169 8 Summary, Nederlandse Samenvatting Chapter 4 presents findings from the prospective cohort study of patients who commenced TB treatment. Three hundred and sixty-nine patients were enrolled into TB care from 11 purposively selected health facilities from the four regions of Eswatini from 01 June to 30 September 2022. The median baseline blood glucose was 5.5mmol/l, and the baseline prevalence of elevated blood glucose was 8%. A family history of diabetes and a reactive HIV status predicted elevated baseline blood glucose. Threequarters of the patients had a favourable TB treatment outcome, and the most common unfavourable treatment outcome was death. Hypertension and unemployment were positive predictors of unfavourable treatment outcome, while high school education and education in general was protective from unfavourable treatment outcome. The blood glucose of patients was not associated with unfavourable outcomes. Large cohort studies are required to identify the causes of death in patients receiving TB treatment and recommendations on how to prevent these deaths. Chapter 5 identifies opportunities and recommendations for improving diabetestuberculosis integrated services in a low- and middle-income country. Most of the healthcare workers indicated they provide integrated diabetes–tuberculosis services, although with different challenges, including staff shortages, limited availability of reporting tools, limited knowledge on care for TB patients with comorbid conditions, frequent stockouts of laboratory testing commodities (glucose test strips, HbA1c, GeneXpert Cartridges, TB-Lam and culture) for screening and monitoring of patients for diabetes and tuberculosis, and frequent stock out of drugs for treatment of diabetes and tuberculosis. Non-adherence to treatment, late presentation and low socioeconomic status of some patients are the patient-level factors identified by the healthcare workers. Despite the limitations, healthcare workers used fast-track services, bidirectional screening, staff rotation, synchronized clinic visits and health education to improve their patients’ services. This study emphasizes the need to ensure healthcare workers are trained and provided with updated treatment guidelines with appropriate systems to ensure the availability of pharmaceutical and laboratory supplies. Standardizing patient support services to provide counselling and psychosocial support, health education, treatment adherence counselling, transport and nutritional support can increase treatment adherence and improve treatment outcomes. Chapter 6 describes the impact of the COVID-19 pandemic on TB service delivery and approaches adopted by healthcare workers for continued service delivery. At the pandemic’s peak, services other than those targeting COVID-19 were limited, health system challenges worsened, and patients defaulted treatment due to movement restrictions to control infections. Increased risk of COVID-19 infection amongst healthcare workers with limited availability of personal protective equipment negatively impacted
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