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.

项目总结 艾滋病毒、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 糖尿病前期(PreDM)在全球范围内迅速增长，但在撒哈拉以南非洲地区，69%的糖尿病患者 他们没有意识到自己患有糖尿病。携带艾滋病毒的人比没有感染艾滋病毒的人更有可能患有糖尿病，而糖尿病是 在全球新诊断的结核病患者中尤其流行。糖尿病控制不佳增加患结核病的风险 并导致次优的结核病治疗结果。在结核病治疗中早期诊断糖尿病并评估 血糖控制的充分性很重要。在埃斯瓦蒂尼，艾滋病毒、结核病和糖尿病都是导致死亡的前十大原因， 埃斯瓦蒂尼的糖尿病患病率为6.6%；36.1%的人口超重，14.8%的人口肥胖。使用以下其中之一 世界上最严重的艾滋病毒和结核病流行(艾滋病毒流行率=27%，结核病发病率=329/10万，66% 埃斯瓦蒂尼是评估结核病患者比例的最佳环境 DM谱([DMS]，即有DM或前DM)，他们的结核病治疗结果与结核病患者相比如何 没有DMS，以及它们是否因艾滋病毒状况而异。 DETECT(埃斯瓦蒂尼改善结核病/艾滋病毒护理和治疗的结核病患者糖尿病评估)研究 将使用混合方法评估DMS的患病率和发病率以及结核病的治疗结果 并探讨生活方式管理干预策略的适宜性，以促进结核病的发生 治疗成功和血糖控制。我们将筛查所有在卫生部确诊和治疗的成年结核病患者 在研究期间，Manzini地区的卫生设施对DMS的影响，以及结核病治疗结果摘要 从医疗记录中找到的。我们将对DMS风险因素和生活方式进行量化调查 对患有和不患有DMS的两个结核病患者的测量队列的偏好，并在 结核病治疗结束。我们还将对结核病/DMS患者、医疗保健等进行定性的深入访谈 提供者和主要信息者，以了解结核病治疗成功的障碍和促进者和血糖 对结核病/糖尿病患者进行控制，评估潜在生活方式干预措施的可行性和可接受性。 这项研究将利用ICAP、埃斯瓦蒂尼国家结核病控制、艾滋病和 非传染性疾病计划，以及训练有素、工作效率高、经验丰富的团队 在撒哈拉以南非洲开展实施科学研究，为改善非洲的结核病/登革热护理提供信息 在结核病和艾滋病毒负担高的环境中艾滋病毒感染的背景。在这项研究之后，与卫生部合作 基于上述结果，我们将开发一种多成分的、针对文化定制的行为干预 支持改善结核病转归和改善结核病/糖尿病患者血糖控制的战略。干预措施 该策略的有效性、成本效益和可接受性将在未来更大规模的试验中得到检验。