Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
Health and Development Solutions Network, Tamale, Ghana.
PLoS One. 2020 Jul 14;15(7):e0235914. doi: 10.1371/journal.pone.0235914. eCollection 2020.
The tuberculosis (TB) and diabetes mellitus (DM) co-epidemic continues to increase globally. Low-and middle-income countries bear the highest burden of co-epidemic, and Ghana is no exception. In 2011, the World Health Organisation (WHO) responded to this global challenge by launching a collaborative framework with a view to guide countries in implementing their DM and TB care, prevention and control plans. Subsequently, several countries, including Ghana, adopted this framework and began implementing bidirectional screening of TB and DM patients. Almost a decade later since the launch of the framework, the implementation of bidirectional screening in Ghana has not been subjected to empirical research. This study explored the barriers and facilitators to bidirectional screening through the lenses of the implementing healthcare workers.
This was an exploratory qualitative study conducted in three public health facilities offering both TB and DM services in Northern Ghana. In-depth interviews, document review and observations, were used to generate data. In total twenty-three healthcare workers (doctors, nurses, prescriber, health managers and TB task- shifting officers delivering care in TB and DM clinics) were interviewed, using semi-structured interview guides. The interview questions solicited information on the screening process, including knowledge of the collaborative framework, comorbidity, collaboration and workload.
Six themes emerged from the analysis, of which two (Increase in staff capacity, and Institutionalisation of bidirectional screening) were facilitators, and four (Delays in screening, Fear and stigmatization of TB, Poor collaboration between TB and DM units, and Skewed funding for screening) were barriers.
The implementation of bidirectional screening at public health facilities in Ghana was evident in this study and increased staff capacity, funding and institutionalisation enhanced the policy implementation process. However, the screening of TB patients for DM is yet to be prioritised, and emphasis should be put on the design for cost-effective screening approaches for low- and middle-income countries.
结核病（TB）和糖尿病（DM）的共同流行在全球范围内继续增加。中低收入国家承担着共同流行的最大负担，加纳也不例外。2011 年，世界卫生组织（WHO）通过发起一个合作框架来应对这一全球挑战，旨在指导各国实施其 DM 和 TB 护理、预防和控制计划。随后，包括加纳在内的几个国家采用了这一框架，并开始对 TB 和 DM 患者进行双向筛查。自该框架启动近十年后，加纳的双向筛查实施情况尚未经过实证研究。本研究通过实施医疗保健工作者的视角探讨了双向筛查的障碍和促进因素。
这是一项在加纳北部的三个提供 TB 和 DM 服务的公共卫生机构进行的探索性定性研究。使用深入访谈、文献回顾和观察来生成数据。共对 23 名医疗保健工作者（在 TB 和 DM 诊所提供护理的医生、护士、处方者、卫生经理和 TB 任务转移官员）进行了采访，使用半结构化访谈指南。访谈问题旨在了解筛查过程，包括对合作框架、合并症、合作和工作量的了解。
分析得出了六个主题，其中两个（增加员工能力和双向筛查的制度化）是促进因素，四个（筛查延误、对 TB 的恐惧和污名化、TB 和 DM 单位之间合作不佳以及筛查资金偏斜）是障碍。
本研究表明，加纳公共卫生机构实施双向筛查的情况明显，增加员工能力、资金和制度化增强了政策实施过程。然而，对 DM 患者进行 TB 筛查尚未得到优先重视，应重视为中低收入国家设计具有成本效益的筛查方法。
