Context:
Dual burden of Diabetes-TB is a serious and growing challenge for the poorly resourced health system of Pakistan
Pakistan ranks 5th among the highest TB burden countries in the world (WHO Global TB Report)
The number of diabetics is anticipated to rise to 13.9 million by 2020 in Pakistan and may increase country ranking to 4th in the world (Wild S, etal)
Limited efforts concerning linking Diabetes and TB care are in place in the government hospitals momentarily
An integrated and structured screening, referral, case management and follow up is required
Objectives:Develop operational guideline and tools for integrating diabetic and TB care in routine district health care setting
Systematic screening of 75% i.e. 75,000 of 100,000 diabetic and 8,625 of 11,500 TB patients in selected  five districts of Pakistan
Train physicians and  paramedics in Diabetic and TB clinics for systemic screening , referral , case management and follow-up
Organize TB-DM awareness & screening camps
Develop a scale-up action plan for Diabetes-TB care.
Methods:
 Development Phase
Develop screening algorithms (Diabetic patients suspected for TB and TB patients suspected for Diabetes)
Developing care delivery tools (screening, management, registration, follow-up, education/ motivations, etc)
Developing a joint plan of implementation (Program level, Hospitals level)
Implementation Phase:
Training of care providers both in Diabetic clinic and TB care providers
Screening (verbal and blood glucose testing) and  Registration of cases both at Diabetic clinic (12) and TB clinics (13)
Outreach TB-DM screening and advocacy camps
Evaluation of disease outcomes
Scale-up Phase  
Develop scale-up plan to involve additional districts and hospitals .
Results:
At TB clinics against 8625 targeted patients 12496 were screened for DM, while at DM clinics against targeted 75000 patients 67213 were screened for TB.
Implementing challenges:
Under developed referral system
No national diabetes program
Lack of dedicated staff- compromised documentation
Lack of coordination with private sector
Not all patients referred from TB clinics are getting registered at Diabetics clinics
Screening all TB patients for Diabetes at high yield TB clinics is a challenge.
Way forward:
National Dissemination meeting
Scale up plan to be prepared & disseminated 
Scale up of intervention has been  considered through public sector funding

Introducing enhanced and integrated care for diabetic and tuberculosis patients in five districts of Pakistan