Abstract
BackgroundEvidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs). Bi-directional screening for TB and diabetes mellitus (DM) is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme.ObjectiveTo assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017.MethodsIt was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data).ResultsAmongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening.ConclusionIntegrating screening for NCDs and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.
Highlights
The global dual burden of tuberculosis (TB) and non-communicable diseases (NCDs) manifests through vulnerability of those with NCDs to TB and through negative effects of NCDs on treatment outcomes for TB.[1]
Clustering of four or more risk factors was associated with increasing age and male sex (p
TB and most NCDs share many risk factors such as smoking, poor diet and harmful use of alcohol, that need to be addressed for effective prevention.[1]
Summary
The global dual burden of tuberculosis (TB) and non-communicable diseases (NCDs) manifests through vulnerability of those with NCDs to TB and through negative effects of NCDs on treatment outcomes for TB.[1]. The 2030 Agenda for Sustainable Development and Universal Health Coverage (UHC) provides a collaborative framework for integration of NCDs into primary health care.[6]
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