127 5 Diabetes – Tuberculosis Care in Eswatini services where they provide multiple services for patients at one service point, so patients do not queue at other service points. Table 3 – Sub-themes describing best practices by healthcare workers with illustrative quotes (Eswatini, 2022) Sub-themes Illustrative quote Staff rotation “To ensure continual service provision we do staff rotation, if a TB nurse is not available, one is always assigned to the TB department” R4 “We do have enough clinical staff because we rotate the nursing staff working on the chronic care site, we provide training to our staff so that they can familiarize themselves on HIV and TB care, this is the same staff that we normally use for the rotation” R7 Synchronized clinic visits “We allow the patients to start at the DM clinic and then come to the TB clinic so that we can assign the very same date as that of DM refill, this is a way of avoiding an instance whereby the patient has to come for TB/DM treatment at different dates, hence we are treating TB and DM as one package together with ART” R12 Health education “Health education is important to both the patient and the nurse. On the patient aspect, we need to teach the patient about the importance of insulin treatment for the good control of blood sugar and a good response to the TB drug …we are having a challenge of adherence when it comes to the patients that is why the health education is important” R5 “We then discuss with the patient what is expected and see if we can start on oral medication, we also articulate on the diet issue.” R14 Integrated services “...we have integrated the services, such that an ART patient, who has DM and TB is going to get all the services at our department even his/her medication. There is no need of going to the pharmacy or laboratory, we do everything here at our department” R3 “We have also integrated all the services at one consultation room such that ART, DM, TB and hypertension patients or any NCD patient receive all the services at one point.” R18 Fast-track services “We do NCDs screening and highlight if that patient has one and then fast-track the patient, this helps us to easily check and manage the patient monthly to avoid complications” R7 “…we normally fast-track them because we don’t want them to queue, everything is provided at one place, and we don’t want them to go here and there for their services.” R20 “But one challenge that we normally face is that patients are not honest when giving such information, they tend to say they have no history or family history of DM, such that when a patient has no family history of, we don’t fast-track that patient” R7 Bidirectional TB – DM screening and COVID-19 “…now we have adopted at least to screen all TB patients for DM and so far, we have started picking some that we were missing all along. So, in our diabetic clinic we were not screening our DM patients for TB but now we have started screening all our DM patients when they come for a refill, and we are picking patients who are TB positive, but we have been missing them all along” R11 “COVID-19 was severe for DM patients, thus in our facility we are now screening every patient above 40 for DM if they are found to be positive, we fast track them to the focal person for NCDs” R20
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