evidence on the HPV and CC screening methods, their limitations and the POC tests for HPV that are under R&D globally by synthesising data from quantitative and qualitative studies. It is anticipated that findings from this study will enable the researchers to identify research gaps and guide future research towards improved diagnostics for women in CC screening programmes. The results of this study will also guide policymakers in designing CC screening programmes based on HPV and CC diagnostics that are more accessible to end-users to increase the uptake of CC screening services globally. A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports was conducted. No current or in progress scoping reviews or systematic reviews on the topic were identified that assessed the HPV and CC screening methods, their limitations and the POC tests for HPV that are still under R&D. The objective of this scoping review is to assess the extent of the literature on the HPV and CC screening methods, their limitations and the POC tests for HPV that are still under R&D. We will conduct a scoping review to identify gaps in HPV and CC screening. Results from an updated review will inform implementation strategies for improving the accessibility of diagnostics that can be used in the primary care setting to increase rates for both HPV and CC screening and potentially reduce disparities. METHODS AND ANALYSIS The scoping review will be developed according to Arksey and O’Malley33 and Levac et al34 and guided by the PRISMA-ScR checklist35 (supplementary file 1). Following the search, all identified citations will be collated and uploaded into the EndNote 21 Reference Management Software36 and deduplicated. The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of sources of evidence at full text that will not meet the inclusion criteria will be recorded. Any disagreements that arise between the reviewers at each stage of the selection process will be resolved through discussion, or with an additional reviewer. The results of the search and the study inclusion process will be presented in a PRISMA flow diagram (figure 1). Figure1: PRISMA flow diagram of the study selection procedure. PRISMA is denoted as Preferred Reporting Items for Systematic Reviews and Meta Analysis Review objectives and Questions Main objective The main objective of this review will be to map the available evidence on screening methods for human papillomavirus and cervical cancer, including their limitations and emerging point-of-care technologies under research and development. Specific objectives 1. To describe the characteristics of existing HPV and cervical cancer screening methods. 2. To identify reported limitations of current screening approaches. 3. To summarize, emerging point-of-care HPV screening technologies under development. Review questions 1. What are the characteristics of the current HPV and Cervical cancer screening methods? 2. What are the reported limitations of the current HPV and Cervical cancer screening methods? 3. What are the emerging point of care HPV screening technologies under Research and Development? Table 1: PCC for assessing research question eligibility Population Women ≥ 25 years Concept HPV and Cervical cancer screening methods, limitations, and POC Technologies Context Global (with emphasis on LMIC if relevant) Types of sources This scoping review will consider both experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports and descriptive cross-sectional studies for inclusion. Qualitative studies will also be considered that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. In addition, systematic reviews that meet the inclusion criteria will also be considered, depending on the research question. Text and opinion papers will be considered for inclusion in this scoping review. Search strategy for relevant studies The search strategy will aim at locating both published and unpublished studies. A three-step search strategy will be utilized in this review. First an initial limited search of MEDLINE (PubMed) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) will be undertaken to identify articles on the topic. The keywords contained in the titles and abstracts of relevant articles, and their synonyms will be used to develop a full search strategy for review (Appendix I for a detailed search strategy). The search strategy will be adapted for each included database and information source. The reference list of all included sources of evidence will be screened for additional studies. The search string will include the following terms: HPV, Cervical cancer and screening and their synonyms. Studies published in English language as appropriate will be included. While performing the search, the Boolean terms AND/OR will be employed to separate the key words. Studies published between January 2016 and 11th March 2026 will be included to capture recent advancements in HPV screening technologies. All information sources (eg, electronic databases, conference proceedings, websites, search engines or other online sources, contact with study authors) will be included. Other sources of information such as grey literature will also be searched for additional studies. Selection of eligible studies Data available for this study will be selected based on the following criteria Inclusion criteria The following will be included; studies published on HPV and CC screening methods in women 25 years and older, studies on POC technologies under development, articles published on limitations of HPV and CC screening, articles published between 2016-2026, and studies published in English. Exclusion criteria The following will be excluded from the review; articles published on HPV and CC screening in women under 25 years, articles published on CC diagnosis in women, articles published before 2016, non-English literature, articles that cannot be digitally accessed, articles that need to be peer-reviewed, including preprints and abstracts Data extraction Data will be extracted from included studies by independent reviewers using a data extraction tool developed by the reviewers. The data extracted will include specific details about the participants, concept, context, study methods and key findings relevant to the review question/s. A draft extraction form (Appendix II) will be employed. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. Where required, authors of inaccessible papers will be contacted for additional data. Charting the data A data charting form (appendix II) will be developed for capturing data from each selected study using Microsoft. Prior to the start of the review, two reviewers (FJ and MT) will pilot the data charting form and their experiences with the form will guide any modifications from time to time within the review period. As a pilot, FJ and MT will test the data charting tool with 10 included studies. Key variable for extraction will include; study population, country, sample size, age range, study design, intervention, narrative findings and quantitative findings. Following the pilot phase, FJ will capture all the data which will then be reviewed by MT to ensure all the data are fully and correctly captured. Data analysis and presentation The STATA V.17(StataCorp LLC Texas USA) statistical software will be employed for the extraction of themes from the selected studies. The attributes of eligible studies will be shown inform of a descriptive numeral summary. Findings consistent with the objectives of the review will be displayed in form of tables and figures. Descriptive summary will be presented inform of counts, frequencies, percentages, tables and charts. The screening methods (e.g., cytology, HPV DNA, VIA, POC) will be categorized according to type. We will undertake the thematic analysis for limitations, barriers and emerging technologies. Subgroup summaries will be made for LMIC verses HIC and HIV verses non-HIV populations. Through a narrative account of our results, we will present the key concepts from the selected articles consistent with our research questions. The gaps identified in this review consistent with the current HPV and CC screening will be highlighted to guide future research into diagnostics for HPV and CC especially in resource constrained settings. Quality Appraisal To determine the quality of the eligible studies, selected JBI quality appraisal tools37 will be employed. The JBI appraisal method is advantageous in that it is applicable to a variety of studies such as Cross-sectional studies, Cohort studies, Prevalence studies, Systematic Reviews and Case control studies among others. The number of studies found to be showing poor quality will be harmonized by FJ and MT. Eligible studies will be separately evaluated by the two reviewers and any discrepancies will be harmonized via discussions. Articles with poor quality will be considered for mapping evidence from the analysis. Ethics and dissemination Ethical approval is not required as this uses publicly available data. The results of this Scoping review will be disseminated electronically in peer-reviewed journals, in-print, policy briefs and through local or international conference presentations. Patient and public involvement This scoping review protocol has not involved any patients and the public in the design, conduct, reporting and dissemination plans of this research. Acknowledgements We would like to thank the Department of General Virology at Uganda Virus Research Institute Entebbe, College of Health Sciences as well as Centre for Biosecurity and Global Health (CeBIGH) under College of Veterinary Medicine, Animal Studies and Biosecurity at Makerere University for supporting the development of the review. Funding No external funding was received for this work Declarations No competing interests declared Author contributions Conceptualisation: FJ, OS and MN, SM, BSB and AKK. Developing and conducting the search strategy: FJ, AKK. Screening: FJ, NM. Writing—original draft: FJ, OS and MN, SM, BSB and AKK. Writing, reviewing and editing: MN, SM, BSB, FB, DPK, RD, EM, PK, DM, HO, EO, AKK. Supervision: OS, MN, SM, BSB. All authors have read and agreed to the published version of the manuscript. NM is the guarantor responsible for the conduct of the study and its overall content. Conflicts of interest There is no conflict of interest in this project. 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Accessed April 19, 2026. jbi.global Appendices Appendix I: Results of the search strategy for electronic databases and grey literature DATABASE SEARCH STRING EMBASE: 1974 to 2026 March 09 1 ("cervical cancer*" or "cervical neoplas*" or "cancer of the cervix" or "cervical carcinoma" or CIN or "cervical intraepithelial neoplasia" or "uterine cervix cancer" or "Uterine Cervical Neoplasms").mp. 2 ("Human papillomavirus" or "HPV" or "high-risk HPV" or "oncogenic HPV" or Papillomaviridae or Alphapapillomavirus or "Papillomavirus Infections" or "human papillomavirus infection").mp. 3 1 AND 2 4 ("cancer screening" or "mass screening" or screen* or "screening methods" or "early detection" or "early detection of cancer" or "Papanicolaou smear" or colposcop* or "HPV testing" or "Pap smear" or "Pap test*" or cytology or VIA or VILI or "DNA test*" or self-sampling or test* or "screening test*" or "early detection of cancer" or "cervical screening" or "screening test*" or "HPV test*" or "Pap smear" or "Pap test*" or "papanicolaou Test" or Cytology or "visual inspection with acetic acid" or VIA or "visual inspection with Lugol's iodine" or VILI or "molecular testing" or "screening test" or "Human papillomavirus DNA test*" OR "DNA HPV point-of-care screening test*" OR "point-of-care HPV screening test*" OR "oncoprotein HPV point-of-care test*").mp. 5 3 AND 4 6 (women or woman or female*) AND ("25 years or older" or "25 years and above" or "aged 25" or "≥25 years" or "age 25+").mp. 7 5 AND 6 8 PDAT: 2016-2026 Ovid MEDLINE(R) ALL 1946 to March 10, 2026 1 ("cervical cancer*" or "cervical neoplas*" or "cancer of the cervix" or "cervical carcinoma" or CIN or "cervical intraepithelial neoplasia" or "uterine cervix cancer" or "Uterine Cervical Neoplasms").mp. 2 ("Human papillomavirus" or "HPV" or "high-risk HPV" or "oncogenic HPV" or Papillomaviridae or Alphapapillomavirus or "Papillomavirus Infections" or "human papillomavirus infection").mp. 3 1 AND 2 4 ("cancer screening" or "mass screening" or screen* or "screening methods" or "early detection" or "early detection of cancer" or "Papanicolaou smear" or colposcop* or "HPV testing" or "Pap smear" or "Pap test*" or cytology or VIA or VILI or "DNA test*" or self-sampling or test* or "screening test*" or "early detection of cancer" or "cervical screening" or "screening test*" or "HPV test*" or "Pap smear" or "Pap test*" or "papanicolaou Test" or Cytology or "visual inspection with acetic acid" or VIA or "visual inspection with Lugol's iodine" or VILI or "molecular testing" or "screening test" or "Human papillomavirus DNA test*" OR "DNA HPV point-of-care screening test*" OR "point-of-care HPV screening test*" OR "oncoprotein HPV point-of-care test*").mp. 5 3 AND 4 6 (women or woman or female*) AND ("25 years or older" or "25 years and above" or "aged 25" or "≥25 years" or "age 25+").mp. 7 5 AND 6 8 PDAT: 2016-2026 WEB OF SCIENCE – Core collection: 11march2026 1 TS=("cervical cancer*" or "cervical neoplas*" or "cancer of the cervix" or "cervical carcinoma" or CIN or "cervical intraepithelial neoplasia" or "uterine cervix cancer" or "Uterine Cervical Neoplasms") 2 TS=("Human papillomavirus" OR HPV or "high-risk HPV" OR "oncogenic HPV" OR Papillomaviridae or Alphapapillomavirus OR "Papillomavirus Infections" OR "human papillomavirus infection" OR "human papillomavirus") 3 1 AND 2 4 TS=("cancer screening" or "mass screening" or screen* or "screening methods" or "early detection" or "early detection of cancer" or "Papanicolaou smear" or colposcop* or "HPV testing" or "Pap smear" or "Pap test*" or cytology or VIA or VILI or "DNA test*" or self-sampling or test* or "screening test*" or "early detection of cancer" or "cervical screening" or "screening test*" or "HPV test*" or "Pap smear" or "Pap test*" or "papanicolaou Test" or Cytology or "visual inspection with acetic acid" or VIA or "visual inspection with Lugol's iodine" or VILI or "molecular testing" or "screening test" or "Human papillomavirus DNA test*" OR "DNA HPV point-of-care screening test*" OR "point-of-care HPV screening test*" OR "oncoprotein HPV point-of-care test*") 5 3 AND 4 6 TS=(women or woman or female*) AND TS=("25 years or older" or "25 years and above" or "aged 25" or "≥25 years" or "age 25+") 7 5 AND 6 8 PDAT: 2016-2026 CINAHL Ultimate – 11 March 2026 1 XB ("cervical cancer*" or "cervical neoplas*" or "cancer of the cervix" or "cervical carcinoma" or CIN or "cervical intraepithelial neoplasia" or "uterine cervix cancer" or "Uterine Cervical Neoplasms") 2 XB ("Human papillomavirus" OR HPV or "high-risk HPV" OR "oncogenic HPV" OR Papillomaviridae or Alphapapillomavirus OR "Papillomavirus Infections" OR "human papillomavirus infection" OR "human papillomavirus") 3 1 AND 2 4 XB ("cancer screening" or "mass screening" or screen* or "screening methods" or "early detection" or "early detection of cancer" or "Papanicolaou smear" or colposcop* or "HPV testing" or "Pap smear" or "Pap test*" or cytology or VIA or VILI or "DNA test*" or self-sampling or test* or "screening test*" or "early detection of cancer" or "cervical screening" or "screening test*" or "HPV test*" or "Pap smear" or "Pap test*" or "papanicolaou Test" or Cytology or "visual inspection with acetic acid" or VIA or "visual inspection with Lugol's iodine" or VILI or "molecular testing" or "screening test" or "Human papillomavirus DNA test*" OR "DNA HPV point-of-care screening test*" OR "point-of-care HPV screening test*" OR "oncoprotein HPV point-of-care test*") 5 3 AND 4 6 XB (women or woman or female*) AND XB ("25 years or older" or "25 years and above" or "aged 25" or "≥25 years" or "age 25+") 7 5 AND 6 8 PDAT: 2016-2026 TOTAL RETRIEVED DUPLICATES REMOVED REMAINING FOR SCREENING Appendix II: Data extraction instrument No Authors Pub.Year Citation (DOI) Country Study population Sample size Age range Study Design Intervention Narrative study findings Quantitative findings Key findings & conclusion 1 2 3 4 5 6 7 8 9 10 Supplementary files File1: Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist SECTION ITEM PRISMA-ScR CHECKLIST ITEM REPORTED ON PAGE # TITLE Title 1 Identify the report as a scoping review. ABSTRACT Structured summary 2 Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives. INTRODUCTION Rationale 3 Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach. Objectives 4 Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives. METHODS Protocol and registration 5 Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number. Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale. Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. Search 8 Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated. Selection of sources of evidence† 9 State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. Data charting process‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators. Data items 11 List and define all variables for which data were sought and any assumptions and simplifications made. Critical appraisal of individual sources of evidence§ 12 If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate). Synthesis of results 13 Describe the methods of handling and summarizing the data that were charted. RESULTS Selection of sources of evidence 14 Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram. Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations. Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12). Results of individual sources of evidence 17 For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives. DISCUSSION Summary of evidence 19 Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups. Limitations 20 Discuss the limitations of the scoping review process. Conclusions 21 Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps. FUNDING Funding 22 Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review. JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O’Malley (6) and Levac and colleagues (7) and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting. § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document). Source: Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850 or (prisma-statement.org)