SCOPING REVIEW PROTOCOL
NURSING PRACTICES IN MANAGING SEXUALLY TRANSMITTED INFECTIONS IN PRIMARY HEALTH CARE: SCOPing REVIEW PROTOCOL
Prácticas de enfermería en el manejo de infecciones de transmisión sexual en Atención Primaria de Salud: protocolo de revisión de alcance
Práticas dos enfermeiros no manejo das infecções sexualmente transmissíveis na Atenção Primária à Saúde: protocolo de revisão de escopo
https://doi.org/10.31011/reaid-2025-v.99-n.4-art.2446
1Caren Fabiana Alves
2Jarbas da Silva Ziani
3Igor Rodrigues Barrozo
4Luiza Silveira de Oliveira
5Juliana Maia Borges
6Eliana Rosa da Fonseca
7Fernando Mitano
8Laís Mara Caetano da Silva Corcini
1Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0000-0001-6911-8195
2Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0000-0002-9325-9390
3Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0009-0008-8960-6039
4Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0009-0008-7787-6736
5Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0000-0002-8433-984X
6Universidade Federal do Rio de Janeiro. Rio de Janeiro, Brazil. ORCID: https://orcid.org/0000-0003-0103-2859
7Universidade Lúrio, Moçambique, África Ocidental. ORCID: https://orcid.org/0000- 0003-4069-9314
8Universidade Federal de Santa Maria, Santa Maria, Brazil. ORCID: https://orcid.org/0000-0003-4069-9314
Corresponding Author
Jarbas da Silva Ziani
Amélia Rodrigues 255, apartamento 407, Santa Maria, Rio Grande do Sul, Brazil. CEP: 97010020. Phone: +55(55) 999156226. E-mail: jarbasziani230@gmail.com
Submission: 10-12-2024
Approval: 29-07-2025
ABSTRACT
Objective: To map nurses' practices in the management of sexually transmitted infections in Primary Health Care. Methods: Scoping review protocol developed according to the JBI approach. The search strategy will be defined and applied in the following databases: MEDLINE (PubMed), LILACS, BDENF, and others (VHL), SCOPUS and EMBASE (Elsevier), Core Collection (Clarivate Analytics), CINAHL, ASP, and Academic Source (EBSCO). For gray literature, the sources WorldWideScience.org and Science.org will be used. The review will consider studies in Portuguese, English, and Spanish and will have no time restrictions. The selection will be carried out in the Rayyan system by two independent reviewers, following the established eligibility criteria, with consultation of a third reviewer in case of disagreements. A data extraction tool developed by the reviewers will be used, in the form of a spreadsheet in Microsoft Excel. The data will be presented graphically, in diagrammatic and/or tabular form, accompanied by a narrative summary. The search results and study selection process will be displayed in the flowchart following the *Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The protocol has been registered on the Open Science Framework platform: [https://doi.org/10.17605/OSF.IO/H7KN6] (https://doi.org/10.17605/OSF.IO/H7KN6).
Keywords: Nursing; Sexually Transmitted Infections; Primary Health Care; Rapid Diagnostic Tests; Professional Practice.
RESUMEN
Objetivo: Mapear las prácticas de las enfermeras en el manejo de las infecciones de transmisión sexual en la atención primaria de salud. Métodos: protocolo de revisión de alcance elaborado de acuerdo con el enfoque de JBI. La estrategia de búsqueda se definirá y se aplicará en las bases de datos MEDLINE (PubMed), LILACS, BDENF y otras (BVS), SCOPUS y EMBASE (Elsevier), Core Collection (Clarivate Analytics), CINAHL, ASP y fuente académica (EBSCO) y para la literatura gris las fuentes WorldWideScience.org y Science.org. Considerará los idiomas, portugués, inglés y español y no tendrá límite de tiempo La selección será realizada en el sistema Rayyan por dos revisores independientes, siguiendo los criterios de elegibilidad establecidos y con consulta al tercer revisor en caso de desacuerdos. Se utilizará un instrumento de extracción de datos desarrollado por los revisores, en forma de hoja de cálculo en Microsoft Excel. Los datos se presentarán gráficamente, en forma diagramática y/o tabular, acompañados de un resumen narrativo. Los resultados del proceso de búsqueda y selección de estudios se mostrarán en el diagrama de flujo Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). El protocolo se registró en la plataforma Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/H7KN6.
Palabras clave: Enfermería; Enfermedades de Transmisión Sexual; Atención Primaria de Salud; Prueba de Diagnóstico Rápido; Práctica Profesional.
RESUMO
Objetivo: Mapear as práticas dos enfermeiros no manejo das Infecções sexualmente transmissíveis na Atenção Primária à Saúde. Métodos: protocolo de revisão de escopo elaborado conforme a abordagem do JBI. A estratégia de busca será definida e aplicadas nas bases de dados MEDLINE (PubMed), LILACS, BDENF e outras (BVS), SCOPUS e EMBASE (Elsevier), Core Collection (Clarivate Analytics), CINAHL, ASP e fonte acadêmica (EBSCO) e para literatura cinzenta as fontes WorldWideScience.org e Science.org. Considerará os idiomas português, inglês e espanhol e não terá limite temporal A seleção será realizada no sistema Rayyan por dois revisores independentes, seguindo os critérios de elegibilidade estabelecidos e com consulta ao terceiro revisor em caso de dissensos. Será utilizado um instrumento de extração de dados desenvolvido pelos revisores, em forma de planilha no Microsoft Excel. Os dados serão apresentados graficamente, em forma diagramática e/ou tabular, acompanhados de resumo narrativo. Os resultados da busca e do processo de seleção de estudos serão exibidos no fluxograma Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Protocolo foi registrado na plataforma Open Science Framework: https://doi.org/10.17605/OSF.IO/H7KN6.
Palavras-chave: Enfermagem; Infecções Sexualmente Transmissíveis; Atenção Primária à Saúde; Testes de Diagnóstico Rápido; Prática Profissional.
INTRODUCTION
The present scoping review originates from the need to highlight the main aspects related to the management of Sexually Transmitted Infections (STIs) in Primary Health Care (PHC) by nurses.
Considering that STIs are a public health problem and that PHC plays a fundamental role as the primary setting for the development of actions aimed at diagnosis, treatment, control, and prevention, it becomes necessary to focus on the actions carried out by nurses. The minimum core team of both Primary Care Teams (PCT) and Family Health Strategy (FHS) teams includes a nurse, a nursing technician, and a physician.
It is important to emphasize that nurses have autonomy in several procedures related to STIs, being able to perform diagnosis, treatment, provide guidance on combined prevention strategies, assist in decision-making, and, when necessary, refer patients to specialized care. According to the technical manuals for the diagnosis of HIV infection, syphilis, and viral hepatitis, any trained individual, whether in person or remotely, can perform Rapid Tests (RT). However, issuing the report and supervising the team are responsibilities of higher-level health professionals who are licensed by their respective regional professional councils. Nursing professionals represent the majority in addressing STIs, working on different key fronts to contain the spread of these diseases(1).
Furthermore, it is the exclusive responsibility of nurses to conduct nursing consultations aimed at promoting health and improving the quality of life of the population(2). The regulation of nursing practice, according to Law No. 7,498/86, establishes the duties of nurses, which are important to highlight: prescribing medications established in public health programs and approved institutional protocols; preventing and controlling communicable diseases in general; conducting nursing consultations; and providing health education aimed at improving the population's health(2).
Therefore, the role of nursing professionals in providing care to individuals with STIs is essential, with the aim of promoting early diagnosis and treatment. In this way, conducting research on this topic becomes important in order to improve the quality and effectiveness of STI care.
This study aligns with the Sustainable Development Goals (SDGs), particularly Goal 3, “Good Health and Well-being,” which establishes the guarantee of access to quality healthcare and the promotion of well-being for all, at all ages(3).
Based on the above, there is a need to investigate and map the practices of nurses in the management of sexually transmitted infections in Primary Health Care, considering the main aspects that permeate these practices, and identifying strengths and weaknesses within the professional scope.
METHODS
This is a scoping review protocol, conducted according to the Joanna Briggs Institute (JBI) approach. The development of a review protocol is one of the key characteristics of a high-quality review, as it aims to guide the study, minimize bias, and ensure transparency in the process. The scoping review was chosen as the main research method because it allows for mapping and exploring the current literature to build the foundation of this study(4). The intention is to identify whether primary studies on the topic have already been published, with the purpose of mapping existing protocols and scoping and/or systematic reviews.
Accordingly, this study protocol is registered on the Open Science Framework (OSF) and is available at: [https://doi.org/10.17605/OSF.IO/H7KN6] (https://doi.org/10.17605/OSF.IO/H7KN6).
The organization of the scoping review follows five stages:
1. Formulation of the research question; 2. Identification of relevant studies; 3. Selection of references; 4. Organization and analysis of extracted data; 5. Synthesis and presentation of results(5).
The mnemonic Participants, Concept, and Context (PCC) will be used to structure the review question. The review report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (6).
Preliminary Search
A preliminary search was carried out in the following data sources: International Prospective Register of Systematic Reviews (PROSPERO), JBI Evidence Synthesis, Open Science Framework (OSF), Cochrane Database of Systematic Reviews, and Medical Literature Analysis and Retrieval System Online (MEDLINE/PUBMED). A total of 11 primary studies were identified. No scoping review protocols were found in the JBI database. Finally, two studies were included from PROSPERO. This study differs from the other existing manuscripts due to its approach of considering the four STIs for which rapid tests are currently available through the Brazilian Unified Health System (SUS).
Review Question
The main guiding research question was: “What are the nurses’ practices in the management of STIs in Primary Health Care (PHC)?” Additionally, the following secondary questions were established: “What are the nurses’ practices in the management of rapid STI tests in PHC?” and “What is the nurses’ knowledge regarding the management of rapid STI tests in PHC?”
Eligibility Criteria
Participants
Studies that target healthcare professionals, specifically nurses, will be included. These nurses must work directly in the care of people with STIs (syphilis, HIV, and hepatitis B and C), focusing on individuals aged 19 years and older. There will be no distinction regarding sex, gender, age, race, or other differentiating characteristics for inclusion. Exclusion criteria include professionals working in other professional settings, such as public or private hospitals, nursing clinics, or studies addressing the condition of pregnant women.
Concept
STIs are conditions primarily transmitted through sexual relations, via sexual contact, including vaginal, anal, and oral sex. This study included HIV, syphilis, and hepatitis B and C, as these are the infections for which rapid tests are available in Primary Health Care (PHC) facilities throughout the country.
Other examples of STIs, such as genital herpes, gonorrhea, trichomoniasis, Human Papillomavirus (HPV) infection, herpes simplex, and chlamydia, were excluded from this study(7). Studies focusing on the professional practice of nurses who directly care for individuals with any of these four STIs will be included, provided they address the nurses’ skills and professional knowledge related to health care or the provision of care within the PHC context. This includes actions such as health promotion, prevention, diagnosis, treatment, and rehabilitation.
Context
PHC is characterized as the main entry point to the Unified Health System (SUS) in Brazil. It plays a prominent role in the management of patient care and fulfills a strategic function within the health care network. Serving as a foundation for the development and implementation of comprehensive care, studies conducted in this setting—in rural, and urban, suburban, or even global contexts—will be included. In this sense, only studies in which PHC is the guiding context will be considered(8).
Types of Sources
This review will consider experimental and quasi-experimental study designs, including randomized controlled trials, non-randomized controlled trials, before-and-after studies, and interrupted time series studies. Additionally, it will include analytical observational studies, such as prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies. Descriptive observational study designs will also be considered, including case series, individual case reports, and descriptive cross-sectional studies.
Qualitative studies focused on qualitative data will also be included, encompassing but not limited to designs such as phenomenology, grounded theory, ethnography, and action research. Furthermore, articles derived from theses and dissertations will be considered.
Research strategy
The search strategy will be conducted in three stages with the aim of locating both published and unpublished studies. 1: The preliminary search will be carried out using terms from the Health Sciences Descriptors (DeCS), Medical Subject Headings (MeSH), and Embase Subject Headings (Emtree), combined using the Boolean operators OR and AND, in the following sources: MEDLINE/PubMed, OSF, PROSPERO, JBI Synthesis, and the Cochrane Library. The objective of this stage is to identify protocols, reviews, and primary articles. This initial search will allow the identification of keywords and index terms for a comprehensive search strategy. 2: In the second stage, the terms identified will be used to build a definitive and comprehensive search strategy, which will be adapted for each database and information source: MEDLINE/PubMed, PubMed Central/NLM, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Fonte Acadêmica (EBSCO); Scopus, Embase, and Educational Resources Information Centre (ERIC); Latin American and Caribbean Health Sciences Literature (LILACS), Nursing Databases (BDENF) of the Virtual Health Library (VHL); and Scientific Electronic Library Online (SciELO). Additional sources such as Google Scholar and the Theses and Dissertations Catalog of the Coordination for the Improvement of Higher Education Personnel (CAPES), as well as other sources of grey literature, including WorldWideScience.org and Science.org, will also be considered. Studies in Portuguese, English, and Spanish will be included, with no time restrictions. 3: All references from the included articles will be manually searched.
Study/Source of Evidence Selection
After the search is completed across the various sources, all references will be compiled and imported into EndNote 21 of Clarivate for duplicate removal. The remaining references will then be exported to the Intelligent Systematic Review Software (Rayyan) for selection management.
Following a pilot test, titles and abstracts will be screened independently by two or more reviewers to assess their eligibility based on the predefined inclusion criteria. Potentially relevant sources will be assessed in full text. The full texts will be made available to the review team via Google Drive, decisions will be marked in Rayyan, and citation details will be imported into PRISMA-ScR.
The reasons for excluding full-text sources that do not meet the inclusion criteria will be documented and reported. Any disagreements between reviewers at any stage of the selection process will be resolved through discussion or with the involvement of one or more additional reviewers. The results of the search and study selection process will be fully reported in the final scoping review and presented in a flow diagram based on the PRISMA-ScR checklist model.
Data Extraction
A spreadsheet template in Excel 2019, developed by the reviewers, will be used as a data extraction tool to assist in the extraction and organization of the relevant data. The tool will undergo a pilot test for reviewer training and, throughout the process, it may be modified, with any changes to be detailed in the final review.
Data will be extracted from the articles included in the scoping review by two or more independent reviewers using a data extraction tool developed by the reviewers. The extracted data will include specific details about the participants, the concept, the context, the study methods, and the main results relevant to the review questions. Any discrepancies between reviewers will be resolved through discussion or by involving a third reviewer. When appropriate, the authors of the articles will be contacted to request missing or additional data if necessary.
Data Presentation
The data will be presented graphically, in diagrammatic and/or tabular form. A narrative summary will accompany the tabulated and/or graphical results, describing how the findings relate to the review’s objective and research questions.
Acknowledgments
The development of this scoping review is part of the author's master's project, which is part of the Graduate Program in Nursing at the Federal University of Santa Maria.
Funding
This work received no external funding and was self-financed by the authors.
REFERENCES
1. Ministério da Saúde (BR). Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis (DCCI) [Internet]. Testes Rápidos [acesso 2021 Dez 20]. Disponível em: http://www.aids.gov.br/pt-br/profissionais-de-saude/testes-rapidos.
2. Ministério da Saúde (BR). Presidência da República, Casa Civil. Lei n. 7.498, de 25 de junho de 1986.
3. Nações Unidas (US). Report on the Sustainable Development Goals [Internet]. New York: United Nations; 2015 [cited 2023 Abr 24]. Available from: http://abm.org.br/ods/wp-content/uploads/2017/10/Relatorio-sobre-os-Objetivod-do-Milenio-2015.pdf.
4. Cordeiro L, Soares CB. Scoping review: potentialities for a synthesis of methodologies used in qualitative primary research. BIS, Bol. Inst. Saúde (Impr.) [Internet]. Dez. 2019 [citado 2025 Fev 24]; 20(2): 37-43. Available from: https://docs.bvsalud.org/biblioref/2019/10/1021863/bis-v20n2-sintese-de-evidencias-qualitativas-37-43.pdf.
5. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC,Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI;2020 [citado 2024 Fev 24]. Available from https://synthesismanual.jbi.global.
6. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAS-cR): Checklist and Explanation. Ann Intern Med. 2018; 467-73. DOI: http://dx.doi.org/10.7326/M18-0850.
7. World Health Organization. Global Strategy for Intervention and Control of Sexually Transmitted Infections: 2016-2021. Geneva: WHO; 2016. p. 64. DOI: https://www.who.int/publications/i/item/WHO-RHR-16.09.
8. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Política Nacional de Atenção Básica. Brasília-DF: Ministério da Saúde; 2012.
Funding and Acknowledgments:
Nothing to declare.
Authorship Criteria (Author Contributions)
Caren Fabiana Alves: Contributed substantially to the study design and planning. Contributed to data collection, analysis, and interpretation. Contributed substantially to the drafting, critical review, and final approval of the published version.
Jarbas da Silva Ziani: Contributed substantially to the study design and planning. Contributed to data collection, analysis, and interpretation. Contributed substantially to the drafting, critical review, and final approval of the published version.
Igor Rodrigues Barrozo: Contributed substantially to the study design and planning, data collection, analysis, and interpretation, as well as the drafting, critical review, and final approval of the published version.
Luiza Silveira de Oliveira: Contributed substantially to the study design and planning, data collection, analysis, and interpretation, as well as the drafting, critical review, and final approval of the published version.
Eliana Rosa da Fonseca: Contributed substantially to the study design and planning, data collection, analysis, and interpretation, as well as the drafting, critical review, and final approval of the published version.
Fernando Mitano: Contributed substantially to the study design and planning, data collection, analysis, and interpretation, as well as the drafting, critical review, and final approval of the published version.
Laís Mara Caetano da Silva Corcini: Contributed substantially to the study design and planning, data collection, analysis, and interpretation, as well as the drafting, critical review, and final approval of the published version.
Declaration of Conflict of Interest
Nothing to declare.
Scientific Editor: Francisco Mayron Morais Soares. Orcid: https://orcid.org/0000-0001-7316-2519
Rev Enferm Atual In Derme 2025;99(4): e025107
Atribuição
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