Tuberculosis and Diabetes in India: Stakeholder Perspectives on Health System Challenges and Opportunities for Integrated Care.
Shaffi Fazaludeen Koya, Jinbert Lordson, Salman Khan, Binod Kumar, Chitra Grace, K Rajasekharan Nayar, Vinod Kumar, Anand M Pillai, Lal S Sadasivan, A Marthanda Pillai, Abu S Abdullah
Author Information
Shaffi Fazaludeen Koya: Global Institute of Public Health, Trivandrum, Kerala, India. ORCID
Jinbert Lordson: Global Institute of Public Health, Trivandrum, Kerala, India.
Salman Khan: Global Institute of Public Health, Trivandrum, Kerala, India.
Binod Kumar: Independent Public Health Consultant, Patna, Bihar, India.
Chitra Grace: Global Institute of Public Health, Trivandrum, Kerala, India.
K Rajasekharan Nayar: Global Institute of Public Health, Trivandrum, Kerala, India.
Vinod Kumar: Global Institute of Public Health, Trivandrum, Kerala, India.
Anand M Pillai: Global Institute of Public Health, Trivandrum, Kerala, India.
Lal S Sadasivan: Global Institute of Public Health, Trivandrum, Kerala, India.
A Marthanda Pillai: Global Institute of Public Health, Trivandrum, Kerala, India.
Abu S Abdullah: Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China. abu.abdullah@dukekunshan.edu.cn.
BACKGROUND: India has a dual burden of tuberculosis (TB) and Diabetes mellitus (DM). Integrated care for TB/DM is still in the early phase in the country and can be considerably enhanced by understanding and addressing the challenges identified from stakeholders' perspectives. This study explored the challenges and opportunities at individual, health system and policy level for integrated care of TB/DM comorbidities in India. METHODS: We used an outlier case study approach and conducted stakeholder interviews and focus group discussions with relevant program personnel including field staff and program managers of TB and DM control programs as well as officials of partners in Indian states, Kerala and Bihar. RESULTS: The integrated management requires strengthening the laboratory diagnosis and drug management components of the two individual programs for TB and DM. Focused training and sensitization of healthcare workers in public and private sector across all levels is essential. A district level management unit that coordinates the two vertical programs with a horizontal integration at the primary care level is the way forward. Substantial improvement in data infrastructure is essential to improve decision-making process. CONCLUSION: Bi-directional screening and management of TB/DM comorbidities in India requires substantial investment in human resources, infrastructure, drug availability, and data infrastructure.
