55 3 Epidemiology and control of DM-TB Comorbidity and treatment centre and all patients relocated to one of these selected facilities. Eswatini is a landlocked country in Southern Africa with a population of about 1.2 million (29). It is surrounded by South Africa, except in the North-East which is bordered by Mozambique. Patients on drug-susceptible TB treatment in Eswatini receive treatment for 6-9 months depending on if they have received the first-line drug before and are followed up monthly till after two consecutive sputum conversions (expected in the 2nd or 3rd month). Monthly follow-up continues after sputum conversion till they complete treatment. Sputum microscopy for Acid Fast Bacilli (AFB) and culture are reviewed on each follow-up visit. Drugresistant tuberculosis (DRTB) patients are initially admitted until they have two consecutive negative sputum culture tests (sputum conversion) before discharge and monthly followup visits for clinical evaluation which includes medication review, sputum AFB and culture results review, and general assessment. The duration of treatment for DRTB is varied and can last 12-24 months depending on the drug regimen and response to treatment. Patients receive routine laboratory assessments during their treatment including fasting blood glucose at baseline, twice during treatment and at the end of treatment before final discharge. Three follow-up visits post-discharge is advocated but most patients do not keep this appointment except those receiving antiretroviral medications from the same facility. Study Population From 2015 to 2020, about 19, 000 patients received treatment for tuberculosis in Eswatini and 6% of these were pediatric patients (32). The male-female ratio ranged from 1.4 to 1.6 within the same period and the TB/HIV co-infection rate in 2020 was 64% (32). Report of other comorbidities e.g., T2DM, or hypertension is not available. For the years 2015 – 2020, about 98% of all patients have a documented treatment outcome for all types of tuberculosis and the treatment success rate in 2019 and 2020 was 89% and 86% respectively (32). Different cadres of healthcare workers provide care for TB patients but those who will participate in the key informant interview will be nurses and doctors. Sampling and Sample Size A consecutive sampling approach will be used to enrol newly diagnosed TB patients on the study. Current TB program data indicate that on average, in a period of four months, about 410 patients are enrolled on TB care at the 12 selected health facilities. Therefore, it is estimated that a minimum of 380 – 430 participants will be enrolled on this study. Using an estimated diabetes prevalence of 3.6% in Eswatini (27), an effect size of 0.05
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