119 5 Diabetes – Tuberculosis Care in Eswatini Before the COVID-19 pandemic, there was a limited effort at integrating DM–TB, but in 2021, tools for the screening of TB patients for NCDs including DM became available. This process is still in its infancy with limited data available to assess the level of implementation or guide practice and policy for TB patient care. This study assesses the integration of DM care into TB services at select health facilities in Eswatini and describes the availability of basic services, equipment, and commodities for integrated TB–DM services delivery, best practices by healthcare workers, key challenges, and recommendations on how services can be improved. Methods Study design, setting, and participants This qualitative study (with a pilot survey) is part of an ongoing prospective cohort study of newly enrolled patients in TB care in Eswatini from June 2022 and is based on the social-ecological model. The social-ecological model explores various relationships – individual, interpersonal, community, organisational, and policy/environmental factors which determine the health outcome of an individual [26,27]. Healthcare workers from twelve health facilities were purposively selected to participate in the study – a pilot survey followed by a semi-structured interview. The health facilities were selected from the four regions of Eswatini based on the highest average number of new tuberculosis patients enrolled in the two quarters before this study. These consisted of five hospitals, one health centre, and six primary care clinics. The healthcare workers were invited to participate if they were doctors or nurses, worked in the TB clinic for at least one year, and directly provided routine care to TB patients. A minimum of two healthcare workers (one doctor and one nurse) who met the above criteria were purposively selected from the TB clinic for interview per health facility. It was expected saturation would be achieved after interviewing 20 – 30 participants [28]. Data collection and interviews Healthcare workers who met the selection criteria and consented to participate were interviewed between May and June 2022. They were requested to respond to a short survey administered through REDCap [29] before the interview. The survey obtained basic demographic details of the healthcare worker, the availability of certain services, and basic requirements for DM-TB care at their health facilities (Supplementary file 1). A semi-structured interview guide was used to obtain healthcare workers' views on DM– TB care, challenges during service delivery and recommendations for improvement (Supplementary file 2). A trained research assistant fluent in English and Siswati conducted
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