Diabetes Evaluation in TB Patients in Eswatini for Improving TB/HIV Care and Treatment (DETECT) Study

斯威士兰结核病患者糖尿病评估以改善结核病/艾滋病毒护理和治疗 (DETECT) 研究

• 批准号: 10158678
• 负责人: Yael R Hirsch-Moverman
• 金额: $ 20.15万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-23 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10158678
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Adult; Africa South of the Sahara; Age; Area; Asia; Behavior Therapy; Biological Availability; Caring; Cause of Death; Cessation of life; Collaborations; Data; Detection; Development; Diabetes Mellitus; Diagnosis; Diet; Disease; Drug resistance in tuberculosis; Effectiveness; Epidemic; Evaluation; Future; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV/TB; Health; Health Personnel; Health care facility; High Prevalence; Impairment; Incidence; International; Intervention; Interview; Life Style; Measurement; Medical Records; Methodology; Methods; Morbidity - disease rate; Newly Diagnosed; Non-Insulin-Dependent Diabetes Mellitus; North America; Obesity; Obesity Epidemic; Outcome; Overweight; Patients; Persons; Pharmaceutical Preparations; Population; Prediabetes syndrome; Prevalence; Regimen; Relapse; Research; Research Personnel; Risk; Risk Factors; Services; Southern Africa; Surveys; Tenofovir; Testing; Time; Training; Treatment Failure; Treatment outcome; Tuberculosis; Urbanization; Weight Gain; Woman; World Health Organization; acceptability and feasibility; base; cohort; comorbidity; cost effectiveness; emtricitabine; experience; glycemic control; high risk; implementation science; improved; informant; insight; lifestyle intervention; low and middle-income countries; mortality; multidisciplinary; physical inactivity; preference; programs; success; tuberculosis treatment

PROJECT SUMMARY HIV, tuberculosis (TB), and diabetes mellitus (DM) are major causes of morbidity and mortality globally. DM and prediabetes (preDM) are growing rapidly worldwide but 69% of persons living with DM in sub-Saharan Africa are unaware they have DM. Persons living with HIV are more likely to have DM than those without HIV, and DM is especially prevalent among newly diagnosed TB patients globally. Poorly controlled DM increases the risk of TB and leads to suboptimal TB treatment outcomes. Diagnosing DM early in TB treatment and assessing the adequacy of glycemic control are important. HIV, TB, and DM are all in the top 10 causes of mortality in Eswatini, and DM prevalence in Eswatini is 6.6%; 36.1% of the population is overweight and 14.8% obese. With one of the world’s most severe HIV and TB epidemics (HIV prevalence=27%, TB incidence=329 per 100,000, and 66% of TB patients are HIV-positive), Eswatini is an optimal setting to evaluate what proportion of TB patients are on the DM spectrum ([DMS], i.e., have DM or preDM), how their TB treatment outcomes compare to TB patients without DMS, and whether they vary by HIV status. The DETECT (Diabetes Evaluation in TB patients in Eswatini for improving TB/HIV Care and Treatment) study will use mixed methods to assess DMS prevalence and incidence as well as TB treatment outcomes in TB patients in Eswatini and explore the suitability of lifestyle management intervention strategies to facilitate TB treatment success and glycemic control. We will screen all adult TB patients diagnosed and treated in Ministry of Health facilities in the Manzini Region for DMS during the study period, and abstract TB treatment outcomes from medical records. We will administer a quantitative survey regarding DMS risk factors and lifestyle preferences to two measurement cohorts of TB patients with and without DMS and retest them for DMS at the end of TB treatment. We will also conduct qualitative in-depth interviews with TB/DMS patients, healthcare providers, and key informants to elicit insights on barriers to and facilitators of TB treatment success and glycemic control in TB/DMS patients and assess feasibility and acceptability of potential lifestyle intervention components. The study will leverage long-standing collaborations between ICAP, the Eswatini National TB Control, AIDS, and Non-Communicable Diseases Programs, and a well-trained, highly productive team with substantial experience in implementation science research in sub-Saharan Africa to inform the improvement of TB/DMS care in the context of HIV infection in high TB and HIV burden settings. Following this study, in collaboration with the MOH and based on the above results, we will develop a multicomponent, culturally-tailored behavioral intervention strategy to support the improvement of TB outcomes and glycemic control in TB/DMS patients. The intervention strategy’s effectiveness, cost-effectiveness, and acceptability will be tested in a future, larger trial.

项目摘要 HIV，结核病（TB）和糖尿病（DM）是全球发病率和死亡率的主要原因。 DM和 糖尿病前（PERM）在全球范围内迅速增长，但在撒哈拉以南非洲的DM中有69％的人是 不知道他们有DM。与没有艾滋病毒的人相比，患有艾滋病毒的人更有可能拥有DM，而DM是 在全球新诊断的结核病患者中尤其普遍。控制不良的DM增加了结核病的风险 并导致TB的次错治疗结果。在结核病治疗中诊断DM并评估 血糖控制的充分性很重要。艾滋病毒，结核病和DM都在埃斯瓦蒂尼死亡的前十名中， Eswatini的DM患病率为6.6％； 36.1％的人口超重，肥胖为14.8％。与一个 世界上最严重的艾滋病毒和结核病流行病（HIV患病率= 27％，结核病发生率= 329每100,000，而66％ TB患者的HIV阳性），Eswatini是评估TB患者比例的最佳环境 DM频谱（[DMS]，即具有DM或PERPM），其结核病治疗结果与结核病患者相比 没有DM，以及它们是否因艾滋病毒状况而异。 检测（Eswatini中结核病患者的糖尿病评估以改善结核病/HIV护理和治疗） 将使用混合方法来评估DMS的患病率和入口以及结核病的结核病治疗结果 埃斯瓦蒂尼（Eswatini）的患者并探讨了生活方式管理干预策略的适用性，以促进结核病 治疗成功和血糖控制。我们将筛选所有在事工中诊断和治疗的成年结核病患者 在研究期间，Manzini地区的DMS卫生设施和抽象的结核病治疗结果 从病历。我们将管理有关DMS风险因素和生活方式的定量调查 对具有和没有DMS的TB患者的两个测量队列的偏好，并在DM处重新测试。 结核病治疗结束。我们还将对结核病/DMS患者，医疗保健进行定性的深入访谈 提供者以及主要的线人，以引起有关结核病治疗成功和血糖的障碍和促进者的见解 TB/DMS患者的控制以及评估可行性和潜在生活方式干预组件的可接受性。 该研究将利用ICAP，Eswatini National TB控制，AIDS和 非传染性疾病计划，以及一支训练有素，高产的团队，拥有丰富的经验 在撒哈拉以南非洲的实施科学研究中，以告知TB/DMS护理的改善 高结核病和艾滋病毒伯嫩环境中艾滋病毒感染的背景。在这项研究之后，与MOH合作 并基于上述结果，我们将开发一种多组分的文化行为干预 支持改善结核病/DMS患者TB结局和血糖控制的策略。干预 战略的有效性，成本效益和可接受性将在未来的更大试验中进行测试。