142 Chapter 6 2.2 Study design and setting This qualitative study, evaluated cross-sectionally, is based on the socio-ecological framework and is part of a prospective cohort study which has been described earlier 12. Healthcare workers from eleven health facilities in Eswatini were interviewed to identify barriers to TB and integrated TB–DM services, the effect of COVID-19 on TB and TB-DM services and the practices adopted to ensure sustained services delivery. This article focuses on the effect of COVID-19 on TB services and the different practices adopted by healthcare workers to ensure sustained TB services. The research team consists of specialist physicians and epidemiologists (AV, MC, SH, DEG, VW), a nurse practitioner in the national TB program (LM), a biostatistician experienced in quantitative and qualitative TB research (KO), an epidemiologist and global health researcher (KKG). 2.3 Data collection The eleven health facilities selected for this study consist of five hospitals, one health centre and five primary care clinics across the four regions in Eswatini. The facilities were purposively selected based on a ranking criterion of the highest number of patients two quarters before the study. Doctors and nurses were invited to participate if they had worked at the health facility for a minimum of one year and provided care for TB patients. Those who met the inclusion criteria and provided informed consent were included. Interviews were conducted between May and June 2022 by a trained research assistant assisted by the principal investigator at the clinic. Participants informed consent included consent to record the interviews. One participant declined to consent to the recording and interview notes were taken. Participants received an orientation on the study and a study information sheet. In-person interviews were conducted with 20 participants and two participants were interviewed telephonically. A semi-structured interview guide (Supplementary file 1) was used for the interview. Each interview lasted 30–45 minutes and healthcare workers used the language of their preference (English or Siswati). The study was approved by the Eswatini Health and Human Research Review Board (EHHRRB036/2021). 2.4 Data analysis Each interview was transcribed immediately afterwards without linking it to the healthcare worker. The research assistant and the study principal investigator reviewed each transcript against the interview recording to ensure the accuracy of the transcript. Inductive and deductive codes were identified from the transcripts and documented in a codebook (VW). Similar codes in the codebook were grouped into
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