Received: SeptemAccepted: DecemPublished: January 18, 2022Ĭopyright: © 2022 Foo et al. PLoS Med 19(1):Īcademic Editor: Amitabh Bipin Suthar, PLOS Medicine Editorial Board, UNITED STATES (2022) Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness.Ĭitation: Foo CD, Shrestha P, Wang L, Du Q, García-Basteiro AL, Abdullah AS, et al. A few barriers identified were poor public awareness of the diseases leading to poor uptake of services, lack of programmatic budget and resources, and additional stress on providers due to increased workload. Some facilitators of integrated service include improved accessibility to integrated services, motivated and engaged providers, and low to no cost for additional services for patients. We categorised them into 3 levels with entry into the health system based on either TB or NCDs, with level 1 integration offering only testing services for either TB or NCDs, level 2 integration offering testing and referral services to linked care, and level 3 integration providing testing and treatment services at one location. Our synthesised framework explicates the different levels of service integration of TB and NCD services. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Additionally, we developed themes on the facilitators and barriers facing integrated service delivery models and mapped them to the World Health Organization’s (WHO) health systems framework, which comprises the building blocks of service delivery, human resources, medical products, sustainable financing and social protection, information, and leadership and governance.Ī total of 22 articles published between 20 were used, out of which 13 were cross-sectional studies, 3 cohort studies, 1 case–control study, 1 prospective interventional study, and 4 were mixed methods studies. Subsequently, these themes were used to reconfigure and update an existing framework for integration of TB and HIV services by Legido-Quigley and colleagues, which categorises the levels of integration according to types of services and location where services were offered. We performed a comparative analysis of key themes from these studies and organised the themes based on integration of service delivery options for TB and NCD services. Articles were included if they were descriptions or evaluations of a management or organisational change strategy made within LMICs, which aim to increase integration between TB and NCD management at the service delivery level. For our search strategy, the terms “tuberculosis” AND “NCDs” (and their synonyms) AND (“delivery of healthcare, integrated” OR a range of other terms representing integration) were used. There is a lot of stuff that I want to get done and if trying to get the minimum wage increased for example, if Republicans throw up an artificial roadblock in my way, I am inclined to say,' Wait, it is what people want, it is what we promised,' i am not going to elevate an artificial rule over the substance of what I am here for, but I also don't come into this saying we have to change a rule to change a rule.A systematic search was conducted in the Cochrane Library, MEDLINE, Embase, PubMed, Bibliography of Asian Studies, and the Global Index Medicus from database inception to November 4, 2021. What is important to me is getting stuff done so if we were to get a majority. The rules are just not that important to me. The agenda of the roadblock is the philosophy of the stop sign. What we're actually talking about is clearing the path for legislation that's going to support the needs of working people throughout our country, and the filibuster is a roadblock to doing that. Washington will now be your partner.Ĭhanging your password will just add one more roadblock to a potential hacker getting into your system. Washington will no longer be a roadblock to progress.
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