Barriers and facilitators associated with diagnostic and treatment delays in lupus in the Global South and North: a systematic review of qualitative and mixed methods studies.

Currently, there is no specific definition of delay in the diagnosis and treatment of systemic lupus erythematosus. This study aimed to describe the experiences of diagnostic and treatment delays in lupus, along with their associated barriers and facilitators, and to contrast this phenomenon in the Global South and North. A qualitative systematic review of the literature was conducted following the Joanna Briggs Institute and PRISMA guidelines. A targeted electronic search strategy was performed in Scopus, PubMed, and Web of Science. This protocol was registered with the international prospective register of systematic reviews (PROSPERO CRD42023456508). From 1,135 identified registries, 12 (ten qualitative and two mixed methods) articles were included in the analysis, most from the Global North. None of the publications clearly define diagnostic delay in lupus. Patients, caregivers, and healthcare professionals identified a range of barriers and facilitators. Misdiagnosis, miscommunication, the lack of rheumatology knowledge and education, and the diagnostic pilgrimage were barriers reported in both regions. In the Global South, barriers were related to a fragmented and complex healthcare system, stigma, and economic and geographic difficulties. In the Global North, physician-patient interactions and reliance on antinuclear antibody testing were significant barriers. The reported facilitators mostly comprised individual-level factors like self-care and resilience. This review highlights the lack of a clear definition of diagnostic and treatment delays in lupus, integrating the perspectives of patients, family and caregivers, and healthcare providers. The contrasting emphasis on external context factors in the Global South may reflect underlying health inequalities.