Table 1 Information on the Union-WHO framework
Author, Year | Country Rural / Urban Public / Private | Study design | Study population | Findings | Barriers & Facilitators | Outcomes |
|---|---|---|---|---|---|---|
Ekeke, 2017 [29], | Nigeria Urban Public & private | Cross-sectional | TB patients | T2D prevalence was 9.4%; Factors associated with T2D were: age > 40 years old, rural residence and private health facility care | Barriers: Diagnostic method used Facilitators: Authors were able to implement the screening in a routine programme setting across multiple regions and facilities with minimal additional costs and training | Feasibility and effectiveness of T2D screening among TB patients |
Shayo, 2019 [30] | Tanzania Rural & Urban Public & Private | Cross-sectional | Health facilities | Only 38.4% of all T2D facilities offer diagnosis and treatment for TB; The overall readiness of T2D facilities to provide TB services was low (12.6%); Public T2D facilities had comparatively higher availability of TB services than private ones | Barriers: Shortage of staff trained to co-manage TB in T2D care facilities; Inadequate TB management guidelines, medications, and diagnostics Facilitators: Ministry of Health (MoH) has developed the guideline for TB-T2D collaborative care; NCDs strategic plan II prioritises to train healthcare providers on the collaborative TB-T2D care | Availability and readiness of TB management in T2D facilities |
Salifu, 2020 [31] | Ghana Public | Exploratory Qualitative | Healthcare workers (HCW) | Implementing bi-directional screening was achievable, when properly implemented; Screening to detect TB among T2D patients was more organised and focused; TB task-shifting officers improved T2D patients screening for TB | Barriers: Delays in screening; Fear and stigmatisation of TB; Poor collaboration between TB and T2D units; Skewed funding for screening Facilitators: Increase in staff capacity; Institutionalisation of bidirectional screening | Co-management of TB-T2D comorbidity |
Ghana Public | Exploratory Qualitative | HCW | The study revealed 3 major themes: (1) Prioritisation of TB/HIV co-infection while negating TB-T2D comorbidity, (2) Poor working conditions, and (3) Coping mechanisms & 5 sub-themes: (1) Low knowledge and awareness on TB-T2D comorbidity, (2) Limited awareness of The Union-WHO framework among the HCW, (3) High workload in TB & T2D clinics, (4) Multiple roles, (5) Inadequate training and (6) Space shortage | Barriers: Prioritisation of TB-HIV co-infection while negating TB-T2D comorbidity, Poor working conditions, Low knowledge, and awareness on TB-T2D comorbidity, Limited awareness of The Union-WHO framework among the HCW, High workload in TB & T2D clinics, Multiple roles, Inadequate training, and Space shortage Facilitators: Coping mechanisms | Co-management of TB-T2D comorbidity |