132 Chapter 5 treatment outcomes [35]. In our study, the participants expressed concerns as the patient’s economic status limits their access to proper nutrition. This emphasizes the need for continued patient support and the adoption of the patient-centred care model in planning integrated DM – TB services [36]. Studies from Malawi and Angola indicate that integrated DM – TB services can be beneficial [15,17]. In Malawi, they observed no loss to follow-up where services are integrated compared to where there is none or limited integration (14·8%) with higher retention in care of 62·5% after two years for people with diabetes where there is integration compared to 41·8% in sites with no integration [17]. The study from Angola aimed to assess the burden of NCDs amongst TB patients and pilot the integration of diabetes and hypertension screening within the TB program. They observed a high burden of NCDs amongst TB patients and noted that the absence of screening guidelines and protocols to guide patient management limited the implementation of integrated TB – NCD services [15]. Using a qualitative design enabled the collection of comprehensive information on the DM – TB integration. We selected health facilities and healthcare workers across the four regions to ensure adequate representation. To ensure findings will be useful for TB programming, the study focused on the TB program’s key priorities following engagement with the TB program. Finally, the study team consists of diverse expertise, including qualitative research and TB programming. Our study has some limitations. First, healthcare workers from non-selected sites (including some private health facilities) may have had different views based on their training and experiences. Secondly, we did not include community-based organizations that mainly see patients on an outreach basis. Healthcare service delivery in community settings is different from facility-based care and presents different opportunities that could have been included for improvement. Finally, we did not include other healthcare workers who support patient care such as pharmacists, laboratory scientists, adherence, and psychosocial officers, etc. These staffs provide vital services along the care continuum and interact with patients. Their views could have added to describing the care processes and some opportunities that could be improved overall. Nevertheless, we believe the evidence provided in this study will be vital to improving DM – TB care in Eswatini and other LMICs.
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