Implementation Fidelity of Diabetes Mellitus Screening Among Tuberculosis Patients in Primary Healthcare in Karanganyar District, Indonesia: A Mixed-Method Study.

Abstract

Background: Indonesia faces a dual burden of high tuberculosis (TB) burden and rising diabetes mellitus (DM) prevalence. Given that DM is a significant risk factor for TB, screening people with TB for DM comorbidity is important for early management to mitigate adverse outcomes.

Objectives: This study aimed to measure the degree of implementation fidelity, moderating factors, and barriers to implementing DM screening among TB patients in Indonesia's Primary Healthcare setting.

Methods: A sequential explanatory mixed method was used. A cross-sectional survey was conducted with 42 Directly Observed Treatment, Short-course providers to assess adherence to DM screening guidelines. Screening coverage was evaluated through the TB information system. In-depth interviews with providers, managers, and patients identified key barriers and enablers.

Results: Screening coverage ranges from 36.3% to 97.6% between 2020 and 2024. High fidelity was reported among providers, with 95% screening for DM at the time of TB diagnosis. Facilitators included TB-DM policy availability, screening affordability, provision of equipment, and patients' responsiveness. However, delays in data reporting and insufficient cross-sector collaboration posed challenges to the implementation.

Conclusion: Despite positive progress in integrating TB-DM care, addressing barriers is essential to optimize the programme's impact. Strengthening reporting mechanisms and fostering collaboration could enhance programme outcomes.