Addressing TBMM

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Tuberculosis (TB) is a chronic infectious disease. Every year, approximately 10 million people fall ill with TB and 1.6 million die from it. TB often coexists with other chronic diseases including chronic non-infectious conditions (e.g. lung disease and diabetes), mental health conditions (e.g. depression), and chronic infectious diseases (e.g. HIV/AIDS). This coexistence (or 'multimorbidity') is common because these illnesses share similar risk factors. For example, smoking can lead to both chronic lung disease and TB. Having one condition also increases the risk of another; for example, people with diabetes have poor defences against infections making them vulnerable to developing TB. Coexisting conditions also interact adversely with each other, worsening health, quality of life and survival for each, compared with having just one condition alone. Healthcare services for people with TB should, therefore, offer prevention, detection and treatment of other coexisting chronic illnesses. Traditionally, however, services, including TB programmes, typically focus only on a single condition. Our overall goal is to support TB programmes in low- and middle-income countries to improve the prevention, screening, and management of the most common and most devastating chronic illnesses that coexist in people with TB. This approach may improve quality of life and survival for individuals and also help control the rapidly increasing epidemics of chronic conditions. We focus on conditions coexisting with TB due to their common occurrence and their significant negative health consequences. We think that there may be opportunities to integrate care for multimorbidity within relatively well-resourced and functioning TB programmes (compared with other parts of the health system). Knowledge gained about managing multimorbidity could also be transferable to other services.Multimorbidity can manifest in many patterns or combinations of conditions (clusters). In this 'seed-funding' project, we will first estimate how common are the various co-existing illnesses, and identify the clusters that contribute the greatest burden in terms of shortening life expectancy, causing ill health and incurring healthcare costs for people with TB. We will then explore potential interventions for these conditions.To do this, we will review published academic literature on coexisting chronic conditions in people with TB and analyse data from a large world health survey. This will allow us to estimate how common is multimorbidity and how it affects the health, quality of life and life expectancy of people with TB. It will also help to identify the clusters of conditions that cause the most burden for patients, and to understand the sorts of interventions that are effective for these target conditions, which may be feasible to deliver integrated within TB programmes. We will also look for other sources of information on multimorbidity in people with TB, collected in study countries. We will establish a global TB Multimorbidity Network of people and organisations that can contribute expertise in the topic, support efforts to spread our findings to a wide audience, help identify additional countries to improve generalisability of, and support the next stage of research. We will also grow capacity in research methods, leadership and management of research funding, required for a low- and middle income partner organisation to take a lead role in a future programme.We build this proposal on previous work in TB, mental health, chronic diseases and HIV, and expertise in health systems and policy. Our team has established collaborations in global mental and physical health and TB and lung health in South Asia and Africa.This preliminary work will inform plans for a future research programme, in which we will develop and test a package of interventions to prevent, detect and manage chronic conditions in people with TB in 'real world' settings.