Kenneth Chamba
Numerous evidence-based health interventions, especially within low-income contexts, have not yielded the anticipated outcomes. To tackle systemic obstacles in healthcare delivery, we devised the Adaptive Diseases Control Expert Programme (ADEPT) in Tanzania. Our focus was on examining the workability, acceptability, and effectiveness of this model using tuberculosis (TB) and diabetes mellitus (DM) as prototypes. This initiative followed an effectiveness-implementation hybrid type-3 design, which was executed in the Dar es Salaam, Iringa, and Kilimanjaro regions. The approach involved a gradual training methodology facilitated by web-based platforms that incorporated Gibbs' reflective cycle. We expanded health facilities providing TB services to encompass DM diagnostic capabilities, including glycated hemoglobin A1c (HbA1c) measurements. To ensure adherence, a clinical audit was employed as an evaluative tool. To evaluate the model's adherence, acceptability, and feasibility, we employed both retrospective and cross-sectional methodologies. Our findings from 2019 to 2021 demonstrated that health facilities implementing the ADEPT intervention consistently identified a greater number of individuals with both TB and DM (median of 8, IQR 6-19) compared to control facilities (median of 1, IQR 0-3) (p=0.02). Moreover, the application of HbA1c in TB/DM cases within intervention sites proved to be clinically valuable, reaching 63% (IQR: 35-75%), while control sites exhibited no utilization at any level. Although other aspects of the standard clinical management for patients with both TB and DM showed no significant differences, the positive impact of the ADEPT intervention was evident.
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