The Provision of Care for Patients with Tuberculosis and Diabetes Mellitus Multi-Morbidity in Addis Ababa, Ethiopia: An Analysis of Patients' Perspectives.
Providing care for effective management of tuberculosis (TB) and diabetes mellitus (DM) is a challenge, particularly in resource-limited settings. This study assessed factors affecting the provision of care for patients with TB-DM in Addis Ababa, Ethiopia, using the six elements of the SELFIE-Sustainable intEgrated chronic care modeLs for FinancIng and performancE framework. A health facility-based cross-sectional study was conducted with randomly selected patients with TB-DM multi-morbidity. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 27. Logistic regression was employed to identify factors influencing TB-DM care provision. A total of 357 respondents participated, with a response rate of 96.5%. The mean age of the respondents was 49.8 years. Only 13.4% of patients received good TB-DM services. Key factors influencing TB-DM care were (a) insufficient counseling on the proper use of medication (AOR = 2.6, CI: 1.1-6.6, p = 0.035) and the risk of TB for DM patients (AOR = 10, CI: 3.7-27, p < 0.001), (b) leadership and governance including supportive leadership for TB-DM care (77.1%), organized TB-DM care (62.5%), the presence of a care policy (77.1%), and continuity of care (58.3%), (c) workforce factors such as the presence of a multidisciplinary team (60.4%), TB-DM service coordinator (58.3%), HCWs with adequate knowledge (87.5%), (d) costs of health services are fair (75%) and (e) lack of technologies such as EMR (88%) and lack of medical products to treat TB-DM (64.7%) delays care for TB-DM. Most TB-DM patients in Addis Ababa had limited access to care. The continuous monitoring of services can facilitate the identification of care gaps, thereby guiding the implementation of improved interventions.