Implementation Determinants of Integrated Tuberculosis and Diabetes Care in South Asian Association for Regional Cooperation (SAARC) Countries: A Systematic Review.
Background: Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic in low- and middle-income countries (LMICs), particularly across South Asia. The bidirectional relationship between these diseases exacerbates health outcomes and increases system burdens. Although the World Health...
| Publicado en: | International Journal of Integrated Care (IJIC) Vol. 26; no. 2; pp. 1 - 18 |
|---|---|
| Autores principales: | , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Ubiquity Press
Apr-Jun2026
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196095174&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196095174 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15684156 8US jtl: International Journal of Integrated Care (IJIC) issn: 15684156 maglogo: N pubinfo: dt: Apr-Jun2026 vid: 26 iid: 2 pid: 83901 pub: Ubiquity Press artinfo: ui: 196095174 196095174 196095174 10.5334/ijic.9882 196095174 ppf: 1 ppct: 17 formats: tig: atl: Implementation Determinants of Integrated Tuberculosis and Diabetes Care in South Asian Association for Regional Cooperation (SAARC) Countries: A Systematic Review. aug: au: Aleem, Saima Afaq, Saima Gill, Suneel Ahmad, Bilal Michael, Zunaira Zarkaish, Rida Khan, Zohaib affil: Institute of Public Health & Social Sciences, Khyber Medical University sug: subj: Health Care Delivery, Integrated Asia, Southern Tuberculosis Therapy Diabetes Mellitus Therapy Social Determinants of Health Implementation Science Asia, Southern Systematic Review Medline Embase Cochrane Library CINAHL Database Gray Literature Checklists India Pakistan Bangladesh Sri Lanka Politics Commitment Digital Health Health Personnel Education Public Health Infrastructure Financing, Government Personnel Shortage Practice Guidelines Funding Source Telehealth Health Services Accessibility ab: Background: Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic in low- and middle-income countries (LMICs), particularly across South Asia. The bidirectional relationship between these diseases exacerbates health outcomes and increases system burdens. Although the World Health Organization has advocated for integrated management of TB and DM, implementation remains inconsistent across the SAARC region. This systematic review aims to identify and analyse implementation determinants of integrated TB and DM care in SAARC countries. Methods: We conducted a systematic review following PRISMA 2020 guidelines. searching MEDLINE (via Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CINAHL for peer-reviewed studies. Grey literature was sourced from Google Scholar and citation search. Four reviewers independently screened title, abstract and full text using Rayyan. Using a structured Excel form, two reviewers extracted data. Quality assessment was conducted by using Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted in line with SWiM guidelines to categorize implementation determinants as barriers or facilitators. Results: Ten studies met the inclusion criteria and were conducted across five SAARC countries: India (n = 7), Pakistan (n = 1), Bangladesh (n = 1), and Sri Lanka (n = 1). Identified facilitators included political commitment, use of digital tools, and training of healthcare workers. Barriers encompassed inadequate infrastructure and finances, workforce shortages, lack of standardized guidelines and fragmented vertical health systems. Conclusion: Integrated TB-DM care in the SAARC region remains at an early developmental stage, with most efforts limited to pilot projects or small-scale screenings. Despite political and institutional recognition of the dual burden, scale-up is constrained by systemic barriers, resource gaps, and lack of evidence-informed implementation strategies. Future efforts should prioritize system-wide integration guided by implementation frameworks, standardized protocols, and investment in workforce and infrastructure to achieve sustainable impact. Systematic review registration: PROSPERO registration number: CRD42025644263. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|