Abstract
End TB strategy by the WHO suggest active screening of high-risk populations for tuberculosis (TB) to improve case detection. Present study generates evidence for the effectiveness of screening patients with diabetes mellitus (DM) for Pulmonary TB (PTB). A study was conducted among 4548 systematically recruited patients over 45 years attending DM clinic at the National Hospital of Sri Lanka. The study units followed an algorithm specifying TB symptom and risk factor screening for all, followed by investigations and clinical assessments for those indicated. Bacteriologically confirmed or clinically diagnosed PTB were presented as proportions with 95% CI. Mean (SD) age was 62·5 (29·1) years. Among patients who completed all indicated steps of algorithm, 3500 (76·9%) were investigated and 127 (2·8%) underwent clinical assessment. Proportion of bacteriologically confirmed PTB patients was 0·1% (n = 6,95%CI = 0·0–0·3%). None were detected clinically. Analysis revealed PTB detection rates among males aged ≥60 years with HbA1c ≥ 8 to be 0·4% (n = 2, 95%CI = 0·0–1·4%). The study concludes that active screening for PTB among all DM patients at clinic settings in Sri Lanka, to be non-effective measure to enhance TB case finding. However, the sub-category of diabetic males with uncontrolled diabetics who are over 60 years of age is recommended as an option to consider for active screening for PTB.
Highlights
Tuberculosis (TB) remains the world’s deadliest infectious disease
The present study showed that the prevalence of screened Pulmonary TB (PTB) among the diabetes mellitus (DM) population to be 1 7 times higher than the PTB prevalence in the general population
Active screening for PTB among all DM patients at clinic settings in Sri Lanka, a country with low burden for TB, is found to be non-effective measure to enhance TB case finding, given the very low prevalence rates of PTB among DM clinic attendees
Summary
Tuberculosis (TB) remains the world’s deadliest infectious disease. In 2018, TB killed 1.5 million people worldwide [1]. The World Health Organization’s (WHO) End TB strategy aims to reach End TB targets by 2035 while sustainable development goal’s target 3 3 aims at ending. Screening DM patients for TB the TB epidemic by 2030. Achieving these targets require a global annual decline in the incidence of TB to be 4–5%, the current decline is 2% [2]. Implementing systematic screening among selected high-risk groups is one recommended intervention to accelerate the decline [3]
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