161 7 General Discussion About 10% of patients receiving TB treatment died, and this was not associated with HIV. This outcome is a cause for concern and requires additional study to determine the predictors of mortality in people receiving TB treatment apart from HIV and how these can be addressed. Some patients in our study had abnormal baseline blood glucose during treatment. A cohort study post-TB treatment would help determine the DM risk of these patients. The outcome of this study can guide future DM prevention interventions. The scope of this thesis did not accommodate patient perspectives, which could have provided more insight into different factors that impact how they access DM-TB care. Therefore, a future qualitative study targeting patients will clarify the dynamics influencing access to health care from their point of view, with recommendations on how provided services could better meet their needs. Dissemination of key learnings The key lessons from this thesis will be summarised and presented to the Eswatini Ministry of Health and participating health facilities with contextualised recommendations on improving DM-TB services. Additional feedback to stakeholders will be done during the national technical working group meeting for TB/HIV care. Conclusion This thesis has described the risks of DM-TB comorbidity and different opportunities that could improve service delivery for this comorbid condition. Despite technological advancements and significant global progress in diagnosing and treating diabetes and tuberculosis, avoidable deaths still occur. Ministries of health and health program implementers must engage all relevant stakeholders to identify and address funding, research, infrastructure, and service delivery gaps in DM-TB services. Most importantly, a comprehensive improvement in health system planning and service delivery is necessary to overcome disease-specific challenges as they rely on infrastructure from the overall system. In essence, sustaining quality services in one program area will be difficult when the system is dysfunctional. Therefore, a systemwide improvement is required and needs advocacy and commitment by different stakeholders.
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