A systematic review of substance use and substance use disorder research in Kenya

Florence Jaguga; Sarah Kanana Kiburi; Eunice Temet; Julius Barasa; Serah Karanja; Lizz Kinyua; Edith Kamaru Kwobah

doi:10.1371/journal.pone.0269340

Peer Review History

Original SubmissionJanuary 8, 2022
28 Mar 2022 Decision Letter - Judith I Tsui, Editor PONE-D-22-00681A systematic review of substance use and substance use disorder research in KenyaPLOS ONE Dear Dr. JAGUGA, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 12 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: - Tsuei, S.HT., Clair, V., Mutiso, V. et al. Factors Influencing Lay and Professional Health Workers’ Self-efficacy in Identification and Intervention for Alcohol, Tobacco, and Other Substance Use Disorders in Kenya. Int J Ment Health Addiction 15, 766–781 (2017). https://doi.org/10.1007/s11469-017-9775-6 The text that needs to be addressed involves lines 279-283 in your submission. In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed 3. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This manuscript adds value in an under-research area by summarizing main learnings from substance use and substance use disorder research in Kenya. Major revisions are needed though for the article to be presented as a scientifically- acceptable piece. These revision include punctuation, grammar errors (eg: inappropriate use of upper case letter on line 84- 86), and overall flow of some sentences such as line 31, line 39, line 50, line 58, line 69, line 83, line 87- 91, line 104, line 172, line 175 to list a few. In addition to these revision, below are proposed consideration: - In the abstract, please specify the start date used in the search strategy. - Line 53- tobacco kills 8million people where? Worldwide? On a specific continent? Please specify -Line 57- you mentioned one consequence so far ie death which others are you referring to here? - Line 104- inception of what? -Line 111 who checked the duplicates? Was the software used for this or did the authors do it? It's a bit unclear -Line 124-125: Were mixed methods studies included as well? The way this is phrased it sounds like "all designs" refers more to qualitative and quantitative studies -Avoid over using "/" in sentences. If need be list item a "or" b throughout the manuscript. Eg: substance use or SUDs -Line 182- 183- did you mean that 13 additional studies were identified? Please consider reviewing and rephrasing your sentences to improve clarity -Line 185- Is "These" referring to the studies? If yes, can you be a bit more explicit? -Line 238- are you referring to MSM who are commercial sex workers? Please use appropriate languages throughout the manuscript - For the result presentation, it might be helpful to have as part of the main manuscript (not supplemental information) a summary table of the final literature reviewed including information on the title of the article, authors, methods, findings and gap from the articles that were included in the review instead of having long references throughout the result section. - Line 313 Lay healthcare providers might be more appropriate same for line 314 for primary healthcare workers not primary care workers -Line 331-332 that last sentence seems incomplete, please consider reviewing it -Line 371- 372- What are estimates then on what has been done elsewhere in SSA? Is this conclusion based mainly on the 2 scoping work from SA and Bostwana? How about other SSA countries including countries neighboring Kenya like Uganda, Tanzania, etc? How do you define a lot? -Line 392- Emerging substances like which ones? - Line 404- Was the study specifically assessing feasibility? If that was not the case, making such claim is misleading - Reviewer #2: This systematic review highlights several gaps in licit and illicit substance use (SU) and substance use disorder (SUD) literature within Kenya, with the goal of summarizing research within three broad domains: (1) epidemiologic studies, (2) intervention and/or programs and (3) qualitative studies. The authors apply sound methods, with attention to details around decision-making processes when including articles in their review. The attention to target study populations (e.g., community, hospitals, prisons, etc.) is extremely valuable and calls for additional studies within specific populations. In addition, the authors make the case that their review is needed in order to address Kenya’s Vision 2030 and moves towards accomplishing SDG’s. I commend the authors for completing this large undertaking and offer feedback to strengthen and improve their paper. Major Edits • There is an absolute need for SU and SUD systematic review; however, this paper may have limited applications in its current state. In the introduction, the authors state this paper will “guide future research efforts”; however, most SUD researchers work with one substance or one category of substances. It would be helpful within the key findings sections to expand on SU categories, which are discussed briefly in the introduction (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) Another option may be to reformat the paragraphs according to SU categories and discuss the current epidemiologic, interventions/programs, and qualitative studies. • In your criteria, you do not mention whether you included studies conducted out of methadone clinics or harm reduction sites (i.e., drop-in centres, NSPs), specifically. However, when I look over the publications, several were conducted within these sites. Please clarify whether these terms were part of your search categories and include them on Page 11, lines 215-217. • Throughout the descriptions and key findings sections, there should be more syntheses of the data instead of frequencies, which are already conveyed in your tables. For example, under the epidemiology section of SU/SUD, you say that 47% of the studies used evidence-based diagnostic tools, but this should be followed by the key findings of those studies (i.e., X-X% of participants indicated hazardous or harmful alcohol consumption, and X-X% of participants indicated alcohol dependence.) This is just one example, but all of the key finding’s sections should provide more data syntheses. • As it stands, the key findings and other findings sections are a little difficult to follow and are heavily focused on alcohol and tobacco use. For example, in the epidemiologic key findings section the paragraphs are organized as follows: (1) youth and substance use, (2) adults and tobacco use, (3) adults and alcohol use, and (4) two case control studies. Again, this may have a better flow if the authors organized the key findings by SU categories (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) By structuring the paragraphs by SU categories, the reader is able to quickly decipher where there are gaps in the literature. Alternatively, the authors may want to consider narrowing the scope of their paper by solely focusing on alcohol and tobacco use, which seem to be the main focus throughout the paper. • In the qualitative study key findings section, most of the studies apply frameworks and/or theories to their analysis (e.g., stages of change, risk environment framework), which should be synthesized and included as a column in Additional File 5/Qualitative Studies. Minor Edits • Please review the PLOS ONE Guidelines on formatting references and edit references. • Page 11 (line 220) “People with injecting drug use” should be “people (or persons) who inject drugs.” • Page 11 (line 221) “Men who have Sex with Men” should not contain capital letters. • Page 11 (lines 218-225) This section does not sum up to the total studies in the epidemiology section n=144. • Page 11 (line 210-213) Please be consistent in how you mention the study designs with corresponding references. This was completed in the interventions and programs section, but not for the epidemiological studies. • Page 15 (lines 299-303) Conversely, please indicate in the programs and intervention section, how may studies were included in each of the study designs. • Page 12 (line 229) typo, please change to “opioids (n=21)” • In the findings section, please define “hospital,” and whether this includes methadone clinics. • Page 20 (line 398) “Substance use” should be “substance use disorder.” • Page 21 (line 423-424) “Mental disorders” should be “mental health disorders.” • Additional File 3/Epidemiological Studies: The SU category should not include how people consume their drugs (“injection drugs”), which is only seen a few times, but what drugs categories were examined. Please be more specific than “illicit drugs.” • Additional File 4/Interventions and Program: Please review the sample sizes for each study, particularly for those with “not reported.” ****** 6. 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Revision 1
12 May 2022 Author Response Reviewer #1: This manuscript adds value in an under-research area by summarizing main learnings from substance use and substance use disorder research in Kenya. Major revisions are needed though for the article to be presented as a scientifically- acceptable piece. These revision include punctuation, grammar errors (eg: inappropriate use of upper case letter on line 84- 86), and overall flow of some sentences such as line 31, line 39, line 50, line 58, line 69, line 83, line 87- 91, line 104, line 172, line 175 to list a few. We thank the reviewer for this comment. We have thoroughly proof read the paper and made corrections to grammar and punctuation. - In the abstract, please specify the start date used in the search strategy. We have specified that the search was conducted from inception (line 27). - Line 53- tobacco kills 8million people where? Worldwide? On a specific continent? Please specify We have clarified that it is worldwide (line 58) -Line 57- you mentioned one consequence so far ie death which others are you referring to here? The paragraph has been revised to include health consequences of alcohol, tobacco and other substances (line 58-63) - Line 104- inception of what? Inception means from the earliest available study. This term is commonly used in systematic review searches when no date limits have been set -Line 111 who checked the duplicates? Was the software used for this or did the authors do it? It's a bit unclear The Mendeley Reference manager was used to identify and remove duplicates. This has been clarified on line 116-117. -Line 124-125: Were mixed methods studies included as well? The way this is phrased it sounds like "all designs" refers more to qualitative and quantitative studies Yes, we included studies with qualitative, quantitative and mixed methods designs. This has now been clarified (line 133). -Avoid over using "/" in sentences. If need be list item a "or" b throughout the manuscript. Eg: substance use or SUDs This has been corrected throughout the manuscript -Line 182- 183- did you mean that 13 additional studies were identified? Please consider reviewing and rephrasing your sentences to improve clarity The sentence has been reviewed to improve clarity (line 208) -Line 185- Is "These" referring to the studies? If yes, can you be a bit more explicit? We have reworded the sentence to make it more explicit (line 210) -Line 238- are you referring to MSM who are commercial sex workers? Please use appropriate languages throughout the manuscript The authors are referring to MSM who were commercial sex workers. We have corrected this (line 273). - For the result presentation, it might be helpful to have as part of the main manuscript (not supplemental information) a summary table of the final literature reviewed including information on the title of the article, authors, methods, findings and gap from the articles that were included in the review instead of having long references throughout the result section. We have included the tables within the main manuscript (line 367, 439, 504) - Line 313 Lay healthcare providers might be more appropriate same for line 314 for primary healthcare workers not primary care workers This has been corrected line 388, 391, 395, 551, 552 -Line 331-332 that last sentence seems incomplete, please consider reviewing it This sentence has been revised (line 428-430) -Line 371- 372- What are estimates then on what has been done elsewhere in SSA? Is this conclusion based mainly on the 2 scoping work from SA and Bostwana? How about other SSA countries including countries neighboring Kenya like Uganda, Tanzania, etc? We have reworded the paragraph to show that we are comparing our findings with available scoping reviews (line 513-520) How do you define a lot? We have revised this sentence and used the word “more…” (line 515) -Line 392- Emerging substances like which ones? An example has been given (line 541) - Line 404- Was the study specifically assessing feasibility? If that was not the case, making such claim is misleading This line has been deleted (line 554). - Reviewer #2: This systematic review highlights several gaps in licit and illicit substance use (SU) and substance use disorder (SUD) literature within Kenya, with the goal of summarizing research within three broad domains: (1) epidemiologic studies, (2) intervention and/or programs and (3) qualitative studies. The authors apply sound methods, with attention to details around decision-making processes when including articles in their review. The attention to target study populations (e.g., community, hospitals, prisons, etc.) is extremely valuable and calls for additional studies within specific populations. In addition, the authors make the case that their review is needed in order to address Kenya’s Vision 2030 and moves towards accomplishing SDG’s. I commend the authors for completing this large undertaking and offer feedback to strengthen and improve their paper. We thank the reviewer for their comments. Major Edits • There is an absolute need for SU and SUD systematic review; however, this paper may have limited applications in its current state. In the introduction, the authors state this paper will “guide future research efforts”; however, most SUD researchers work with one substance or one category of substances. It would be helpful within the key findings sections to expand on SU categories, which are discussed briefly in the introduction (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) Another option may be to reformat the paragraphs according to SU categories and discuss the current epidemiologic, interventions/programs, and qualitative studies. We acknowledge this comment. We have organized the key findings sections by substance use categories and expanded on the findings (line 162, 266-366, 373-439, 446-503). • In your criteria, you do not mention whether you included studies conducted out of methadone clinics or harm reduction sites (i.e., drop-in centres, NSPs), specifically. However, when I look over the publications, several were conducted within these sites. Please clarify whether these terms were part of your search categories and include them on Page 11, lines 215-217. NSP sites has been included in the general characteristics of epidemiological studies (line 248) • Throughout the descriptions and key findings sections, there should be more syntheses of the data instead of frequencies, which are already conveyed in your tables. For example, under the epidemiology section of SU/SUD, you say that 47% of the studies used evidence-based diagnostic tools, but this should be followed by the key findings of those studies (i.e., X-X% of participants indicated hazardous or harmful alcohol consumption, and X-X% of participants indicated alcohol dependence.) This is just one example, but all of the key finding’s sections should provide more data syntheses. • We have now provided more synthesis of data in the results section (line 266-366, 373-439, 446-503). • As it stands, the key findings and other findings sections are a little difficult to follow and are heavily focused on alcohol and tobacco use. For example, in the epidemiologic key findings section the paragraphs are organized as follows: (1) youth and substance use, (2) adults and tobacco use, (3) adults and alcohol use, and (4) two case control studies. Again, this may have a better flow if the authors organized the key findings by SU categories (e.g., tobacco, alcohol, opioids, cannabis, and stimulants.) By structuring the paragraphs by SU categories, the reader is able to quickly decipher where there are gaps in the literature. Alternatively, the authors may want to consider narrowing the scope of their paper by solely focusing on alcohol and tobacco use, which seem to be the main focus throughout the paper. We acknowledge this comment. We have organized the key findings sections by substance use categories and expanded on the findings (line 162, 266-366, 373-439, 446-503). • In the qualitative study key findings section, most of the studies apply frameworks and/or theories to their analysis (e.g., stages of change, risk environment framework), which should be synthesized and included as a column in Additional File 5/Qualitative Studies. We have incorporated the theoretical frameworks into the results section (line 468,478, 492, 499), and added a column presenting information on theoretical frameworks to the table 4 (line 505). Minor Edits • Please review the PLOS ONE Guidelines on formatting references and edit references. The references have been edited in line with PLOS one guidelines • Page 11 (line 220) “People with injecting drug use” should be “people (or persons) who inject drugs.” This has been corrected (line 251) • Page 11 (line 221) “Men who have Sex with Men” should not contain capital letters. This has been corrected (line 252) • Page 11 (lines 218-225) This section does not sum up to the total studies in the epidemiology section n=144. Yes. This is true because some populations overlapped e.g. some studies were conducted among general population adults with NCDs. • Page 11 (line 210-213) Please be consistent in how you mention the study designs with corresponding references. This was completed in the interventions and programs section, but not for the epidemiological studies. We have now deleted references in the general description section for the intervention studies (line 375-378) and qualitative studies (448-457) to ensure uniformity • Page 15 (lines 299-303) Conversely, please indicate in the programs and intervention section, how may studies were included in each of the study designs. This has been indicated. Line 386-389 • Page 12 (line 229) typo, please change to “opioids (n=21)” This has been corrected. Line 261 • In the findings section, please define “hospital,” and whether this includes methadone clinics. We have separated out studies done within hospitals and those done within methadone clinics (line 247; Kisilu et al. 2019 on table 2 line 367) • Page 20 (line 398) “Substance use” should be “substance use disorder.” This has been corrected. Line 551 • Page 21 (line 423-424) “Mental disorders” should be “mental health disorders.” This has been corrected. Line 578 • Additional File 3/Epidemiological Studies: The SU category should not include how people consume their drugs (“injection drugs”), which is only seen a few times, but what drugs categories were examined. Please be more specific than “illicit drugs.” The studies described the substances as just IDU and illicit substances, and did not provide descriptions of the specific substances assessed for. We have included the phrase ‘not specified’ next to the term illicit drugs and IDU for clarity. (Table 2 line 367) • Additional File 4/Interventions and Program: Please review the sample sizes for each study, particularly for those with “not reported.” These were reviewed and appropriate sample sizes reported (table 3 line 443) Editors’ comments 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: - Tsuei, S.HT., Clair, V., Mutiso, V. et al. Factors Influencing Lay and Professional Health Workers’ Self-efficacy in Identification and Intervention for Alcohol, Tobacco, and Other Substance Use Disorders in Kenya. Int J Ment Health Addiction 15, 766–781 (2017). https://doi.org/10.1007/s11469-017-9775-6 The text that needs to be addressed involves lines 279-283 in your submission. We have addressed this (line 349-354) About data availability. All analyzed data has been included in the main manuscript and in the supporting information files 1 and 2. (line 1264) https://doi.org/10.1371/journal.pone.0269340.r002
19 May 2022 Decision Letter - Judith I Tsui, Editor A systematic review of substance use and substance use disorder research in Kenya PONE-D-22-00681R1 Dear Dr. JAGUGA, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Judith I Tsui Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0269340.r003
Formally Accepted
26 May 2022 Acceptance Letter - Judith I Tsui, Editor PONE-D-22-00681R1 A systematic review of substance use and substance use disorder research in Kenya Dear Dr. Jaguga: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Judith I Tsui Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0269340.r004

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