Addressing TBMM

结核病(TB)是一种慢性传染病。每年约有1000万人罹患结核病，其中160万人死于结核病。结核病常常与其他慢性疾病共存，包括慢性非传染性疾病(如肺部疾病和糖尿病)、精神健康疾病(如抑郁症)和慢性传染病(如艾滋病毒/艾滋病)。这种共存(或“多发病”)很常见，因为这些疾病具有相似的风险因素。例如，吸烟会导致慢性肺部疾病和肺结核。患有一种疾病也会增加患另一种疾病的风险；例如，糖尿病患者对感染的抵抗力较差，这使他们容易患上结核病。与只有一种情况相比，共存的情况也会相互影响，恶化健康、生活质量和存活率。因此，为结核病患者提供的医疗服务应该提供对其他并存慢性病的预防、检测和治疗。然而，传统上，包括结核病规划在内的服务通常只关注一种情况。我们的总体目标是支持低收入和中等收入国家的结核病规划，以改善对结核病患者中并存的最常见和最具破坏性的慢性病的预防、筛查和管理。这种方法可能会提高个人的生活质量和存活率，还有助于控制迅速增加的慢性病流行。由于结核病的常见发生及其严重的负面健康后果，我们将重点放在与结核病并存的疾病上。我们认为，(与卫生系统的其他部分相比)可能有机会将多病护理纳入资源相对充足和运作良好的结核病规划。在管理多发病方面所获得的知识也可以转移到其他服务中。多发病可以表现为多种模式或多种条件的组合(聚集性)。在这个“种子基金”项目中，我们将首先评估各种并存疾病的普遍程度，并确定哪些集群在缩短预期寿命、导致健康状况不佳以及导致结核病患者的医疗费用方面造成最大负担。然后，我们将探索针对这些情况的潜在干预措施。为此，我们将回顾已发表的关于结核病患者并存慢性病的学术文献，并分析来自一项大型世界健康调查的数据。这将使我们能够估计多发病的普遍程度，以及它如何影响结核病患者的健康、生活质量和预期寿命。它还将有助于确定对患者造成最大负担的疾病群，并了解对这些目标疾病有效的干预措施种类，将其纳入结核病规划可能是可行的。我们还将寻找在研究国家收集的有关结核病患者多发病的其他信息来源。我们将建立一个由个人和组织组成的全球结核病多发病网络，这些人和组织可以贡献这一主题的专业知识，支持将我们的发现传播给广大受众的努力，帮助确定更多的国家来提高推广能力，并支持下一阶段的研究。我们还将提高低收入和中等收入合作伙伴组织在未来计划中发挥主导作用所需的研究方法、领导力和研究资金管理方面的能力。我们基于以前在结核病、心理健康、慢性病和艾滋病毒方面的工作以及卫生系统和政策方面的专业知识而提出这项建议。我们的团队已经在全球心理和身体健康以及南亚和非洲的结核病和肺部健康方面建立了合作。这项初步工作将为未来的研究计划提供信息，在该计划中，我们将开发和测试一揽子干预措施，以预防、检测和管理结核病患者的慢性病。

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.