preprint · medRxiv
Individuals with diabetes mellitus face three times the risk of contracting tuberculosis compared to the general population, alongside worse treatment outcomes. While national guidelines advise routine tuberculosis screening for diabetes patients, adherence has historically been poor. A cross-sectional evaluation of ninety-four healthcare providers across twenty public health facilities in Ubungo district assessed implementation fidelity to these guidelines. Overall, eighty-three percent of the providers achieved high fidelity scores, while seventeen percent demonstrated low fidelity. Key drivers of successful adherence included effective teamwork, individual provider self-efficacy, and working within higher-tier facilities such as hospitals rather than dispensaries or health centres. These findings indicate that supporting healthcare teams and strengthening provider confidence through structured training programmes could bolster routine tuberculosis screening in diabetes clinics.
Diabetes significantly increases the vulnerability to tuberculosis and worsens patient health outcomes. Identifying operational bottlenecks and enablers in routine clinic settings helps health administrators design targeted training and workplace interventions, ultimately ensuring that patients at high risk of tuberculosis receive timely screening and care.
The findings can inform the design of healthcare workforce training packages, clinical workflow tools, or public health management programmes targeting chronic disease integration. The potential users are public health authorities, hospital managers, and medical training organisations. As an observational health systems evaluation, this work represents early-stage implementation research rather than a ready-to-deploy commercial product.
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Abstract Globally, the risk of acquiring Tuberculosis (TB) among Diabetes mellitus (DM) patients is three (3) times higher than in the general population. Patients with DM not only have a high risk of getting TB disease but also have poor treatment outcomes Despite the National TB guideline recommending TB screening among DM patients, adherence remains low. This study aims to assess the implementation fidelity (IF) and factors affecting TB screening for DM patients among providers offering DM services in public health facilities in Ubungo district. We conducted a descriptive cross-sectional study from April 4 th to May 25 th , 2025, in 20 public facilities (3 hospitals, 5 health centers, 12 dispensaries) in Ubungo district using quantitative methods among 94 health providers offering DM services. Data were collected through a questionnaire and analyzed for fidelity levels (low or high) using descriptive statistics. Then, regression models using STATA version 16 identified factors affecting the fidelity of TB screening for DM patients among the healthcare providers offering DM services. The overall fidelity score was 83.0% with (n=78) out of 94 providers achieving high fidelity, with only 17.0 % (n=16) of the total providers having lower fidelity levels. Teamwork (aPR 2.28, 95% CI 1.11–7.12; p-value =0.031), self-efficacy (aPR 2.29, 95% CI 1.04–5.02; p-value =0.024), and facility-level the provider was working, especially hospital level (aPR 3.60, 95% CI 1.52–8.50; p-value =0.004) were significantly associated with IF of TB screening for DM patients among healthcare providers. Key factors influencing TB screening for DM patients among healthcare providers were effective teamwork, self-efficacy, and the level of the facility where the healthcare was working, such as hospitals. Therefore, strengthening teamwork and provider self-efficacy through training, is critical in universalizing high-fidelity practice and accelerating TB screening for DM patients among healthcare providers offering DM services in Ubungo district.
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DOI: 10.64898/2025.12.12.25342133
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