How do knowledge hubs support translation of evidence into practice and policy and improve care for non-communicable diseases in low- and middle-income countries? A systematic review

The burden of non-communicable diseases (NCDs) is rising in low-and middle-income countries (LMICs), and limited health service resources are contributing to an evidence-practice gap. Knowledge hubs represent a promising strategy to increase knowledge translation, capacity development, and generate contextually relevant evidence. Despite their potential, little is known about how to best to design, implement and scale up NCD knowledge hubs in LMICs. A systematic review of five electronic databases and grey literature searches were conducted to identify peer-reviewed studies published up to September 2024. Included studies described or evaluated knowledge hubs to improve NCD care in LMICs such as strategies used to develop, sustain or scale up the hub; processes used to support stakeholders or communities to engage with the hub; or mechanisms used by the hub to translate evidence into policy or practice. Data extraction and synthesis were conducted by two reviewers using a structured framework. Twenty-five publications describing 17 knowledge hubs were included. Most hubs originated in high income countries (HICs) and focused primarily on cancer care. All hubs reported using multiple capacity development strategies. Only two knowledge hubs reported engaging with patients or community groups. Strategies for scaling up knowledge hubs included: leveraging existing infrastructure, using technology, leveraging existing funding, and enabling phased expansion of hub sites. Key strategies to support policy and practice change included: developing protocols and guidelines, using monitoring and evaluation processes, adapting roles and responsibilities, using technology, and hosting conferences or symposiums. Nine studies evaluated hub activities, with some noting improvements in knowledge and practice post-implementation of the hub. However, all evaluations were limited in their methodological quality. Knowledge hubs have emerged as a vital tool for enhancing NCD care in LMICs, bridging the gap between evidence and practice. Areas for improvement include a need for greater diversity in addressing NCDs beyond cancer, evolving towards more local ownership and sustainability, and increasing patient and community involvement. Rigorous evaluation of the impact of hubs on health outcomes, policy change, and health system strengthening is also crucial to inform best practices and advocate for sustained investment. The systematic review was preregistered with PROSPERO (CRD42024584992) www.crd.york.ac.uk/PROSPERO/view/CRD42024584992 . Not applicable.