Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

Abstract

IntroductionMost sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.Methods and analysisThe model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.Ethics and disseminationEthical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders’ example in conferences and social media.

Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania

“…ADEPT is a programme, which aims to strengthen the health system in managing communicable and non-communicable diseases using TB/DM as a case study in Tanzania. Before the implementation, we used a stepwise training approach for knowledge and skills improvement for the health care providers as described in the ADEPT model [ 18 ]. In brief, health care providers (medical doctors and nurse officers) from the implementation sites were trained using both web-based and face-to-face modules to acquire theoretical and clinical skills on the objectives, methodology and procedures.…”

“…In brief, health care providers (medical doctors and nurse officers) from the implementation sites were trained using both web-based and face-to-face modules to acquire theoretical and clinical skills on the objectives, methodology and procedures. At the same time, their competencies are being accessed using predefined criteria [ 18 ]. Additionally, each of the health facilities was issued a diabetes screening kit containing; a POC glucometer machine with glucose test strips (GlucoPlus™ Inc; 2323 Halpern, Ville St-Laurent, Canada), and HbA1c analyser (HemoCue Hb1c 501 system- HemoCue AB;SE-262 23, Ängelholm, Sweden), a portable point of care device which is not affected by TB induced hyperglycaemia, and does not require a fasting state [ 2 ] with HbA1c cartridges.…”

“…In response to the stark findings of the readiness assessment, we designed an Adaptive Disease control Expert Programme model in Tanzania (ADEPT) to guide the country to integrate DM screening and care into the TB health care services [ 18 ]. Our initial plan included integrating dual screening and linkage of TB and DM in the health system, and increasing the training of health care providers regarding DM screening using diagnostic equipment such as glucometers with gluco-strips and glycated haemoglobin (HbA1c) at various levels of health facilities [ 18 ]. The aim was to perform DM screening at the TB clinic according to the Ministry of Health, Community Development, Gender, Elderly and Children’s national guideline for TB/DM collaborative care [ 13 ].…”

Where can Tanzania health system integrate clinical management of patients with dual tuberculosis and diabetes mellitus? A cross-sectional survey at varying levels of health facilities

“…Recognizing the complexities of drug-drug or drug-disease interactions particularly in TB/DM with or without HIV, this presents as a new epidemic in our time. We designed a model to create a patient centered approach and supported the health facilities with tools for optimal clinical management of TB and DM [ 17 ]. Prior to implementation of the model, we examined service availability and readiness of Tanzanian health facilities at varying levels focusing on parameters such training of clinicians, ability to monitor safety, and other factors to integrate diagnosis and clinical management of dual TB and DM services.…”

Readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania: A nationwide analysis for evidence-informed policy-making in high burden settings

“…The increasing dual tuberculosis and diabetes mellitus diagnosis in Tanzania [ 22 ] indicate an important public health agenda. However, as of 2015, the National Tuberculosis and Leprosy Program (NTLP) lacked clear commends on screening for DM among TB patients and vice versa [ 23 ].…”