126 Chapter 5 a clinic or the healthcare worker was a nurse. Additional care includes counselling for lifestyle modification and assessment for complications. “If the patient has already been diagnosed with DM and is on treatment, we continue with the treatment. But if I test a patient and find that he/she has abnormal blood glucose and is not a known DM patient, I refer that patient to the doctor for review” R10 Pill burden for TB patients with DM There was a concern associated with adherence due to the pill burden, and the fact DM care was previously not prioritized until the COVID-19 pandemic. “…diabetes mellitus needs more attention than HIV these days. HIV is well funded, patients are now taking one pill per day, but with DM, patients are taking 3-4 tablets” R8 “If I can be precise, there has been poor sensitization of DM, it only gained much attention during the COVID-19 era… we knew about DM but there was no clear guidance and proper management.” R7 COVID-19 affected services delivery The participants also described how the different health measures adopted during the COVID-19 pandemic affected healthcare services resulting in sub-optimal patient care. “If you were living with TB, hypertension or DM during the COVID era, follow-up was poor, because there was an instance where we lowered the volume of people visiting the facility for infection control purposes, hence we were giving patients 3 months, thus in the 3 months no one was following if you have been doing well or if your blood sugar was controlled, so by the end of the 3 months most patients were elevated.” R8 “Patients were not coming to the clinic for monitoring and check-ups due to fear of contracting COVID, this led to other patients being severely attacked by TB and others had their DM escalated” R7 Best practices Participants described some of the best practices they adopted to continue providing healthcare services (Table 3). These include staff rotation, a process where they are routinely reassigned to work in different units and departments within the health facility; synchronizing patients' clinic visits so they can receive care for multiple health conditions on the same day; routinely providing health education for their patients; and integrating
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