129 5 Diabetes – Tuberculosis Care in Eswatini “The standard of care is okay, there are only issues with the white card, one is detailed, and the other is not, now we do not have the detailed white card which I guess it’s the new one, it is very simple and straightforward” R15 DM and TB diagnosis Most participants agreed they had challenges screening for and diagnosing DM due to recurrent stockout of glucometer test strips, absence of a glucometer, variable access to the HbA1c due to lack of reagents, and an unfavourable schedule for specimen submission. For instance, only 6 and 14 respondents reported providing baseline HbA1c and a fasting/random blood glucose test for patients respectively. In addition, 16 and 13 respondents reported stock out of urinalysis and blood glucose test strips respectively in the previous six months. Additional concerns were the absence of GeneXpert cartridges, the long turnaround time for sputum culture, and the limited availability of TB-lam. “We do face numerous challenges, taking for instance, last month we had challenges with cartridges in the laboratory which made it difficult to transition a patient from an intensive phase to a continuation phase…” R2 “… we do not have a glucometer and a BP cuff such that when a patient comes, you need to run around borrowing from other departments and we end up not doing the proper routine care” R10 “We normally run out of glucose strips...” R16 Availability of drugs The participants acknowledged frequent stock-out of medication for the treatment of NCDs and tuberculosis. From the survey, the participants indicated a stockout of antihypertensive medication, insulin, and oral DM drugs within six months of the date they were interviewed. “… shortage of insulin; some patients who are taking the 500mg doses (Metformin) are sometimes given the 850mg doses due to shortage of stock” R3 “…for the past 2 months we did not have metformin 500mg which is a drug that we normally give to TB patients who are diabetic, hence this is a rural area patients cannot afford private pharmacies” R17 Recommendations Participants provided recommendations on how DM – TB services integration can be improved. This is summarized in Table 4.
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