Implementation Fidelity of Tuberculosis Screening for Diabetes Mellitus Patients Among Healthcare Providers Offering Diabetes Mellitus Services at Public Health Facilities in Ubungo District, Dar es Salaam, Tanzania.

Globally, the risk of acquiring Tuberculosis (TB) among Diabetes mellitus (DM) patients is three (3) times higher than in the general population. Patients with DM not only have a high risk of getting TB disease but also have poor treatment outcomes Despite the National TB guideline recommending TB screening among DM patients, adherence remains low. This study aims to assess the implementation fidelity (IF) and factors affecting TB screening for DM patients among providers offering DM services in public health facilities in Ubungo district. We conducted a descriptive cross-sectional study from April 4th to May 25th, 2025, in 20 public facilities (3 hospitals, 5 health centers, 12 dispensaries) in Ubungo district using quantitative methods among 94 health providers offering DM services. Data were collected through a questionnaire and analyzed for fidelity levels (low or high) using descriptive statistics. Then, regression models using STATA version 16 identified factors affecting the fidelity of TB screening for DM patients among the healthcare providers offering DM services. The overall fidelity score was 83.0% with (n=78) out of 94 providers achieving high fidelity, with only 17.0 % (n=16) of the total providers having lower fidelity levels. 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 facility-level the provider was working, especially hospital level (aPR 3.60, 95% CI 1.52-8.50; p-value =0.004) were significantly associated with IF of TB screening for DM patients among healthcare providers. Key factors influencing TB screening for DM patients among healthcare providers were effective teamwork, self-efficacy, and the level of the facility where the healthcare was working, such as hospitals. Therefore, strengthening teamwork and provider self-efficacy through training, is critical in universalizing high-fidelity practice and accelerating TB screening for DM patients among healthcare providers offering DM services in Ubungo district.