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Basham CA, Karim ME, Johnston JC. Multimorbidity prevalence and chronic disease patterns among tuberculosis survivors in a high-income setting. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:264-276. [PMID: 36459364 PMCID: PMC10036698 DOI: 10.17269/s41997-022-00711-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVES Multimorbidity is the presence of two or more chronic health conditions. Tuberculosis (TB) survivors are known to have higher prevalence of multimorbidity, although prevalence estimates from high-income low-TB incidence jurisdictions are not available and potential differences in the patterns of chronic disease among TB survivors with multimorbidity are poorly understood. In this study, we aimed to (1) compare the prevalence of multimorbidity among TB survivors with matched non-TB controls in a high-income setting; (2) assess the robustness of aim 1 analyses to different modelling strategies, unmeasured confounding, and misclassification bias; and (3) among people with multimorbidity, elucidate chronic disease patterns specific to TB survivors. METHODS A population-based cohort study of people immigrating to British Columbia, Canada, 1985-2015, using health administrative data. Participants were divided into two groups: people diagnosed with TB (TB survivors) and people not diagnosed with TB (non-TB controls) in British Columbia. Coarsened exact matching (CEM) balanced demographic, immigration, and socioeconomic covariates between TB survivors and matched non-TB controls. Our primary outcome was multimorbidity, defined as ≥2 chronic diseases from the Elixhauser comorbidity index. RESULTS In the CEM-matched sample (n=1962 TB survivors; n=1962 non-TB controls), we estimated that 21.2% of TB survivors (n=416), compared with 12% of non-TB controls (n=236), had multimorbidity. In our primary analysis, we found a double-adjusted prevalence ratio of 1.74 (95% CI: 1.49-2.05) between TB survivors and matched non-TB controls for multimorbidity. Among people with multimorbidity, differences were observed in chronic disease frequencies between TB survivors and matched controls. CONCLUSION TB survivors had a 74% higher prevalence of multimorbidity compared with CEM-matched non-TB controls. TB-specific multimorbidity patterns were observed through differences in chronic disease frequencies between the matched samples. These findings suggest a need for TB-specific multimorbidity interventions in high-income settings such as Canada. We suggest TB survivorship as a framework for developing person-centred interventions for multimorbidity among TB survivors.
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Affiliation(s)
- C Andrew Basham
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluative and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - James C Johnston
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Khan U, Lotia-Farrukh I, Akhtar A, Khowaja SN, Khan S, Madhani F, Parekh A, Adnan S, Ahmed S, Chaudhry M, Hussain H, Habib A, Butt S, Siddiqui MR, Ijaz R, Jamal S, Khan AB, Keshavjee S, Khan AJ, Salahuddin N, Khan PY. Re-Evaluating the Merits of Decentralisation as a Core Strategy for Effective Delivery of Drug-Resistant Tuberculosis Care in Pakistan. Health Policy Plan 2022; 37:979-989. [PMID: 35527232 PMCID: PMC9384034 DOI: 10.1093/heapol/czac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/04/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models—made increasingly urgent by the COVID-19 pandemic—are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005–1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
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Affiliation(s)
- Uzma Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Ahwaz Akhtar
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saira N Khowaja
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | | | - Asra Parekh
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Sana Adnan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Mariam Chaudhry
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Hamidah Hussain
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Ali Habib
- Interactive Health Solutions, Karachi, Sindh, Pakistan
| | - Shahid Butt
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Muhammad R Siddiqui
- Provincial TB Program, Sindh, Pakistan
- Institute of Chest Diseases, Kotri, Sindh, Pakistan
| | - Raafia Ijaz
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saba Jamal
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Abdul B Khan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Salmaan Keshavjee
- Harvard University, Cambridge, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Aamir J Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Palwasha Y Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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3
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Adegbite BR, Edoa JR, Agbo Achimi Abdul JBP, Epola M, Mevyann C, Dejon-Agobé JC, Zinsou JF, Honkpehedji YJ, Mpagama SG, Alabi AS, Kremsner PG, Klipstein-Grobusch K, Adegnika AA, Grobusch MP. Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon. EClinicalMedicine 2022; 45:101316. [PMID: 35243277 PMCID: PMC8885570 DOI: 10.1016/j.eclinm.2022.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are only limited data from resource-limited settings available on the prevalence of non-communicable diseases and associated risk factors of tuberculosis patients. This study investigated non-communicable disease co-morbidity in tuberculosis patients from Moyen Ogooué Province, Gabon. METHODS All patients aged 18 years or older consulting for tuberculosis (TB) symptoms in Gabon's Moyen Ogooué province and neighbouring provinces from November 2018 to November 2020 were screened for diabetes mellitus, hypertension, and risk factors thereof (obesity, dyslipidaemia, smoking and alcohol consumption). Logistic regression was performed to identify factors associated with TB-diabetes and TB-hypertension co-morbidities. FINDINGS Of 583 patients included, 227 (39%) were diagnosed with tuberculosis. In tuberculosis-confirmed patients, the prevalences of hypertension and diabetes were 16·3% and 12·8%, respectively. The prevalence of diabetes was twice as high in tuberculosis patients compared to non-tuberculosis patients. Factors independently associated with hypertension-tuberculosis co-morbidity were age >55 years (aOR=8·5, 95% CI 2·43, 32·6), age 45-54 years (aOR=4.9, 95%CI 1.3-19.8), and moderate alcohol consumption (aOR=2·4; 95% CI 1·02- 5·9), respectively. For diabetes-tuberculosis co-morbidity, age >55 years was positively (aOR=9·13; 95% CI 2·4-39·15), and moderate alcohol consumption inversely associated (aOR=0·26, 95% CI 0·08- 0·73). One-hundred-and-four (46%) of the tuberculosis patients had at least either dyslipidaemia, hypertension, diabetes, or obesity with a majority of newly-diagnosed hypertension and diabetes. INTERPRETATION Integration of screening of non-communicable diseases and their risk factors during TB assessment for early diagnosis, treatment initiation and chronic care management for better health outcomes should be implemented in all tuberculosis healthcare facilities. FUNDING This study was supported by WHO AFRO/TDR/EDCTP (2019/893,805) and Deutsches Zentrum für Infektiologie (DZIF/ TTU 02.812).
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Affiliation(s)
- BR Adegbite
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JR Edoa
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JBP Agbo Achimi Abdul
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - M Epola
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - C Mevyann
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - JC Dejon-Agobé
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JF Zinsou
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - YJ Honkpehedji
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - SG Mpagama
- Kibong'oto Infectious Diseases Hospital - Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
| | - AS Alabi
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - PG Kremsner
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - AA Adegnika
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - MP Grobusch
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Corresponding author at: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
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Yield, NNS and prevalence of screening for DM and hypertension among pulmonary tuberculosis index cases and contacts through single time screening: A contact tracing-based study. PLoS One 2022; 17:e0263308. [PMID: 35089989 PMCID: PMC8797235 DOI: 10.1371/journal.pone.0263308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/18/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM), hypertension and pulmonary tuberculosis (PTB) are catastrophic illnesses that collectively lead to increased mortality and premature death. However, the size of the problem and the appropriate approach to deal with the burden is still unclear. We aimed to evaluate the yield, number needed to screen (NNS) to prevent one death or adverse event for screening DM and hypertension and assess the prevalence and contributors to DM and/or hypertension. METHODS Based on PTB contact tracing, a cross-sectional study was conducted among 801 PTB index cases and 972 household contacts from April 2019 to October 2020 in Guizhou, China. All the participants were screened for DM and hypertension. The yield was calculated as the proportion of newly detected cases among the study subjects, excluding known cases. The NNS was computed by dividing the number needed to treat for risk factors by the prevalence of the unrecognized diseases. The univariate and multivariate logistic regression analyses were applied to determine the independent predictors of DM and/or hypertension. RESULTS Of the 1,773 participants, the prevalence of DM and hypertension was 8.7% (70/801) and 15.2% (122/801) in the PTB patients, 3.2% (31/972) and 14.0% (136/972) in the contacts, respectively. The prevalence of DM and/or hypertension was 21.2% (170/801) among the PTB patients and 15.4% (150/972) among their contacts. The screening yields to detect new cases of DM and hypertension among PTB patients were 1.9% and 5.2%, and that in the contacts were 0.8% and 4.8%, respectively. The NNS for DM was 359 for the PTB cases and 977 for the contacts, 299 for PTB cases and 325 for hypertension, respectively. Older age, under or overweight and obesity, family history hypertension and earlier diagnosis of other chronic conditions were the independent predictors for DM and/or hypertension among both PTB cases and their contacts. CONCLUSION Screening for DM and hypertension should be mandated in PTB patients and their household contacts to disclose undetected cases of these two conditions during TB contact tracing, which might reduce the potential cardiovascular disease deaths.
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Foo CD, Shrestha P, Wang L, Du Q, García-Basteiro AL, Abdullah AS, Legido-Quigley H. Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review. PLoS Med 2022; 19:e1003899. [PMID: 35041654 PMCID: PMC8806070 DOI: 10.1371/journal.pmed.1003899] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/01/2022] [Accepted: 12/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are facing a combined affliction from both tuberculosis (TB) and noncommunicable diseases (NCDs), which threatens population health and further strains the already stressed health systems. Integrating services for TB and NCDs is advantageous in tackling this joint burden of diseases effectively. Therefore, this systematic review explores the mechanisms for service integration for TB and NCDs and elucidates the facilitators and barriers for implementing integrated service models in LMIC settings. METHODS AND FINDINGS 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. 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. 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. 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. 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. 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. A total of 22 articles published between 2011 and 2021 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. The studies were conducted in 15 LMICs in Asia, Africa, and the Americas. Our synthesised framework explicates the different levels of service integration of TB and NCD services. 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. 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. 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. The limitations include the dearth of data that explores the experiences of patients and providers and evaluates programme effectiveness. CONCLUSIONS Integration of TB and NCD services encourages the improvement of health service delivery across disease conditions and levels of care to address the combined burden of diseases in LMICs. This review not only offers recommendations for policy implementation and improvements for similar integrated programmes but also highlights the need for more high-quality TB-NCD research.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Leiting Wang
- Global Health Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Qianmei Du
- Global Health Program, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Alberto L. García-Basteiro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Mozambique
| | - Abu Saleh Abdullah
- Global Health Program, Duke Kunshan University, Kunshan, Jiangsu, China
- School of Medicine, Boston Medical Center, Boston University, Boston, Massachusetts, United States of America
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6
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Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, van der Zalm MM, Allwood B, Byrne AL, Mortimer K, Wallis RS, Fox GJ, Leung CC, Chakaya JM, Seaworth B, Rachow A, Marais BJ, Furin J, Akkerman OW, Al Yaquobi F, Amaral AFS, Borisov S, Caminero JA, Carvalho ACC, Chesov D, Codecasa LR, Teixeira RC, Dalcolmo MP, Datta S, Dinh-Xuan AT, Duarte R, Evans CA, García-García JM, Günther G, Hoddinott G, Huddart S, Ivanova O, Laniado-Laborín R, Manga S, Manika K, Mariandyshev A, Mello FCQ, Mpagama SG, Muñoz-Torrico M, Nahid P, Ong CWM, Palmero DJ, Piubello A, Pontali E, Silva DR, Singla R, Spanevello A, Tiberi S, Udwadia ZF, Vitacca M, Centis R, D Ambrosio L, Sotgiu G, Lange C, Visca D. Clinical standards for the assessment, management and rehabilitation of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:797-813. [PMID: 34615577 PMCID: PMC8504493 DOI: 10.5588/ijtld.21.0425] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.
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Affiliation(s)
- G B Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, DSI-NRF South African Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - N Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Montescano (PV), Italy
| | - E Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, South Africa
| | - A L Byrne
- Heart Lung Clinic St Vincent´s Hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia, Partners In Health (Socios En Salud Sucursal), Lima, Peru
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - R S Wallis
- Aurum Institute, Johannesburg, South Africa
| | - G J Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C C Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong
| | - J M Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Seaworth
- Heartland National TB Center of Excellence, San Antonio, TX, University of Texas Health Science Center, Tyler, TX, USA
| | - A Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - B J Marais
- The Children´s Hospital at Westmead and the University of Sydney WHO Collaborating Center in Tuberculosis, University of Sydney, Sydney, NSW, Australia
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
| | - O W Akkerman
- University of Groningen, University Medical Center Groningen, department of Pulmonary diseases and Tuberculosis, Groningen, the Netherlands, University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, the Netherlands
| | - F Al Yaquobi
- TB and Acute Respiratory Diseases Section, Department of Communicable Diseases, Directorate General of Disease Surveillance and Control, Ministry of Health, Oman
| | - A F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - S Borisov
- Moscow Research and Clinical Center for Tuberculosis Control, Moscow Health Department, Moscow, Russian Federation
| | - J A Caminero
- Mycobacterial Unit, Pneumology Department. University General Hospital of Gran Canaria "Dr. Negrin", Las Palmas, Gran Canaria, ALOSA TB Academy, Spain
| | - A C C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - D Chesov
- Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
| | - L R Codecasa
- TB Reference Centre, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
| | - R C Teixeira
- National Institute of Respiratory Diseases and the Environment (INERAM), Asunción, Paraguay, Radboud University Medical Center, TB Expert Center Dekkerswald, Department of Respiratory Diseases, Nijmegen - Groesbeek, The Netherlands
| | - M P Dalcolmo
- Reference Center Hélio Fraga, Fundação Oswaldo Cruz (Fiocruz), Ministry of Health, Rio de Janeiro, RJ, Brazil
| | - S Datta
- Department of clinical sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru
| | - A-T Dinh-Xuan
- Université de Paris, APHP Centre, Lung Function Unit, Department of Respiratory Diseases, Cochin Hospital, Paris, France
| | - R Duarte
- Institute of Public Health, Porto University; Medical School, Porto University; Hospital Centre of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - C A Evans
- Innovation For Health And Development (IFHAD) Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru, Innovacion Por la Salud Yel Desarollo, (IPSYD) Asociación Benéfica PRISMA, Lima, Peru, Department of Infectious Diseases, Imperial College London, London, UK
| | | | - G Günther
- Department of Pulmonology, Inselspital Bern, University of Bern, Switzerland
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Huddart
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany, German Center for Infection Research (DZIF), Partner Site Munich, Germany
| | - R Laniado-Laborín
- Clínica de Tuberculosis, Hospital General Tijuana, Universidad Autónoma De Baja California, Mexico
| | - S Manga
- Medecins Sans Frontieres (MSF), Operational Center, Paris, France
| | - K Manika
- Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - A Mariandyshev
- Northern State Medical University, Northern Arctic Federal University, Arkhangelsk, Russian Federation
| | - F C Q Mello
- Thoracic Diseases Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro, Tanzania
| | - M Muñoz-Torrico
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - P Nahid
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, UCSF Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - C W M Ong
- Infectious Disease Translational Research Programme, Department of Medicine, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, National University of Singapore Institute for Health Innovation & Technology (iHealthtech), Singapore
| | - D J Palmero
- Pulmonology Division, Municipal Hospital F.J. Muñiz and Instituto Vaccarezza, Buenos Aires, Argentina
| | | | - E Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - D R Silva
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - R Singla
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
| | - S Tiberi
- Department of Infection, Royal London Hospital, Barts Health NHS Trust, London, UK, Blizard Institute, Queen Mary University of London, London, UK
| | - Z F Udwadia
- Department of Respiratory Medicine, Hinduja Hospital & Research Center, Mumbai, India
| | - M Vitacca
- Respiratory Unit, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane (BS), Italy
| | - R Centis
- Respiratory Diseases Clinical Epidemiology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - L D Ambrosio
- Public Health Consulting Group, Lugano, Switzerland
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany, German Center for Infection Research (DZIF), Clinical Tuberculosis Unit, Borstel, Germany, Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - D Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Tradate, Varese-Como, Italy
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Is It Feasible to Conduct Post-Tuberculosis Assessments at the End of Tuberculosis Treatment under Routine Programmatic Conditions in China? Trop Med Infect Dis 2021; 6:tropicalmed6030164. [PMID: 34564548 PMCID: PMC8482211 DOI: 10.3390/tropicalmed6030164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
There is growing evidence that a substantial proportion of people who complete anti-tuberculosis treatment experience significant morbidity and mortality which can negatively affect their quality of life. It is suggested that national tuberculosis programs conduct end-of-treatment assessments, but whether this is feasible is currently not known. We therefore assessed whether tuberculosis program staff could assess functional and general health status of patients at the end of treatment in five TB clinics in four provinces in China. There were 115 patients, aged 14–82 years, who completed anti-tuberculosis treatment and a post-TB assessment. There were 54 (47%) patients who continued to have symptoms, the commonest being cough, dyspnea and fatigue. Symptom continuation was significantly more common in the 22 patients with diabetes (p = 0.027) and the 12 patients previously treated for TB (p = 0.008). There were 12 (10%) current smokers, an abnormal chest X-ray was found in 106 (92%) patients and distance walked in the 6-min walking test (6MWT) ranged from 30–750 m (mean 452 ± 120); 24 (21%) patients walked less than 400 m. Time taken to perform the post-TB assessment, including the 6MWT, ranged from 8–45 min (mean 21 ± 8 min). In 98% of the completed questionnaires, health workers stated that conducting post-TB assessments was feasible and useful. This study shows that post-TB assessments can be conducted under routine programmatic conditions and that there is significant morbidity that needs to be addressed.
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Marais BJ, Chakaya J, Swaminathan S, Fox GJ, Ehtesham NZ, Ntoumi F, Zijenah L, Maurer M, Zumla A. Tackling long-term morbidity and mortality after successful tuberculosis treatment. THE LANCET. INFECTIOUS DISEASES 2020; 20:641-642. [PMID: 32213333 DOI: 10.1016/s1473-3099(20)30167-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ben J Marais
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | | | - Greg J Fox
- The University of Sydney Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Francine Ntoumi
- Université Marien Gouabi, Fondation Congolaise pour la Recherche Médicale, Brazzaville, Congo; Institute for Tropical Diseases, University of Tübingen, Germany
| | - Lynn Zijenah
- Department of Immunology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Markus Maurer
- Immunosurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal; Department of Oncology and Haematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
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9
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Gadallah M, Amin W, Fawzy M, Mokhtar A, Mohsen A. Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt. Afr Health Sci 2018; 18:884-890. [PMID: 30766551 PMCID: PMC6354872 DOI: 10.4314/ahs.v18i4.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. Objectives To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Methods Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Results Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Conclusion Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.
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Affiliation(s)
- Mohsen Gadallah
- Community, Environmental and Occupational Medicine. Faculty of Medicine - Ain Shams University, Cairo 11566 Egypt
| | - Wagdy Amin
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Magdy Fawzy
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Alaa Mokhtar
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Amira Mohsen
- National Research Center, Cairo, Egypt, Department of Community Medicine, Cairo, Egypt
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