Level of integration of tuberculosis-diabetes mellitus services in China, India and Indonesia: a systematic review

China, India, and Indonesia continue to face a high Tuberculosis (TB) burden. Furthermore, these countries persist in encountering systemic challenges such as inadequate infrastructure, limited professional knowledge, poor Tuberculosis-Diabetes Mellitus (TB–DM) coordination, and budget constraints. This review assesses the level of TB–DM service integration in these countries using the WHO Collaborative Framework. A systematic review was conducted guided by the PRISMA guideline, and the protocol was registered in PROSPERO (CRD42022337104). Seven databases (Embase, PubMed, Medline EBSCO, CINAHL EBSCO, Cochrane Library, Web of Science, and Scopus) were searched between 3 March and 30 August 2022. The search identified studies published between 2007 and 2022 on TB–DM co-management in China, India, and Indonesia. These studies were subsequently evaluated to determine the extent of TB–DM service integration according to the WHO Collaborative Framework. Methodological quality was assessed using Joanna Briggs Institute (JBI) appraisal tools and the findings were synthesized using the Synthesis Without Meta-analysis (SWiM) guideline. A total of 51 publications were included in this review. These publications described 55 TB–DM service implementations. Of these, 53 service implementations could be classified according to the WHO integration framework, while two could not be classified because of insufficient information. Almost half (24/53) of the services were defined as having Level 1 integration; 10/53 were classed as Level 2 integration; 17/53 were classified as Level 3 integration, and 2/53 could not be classified. This systematic review found no studies that achieved Level 4 TB-DM integration. Most studies originated from India, and there was no temporal trend for increasing integration level over time. This review highlights that significant gaps remain in achieving optimal TB-DM service integration in China, India and Indonesia. Not applicable.