Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania

Stellah G. Mpagama (), Kenneth C. Byashalira, Nyasatu G. Chamba, Scott K. Heysell, Mohamed Z. Alimohamed, Pendomartha J. Shayo, Albino Kalolo, Anna M. Chongolo, Catherine G. Gitige, Blandina T. Mmbaga, Nyanda E. Ntinginya, Jan-Willem C. Alffenaar, Ib C. Bygbjerg, Troels Lillebaek, Dirk L. Christensen and Kaushik L. Ramaiya
Additional contact information
Stellah G. Mpagama: Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania
Kenneth C. Byashalira: Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania
Nyasatu G. Chamba: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania
Scott K. Heysell: Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908-1340, USA
Mohamed Z. Alimohamed: Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania
Pendomartha J. Shayo: Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania
Albino Kalolo: Department of Public Health, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara 67501, Tanzania
Anna M. Chongolo: Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania
Catherine G. Gitige: Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania
Blandina T. Mmbaga: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania
Nyanda E. Ntinginya: National Institute of Medical Research-Mbeya Medical Research Centre, Hospital Hill Road, Mbeya 53110, Tanzania
Jan-Willem C. Alffenaar: Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia
Ib C. Bygbjerg: Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
Troels Lillebaek: Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
Dirk L. Christensen: Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
Kaushik L. Ramaiya: Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania

IJERPH, 2023, vol. 20, issue 17, 1-14

Abstract: Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods : This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs’ reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results : From 2019–2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6–19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0–3) ( p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35–75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions : It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.

Keywords: integration; communicable and non-communicable diseases; tuberculosis; diabetes (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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