133 5 Diabetes – Tuberculosis Care in Eswatini Recommendations The healthcare workers have identified different opportunities but some of these e.g., additional human resources, and new laboratory equipment are resource intensive and may require long-term planning to achieve. However, some immediate actions can be taken to ensure improved service delivery. First, is developing a standardized treatment algorithm to guide healthcare workers on how to care for TB patients with NCDs including hypertension and DM. This can be adapted from the guidelines provided by TB Union while ensuring the local context is incorporated [37]. Healthcare workers can be trained on this standardized algorithm with more experienced clinicians serving as mentors. Secondly, the TB program collaborating with the health promotion unit can develop standardized information, education, and communication (IEC) materials for comprehensive patient education that will include information on NCDs and nutrition based on the staple food in Eswatini. Third, indicators for monitoring NCDs amongst TB patients should be tracked in the national reporting system. This will ensure the availability of NCD data for TB patients, and a routine review of this data by the program and stakeholders will identify program needs and guide interventions. Finally, stock out of drugs and other commodities hinders effective care for patients. The procurement process for pharmaceutical commodities can be complex and prolonged. This became worse as the COVID-19 pandemic impacted global supplies. One way of addressing this is to train and mentor healthcare workers to keep accurate records and timely orders of supplies once they have the recommended minimum stock. Issues around financing for the procurement of drugs and laboratory supplies are complex and require multisectoral engagement. Conclusion There is limited implementation of DM–TB integration at health facilities included in this study as the quality and current standard of care varies across health facilities. While challenges and opportunities exist to improve the implementation of DM–TB integration, healthcare workers currently adopt different practices to ensure continued service delivery. Addressing the different patient-level and health system challenges and utilizing the available opportunities is vital for successfully implementing the DM–TB services integration.
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