Operationalization of bi-directional screening for tuberculosis and diabetes in private sector healthcare clinics in Karachi, Pakistan
Operationalization of bi-directional screening for tuberculosis and diabetes in private sector healthcare clinics in Karachi, Pakistan
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DOI：
10.1186/s12913-019-3975-7
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发表时间：
2019-03-06
影响因子：
2.8
通讯作者：
Khan, Aamir J.
中科院分区：
文献类型：
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作者：
Basir, Mashal S.;Habib, Shifa S.;Khan, Aamir J.
背景许多国家正面临着结核病（TB）和糖尿病（DM）的重叠流行。糖尿病增加了患结核病（TB）的总体风险，并导致不良治疗结果。积极筛查这两种疾病可以减少结核病的传播，预防糖尿病并发症的发生。我们调查了双向TB-DM筛查在卡拉奇，巴基斯坦，一个国家，在高结核病负担的国家中排名第五，并具有第七高的国家负担DM。MethodsBetween 2014年2月至11月，以社区为基础的筛选确定推定的结核病和DM通过口头筛选在私人诊所。疑似TB患者转诊接受胸部X线检查和Xpert MTB/RIF。假定DM病例进行随机血糖（RBS）测试。所有细菌学呈阳性的TB患者均接受了糖尿病检测（RBS）。所有糖尿病前期患者和糖尿病患者均接受胸部X线检查和Xpert MTB/RIF检测。这项研究的主要成果是结核病和糖尿病testing.ResultsA共450，385人进行了筛选，其中18，109推定糖尿病和90，137推定结核病。其中14，550人被推定患有DM和TB。在推定糖尿病患者中进行糖尿病检测的比例为26.1%，而在推定结核病例中进行结核检测的比例为5.9%。尽管努力促进结核病和糖尿病的双向筛查，但糖尿病前期和糖尿病病例中结核病检测的接受率仅为4.7%，而结核病阳性病例中糖尿病检测的接受率为21.8%。结论虽然糖尿病前期和糖尿病患者中结核病的发病率很高，但在被诊断患有结核病的个体中，糖尿病的发病率也很高，沿着，在被记录为糖尿病前期或糖尿病的推定结核病患者中，结核病检测的接受率较低。结核病和糖尿病的双向筛查，包括在现有的卫生保健计划中整合结核病诊断、糖尿病筛查和结核-糖尿病治疗，将需要解决在将其作为公共卫生计划中的一项战略实施之前所确定的业务挑战。
BackgroundMany countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM.MethodsBetween February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing.ResultsA total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%.ConclusionWhile a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs.