{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:39:12Z","timestamp":1785404352062,"version":"3.56.0"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"unspecified","delay-in-days":99,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S146342362610111X_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The dual burden of tuberculosis (TB) and diabetes mellitus (DM) presents a growing challenge for health systems in low- and middle-income countries (LMICs), including Pakistan. Despite global and national policies advocating for integrated care, evidence on health facility readiness to operationalize integration remains scarce. This study assessed the readiness of TB basic management units (BMUs) to deliver integrated TB-DM care and explored implementation barriers using the Consolidated Framework for Implementation Research (CFIR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S146342362610111X_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted an explanatory sequential mixed-methods study from September 2024 to February 2025 across 13 TB BMUs in five districts of Pakistan. Quantitative readiness data were collected using a structured tool adapted from the WHO Service Availability and Readiness Assessment (SARA), generating a composite score across four domains. Subsequently, qualitative data were gathered through multi-stakeholder focus group discussions with healthcare providers, facility managers, patients, caregivers, and policymakers. Reflexive thematic analysis was conducted and mapped to CFIR Inner Setting constructs to contextualize quantitative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S146342362610111X_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Only one facility demonstrated high readiness, while 12 showed low readiness. Facilities lacked routine comorbidity screening, trained staff, diagnostic capacity, and essential medicines. Key barriers included inadequate infrastructure, workforce shortages, fragmented information systems, and low prioritisation of integrated care. Financial constraints and limited coordination further hindered implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S146342362610111X_as4\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study highlights critically low readiness among TB facilities in different districts of Pakistan to deliver integrated TB-DM care, reflecting systemic weaknesses across core domains. Strengthening systems, building capacity, and improving integration strategies are essential to bridge gaps between policy and practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s146342362610111x","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T08:06:53Z","timestamp":1775808413000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["From silos to synergy: assessing tuberculosis basic management units readiness for integrated diabetes mellitus care across different districts of Pakistan"],"prefix":"10.1017","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1892-3834","authenticated-orcid":false,"given":"Saima","family":"Aleem","sequence":"first","affiliation":[{"name":"Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Afaq","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04m01e293","id-type":"ROR","asserted-by":"publisher"}],"name":"University of York Department of Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6059-3985","authenticated-orcid":false,"given":"Bilal","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8656-0768","authenticated-orcid":false,"family":"Zala","sequence":"additional","affiliation":[{"name":"Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haroon","family":"Latif Khan","sequence":"additional","affiliation":[{"name":"Government of Khyber Pakhtunkhwa Health Department"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1885-8254","authenticated-orcid":false,"given":"Zohaib","family":"Khan","sequence":"additional","affiliation":[{"name":"Khyber Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"S146342362610111X_ref30","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-5369809\/v1"},{"key":"S146342362610111X_ref24","unstructured":"Nyirenda, JLZ (2023) Health services delivery constraints and opportunities of integrating diabetes mellitus and tuberculosis healthcare services in Malawi: A mixed methods study Dissertation, Universit\u00e4t Freiburg, 2023."},{"key":"S146342362610111X_ref1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-093747"},{"key":"S146342362610111X_ref9","first-page":"76","article-title":"Consequences of disintegrated care for dual tuberculosis and diabetes in Tanzania: A case report on recurrent tuberculosis with severe haemoptysis in a patient with dysregulated diabetes","author":"Chamba","year":"2024","journal-title":"Diabetes"},{"key":"S146342362610111X_ref28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0309372"},{"key":"S146342362610111X_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107140"},{"key":"S146342362610111X_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s10238-025-01797-7"},{"key":"S146342362610111X_ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0263259"},{"key":"S146342362610111X_ref12","unstructured":"Consolidated Framework for Implementation Research. 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e47"}}