Teamwork and confidence boost TB screening for diabetes patients

Tuberculosis (TB) is a particular concern for people living with Diabetes mellitus (DM): globally the risk of getting TB is three times higher among DM patients than in the general population, and DM patients also tend to have worse treatment outcomes. Despite national guidelines calling for routine TB screening of people with DM, many health providers do not consistently follow that practice. To understand how well screening is being implemented and what helps or hinders it, Edwin Christian Chavala and colleagues conducted a study in the Ubungo district of Dar es Salaam, Tanzania. Between April 4 and May 25, 2025, the team assessed healthcare providers offering DM services across 20 public facilities—3 hospitals, 5 health centers and 12 dispensaries. The study focused on implementation fidelity (IF), a measure of how closely real-world practice follows recommended procedures. Using a structured questionnaire and quantitative analysis, the researchers set out to measure fidelity levels among providers and identify the factors that affect whether TB screening for DM patients is done as recommended.

The research was a descriptive cross-sectional study using quantitative methods among 94 health providers offering DM services. Data were collected with a questionnaire and analyzed to classify fidelity levels as low or high using descriptive statistics. The team then applied regression models using STATA version 16 to identify which factors were associated with higher implementation fidelity of TB screening for DM patients. The overall fidelity score was 83.0%: 78 out of 94 providers achieved high fidelity, while 16 providers (17.0%) had lower fidelity levels. Three factors were significantly associated with higher fidelity: teamwork (aPR 2.28, 95% CI 1.11–7.12; p-value =0.031), self-efficacy (aPR 2.29, 95% CI 1.04–5.02; p-value =0.024), and the facility level where the provider worked, especially hospital level (aPR 3.60, 95% CI 1.52–8.50; p-value =0.004). These findings point to measurable links between workplace dynamics, provider confidence, and adherence to TB screening guidelines.

The study’s results underscore practical levers for improving TB screening among people with diabetes in Ubungo district. If teamwork and provider self-efficacy are important predictors of whether screening is done reliably, then interventions that strengthen collaborative practice and boost clinicians’ confidence—such as targeted training, supportive supervision, and team-based workflows—could raise implementation fidelity. The stronger association seen at hospital level suggests that resources, organization or staffing at higher-level facilities may make guideline adherence easier; adapting successful elements from hospitals to health centers and dispensaries could help spread best practices. The authors conclude that prioritizing teamwork and self-efficacy through focused training and organizational support is critical to universalizing high-fidelity screening and accelerating TB case-finding among DM patients. These steps would align practice with national guidelines and could improve early detection and treatment outcomes for a high-risk population in Ubungo district.