51 3 Epidemiology and control of DM-TB Comorbidity Rationale for the Research 1. There is a lack of reliable data on the burden of DM in Eswatini, both in the general population and different population subgroups. This study at its conclusion will generate reliable information on DM-TB comorbidity and the prevalence of DM and hyperglycemia in patients receiving treatment for TB. 2. With the availability of life-saving HIV/TB medications, people are living longer but are now exposed to developing diabetes due to changing lifestyles, ageing and possibly TB infection. This study will identify the risk factors for developing diabetes or hyperglycemia in people receiving treatment for TB. 3. There is an absence of evidence on factors hindering effective management of diabetes at healthcare facilities providing TB services in Eswatini. This research will identify these factors and propose context-specific solutions to improve the integration of TB and DM care. Conceptual Framework The study will be based on the Social-Ecological Model which examines different interactions which determine the health outcome of an individual (31). The different individual, interpersonal, community, organizational and policy/environmental contexts which can influence health outcomes in Eswatini in line with the social-ecological model will be considered. This will be contextualized to ascertain how these affect the services received by people while receiving treatment for TB and how service delivery can be improved. The conceptual framework presented in Figure 1 highlights the possible interactions which determine the health outcome of an individual. The components of the socialecological model have been unpacked to show the different direct and indirect relationships that exist between the components and the health outcome of an individual. Other determinants of the health outcome of an individual such as demand and supply factors are not included here. This is to enable easy interpretation and application of this framework to the context of Eswatini.
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