Implementation fidelity of tuberculosis screening for Diabetes mellitus patients among healthcare providers offering diabetes services in Ubungo District, Dar es Salaam, Tanzania

Abstract

Globally, the risk of acquiring Tuberculosis (TB) among Diabetes mellitus (DM) patients is three 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. Therefore, this study aimed to assess the provider-level implementation fidelity (IF) and factors associated with TB screening among DM patients at public health facilities in Ubungo district. We conducted an analytical cross-sectional study from April 4th to May 25th, 2025, in 20 public facilities (3 hospitals, 5 health centers, 12 dispensaries) in the 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, a modified Poisson regression model using STATA version 16 identified factors associated with provider-level IF of TB screening among DM patients. The overall provider-level IF score was 83.0%, with (n = 78) out of 94 providers self-reporting high fidelity to TB screening guideline components. Teamwork (aPR 2.28, 95% CI 1.11-7.12; p-value = 0.032), self-efficacy (aPR 2.29, 95% CI 1.04-5.02; p = 0.024), and facility-level the provider was working, especially at the hospital level (aPR 3.60, 95% CI 1.52-8.50; p = 0.004) were significantly associated with provider-level implementation of TB screening for patients with DM. These findings suggest that collaborative teamwork, provider self-efficacy, and facility-level context influence the consistency of TB screening practices among patients with DM. Therefore, strengthening these factors could support improved implementation; however, further research is needed to establish effective strategies.