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Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries

In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it...

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Autores principales: Jarde, Alexander, Siqueira, Noemia, Afaq, Saima, Naz, Farah, Irfan, Muhammad, Tufail, Pervaiz, Aslam, Faiza, Todowede, Olamide, Rakhshanda, Shagoofa, Khalid, Humaira, Lin, Yan, Bierman, Olivia, Elsony, Asma, Elsey, Helen, Siddiqi, Najma, Siddiqi, Kamran
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022227/
https://www.ncbi.nlm.nih.gov/pubmed/36962813
http://dx.doi.org/10.1371/journal.pgph.0001205
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author Jarde, Alexander
Siqueira, Noemia
Afaq, Saima
Naz, Farah
Irfan, Muhammad
Tufail, Pervaiz
Aslam, Faiza
Todowede, Olamide
Rakhshanda, Shagoofa
Khalid, Humaira
Lin, Yan
Bierman, Olivia
Elsony, Asma
Elsey, Helen
Siddiqi, Najma
Siddiqi, Kamran
author_facet Jarde, Alexander
Siqueira, Noemia
Afaq, Saima
Naz, Farah
Irfan, Muhammad
Tufail, Pervaiz
Aslam, Faiza
Todowede, Olamide
Rakhshanda, Shagoofa
Khalid, Humaira
Lin, Yan
Bierman, Olivia
Elsony, Asma
Elsey, Helen
Siddiqi, Najma
Siddiqi, Kamran
author_sort Jarde, Alexander
collection PubMed
description In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it is unclear as to what extent these comorbidities are addressed in TB policy and practice. Between August and October 2021, we conducted an online cross-sectional survey in high-TB burden countries. We recruited a purposive sample of TB health workers, managers, policy makers, advisors and advocates from these countries. The survey enquired about the extent to which various comorbid conditions are: (a) mentioned in TB policies, plans, and guidelines; (b) screened, diagnosed, treated or referred to specialist services by TB healthcare workers. We summarised using descriptive analysis. Of the 1100 potential respondents contacted in 33 countries, 543 responded but only 446 (41%) from 27 countries provided sufficient data for inclusion in the study. We found no notable differences between these providing insufficient data and those completing the survey. HIV, diabetes mellitus, depression and tobacco and alcohol use disorders were identified as the most common and concerning comorbid conditions in TB. HIV was screened for and managed by TB services in most countries. Screening for diabetes and/or tobacco and alcohol use disorders was offered by almost half of all TB services but only a few offered relevant treatments. Depression was rarely screened for, almost never treated, and only infrequently referred to specialist services. Most respondents felt confident in screening/diagnosing these comorbid conditions but not in treating these conditions. With the exception of HIV, chronic comorbid conditions are only partially screened for and rarely managed within TB services. Mental health conditions are for the most part neglected. Given their adverse impact on TB outcomes, integrating screening and management of these comorbidities within TB programmes offers a significant opportunity to meet TB targets, address non-communicable diseases and improve patient well-being.
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spelling pubmed-100222272023-03-17 Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries Jarde, Alexander Siqueira, Noemia Afaq, Saima Naz, Farah Irfan, Muhammad Tufail, Pervaiz Aslam, Faiza Todowede, Olamide Rakhshanda, Shagoofa Khalid, Humaira Lin, Yan Bierman, Olivia Elsony, Asma Elsey, Helen Siddiqi, Najma Siddiqi, Kamran PLOS Glob Public Health Research Article In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it is unclear as to what extent these comorbidities are addressed in TB policy and practice. Between August and October 2021, we conducted an online cross-sectional survey in high-TB burden countries. We recruited a purposive sample of TB health workers, managers, policy makers, advisors and advocates from these countries. The survey enquired about the extent to which various comorbid conditions are: (a) mentioned in TB policies, plans, and guidelines; (b) screened, diagnosed, treated or referred to specialist services by TB healthcare workers. We summarised using descriptive analysis. Of the 1100 potential respondents contacted in 33 countries, 543 responded but only 446 (41%) from 27 countries provided sufficient data for inclusion in the study. We found no notable differences between these providing insufficient data and those completing the survey. HIV, diabetes mellitus, depression and tobacco and alcohol use disorders were identified as the most common and concerning comorbid conditions in TB. HIV was screened for and managed by TB services in most countries. Screening for diabetes and/or tobacco and alcohol use disorders was offered by almost half of all TB services but only a few offered relevant treatments. Depression was rarely screened for, almost never treated, and only infrequently referred to specialist services. Most respondents felt confident in screening/diagnosing these comorbid conditions but not in treating these conditions. With the exception of HIV, chronic comorbid conditions are only partially screened for and rarely managed within TB services. Mental health conditions are for the most part neglected. Given their adverse impact on TB outcomes, integrating screening and management of these comorbidities within TB programmes offers a significant opportunity to meet TB targets, address non-communicable diseases and improve patient well-being. Public Library of Science 2022-12-07 /pmc/articles/PMC10022227/ /pubmed/36962813 http://dx.doi.org/10.1371/journal.pgph.0001205 Text en © 2022 Jarde et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Jarde, Alexander
Siqueira, Noemia
Afaq, Saima
Naz, Farah
Irfan, Muhammad
Tufail, Pervaiz
Aslam, Faiza
Todowede, Olamide
Rakhshanda, Shagoofa
Khalid, Humaira
Lin, Yan
Bierman, Olivia
Elsony, Asma
Elsey, Helen
Siddiqi, Najma
Siddiqi, Kamran
Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title_full Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title_fullStr Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title_full_unstemmed Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title_short Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries
title_sort addressing tb multimorbidity in policy and practice: an exploratory survey of tb providers in 27 high-tb burden countries
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022227/
https://www.ncbi.nlm.nih.gov/pubmed/36962813
http://dx.doi.org/10.1371/journal.pgph.0001205
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