Abstract
Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.
Highlights
In recent decades, the prevalence of non-communicable diseases has risen, an increase attributable to historic and projected demographic shifts of the world’s population, together with urbanisation and accompanying lifestyle changes.[1]
Comorbidity of tuberculosis with non-communicable diseases and other communicable diseases is prevalent in regions of the world that are highly endemic for tuberculosis; integrated and efficient responses are required to tackle these comorbidities in resource-poor countries
In China, findings of a multiple risk factor modelling study assessing the effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis showed that complete gradual cessation of smoking and solid-fuel use by 2033 could avoid 26 million deaths from COPD and 6·3 million deaths from lung cancer and would reduce the projected incidence of tuberculosis in 2033 by 14–52% if 80% DOTS coverage were sustained.[65]
Summary
The prevalence of non-communicable diseases has risen, an increase attributable to historic and projected demographic shifts of the world’s population, together with urbanisation and accompanying lifestyle changes.[1]. In sub-Saharan Africa, communicable diseases and maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden.[3,4] Deaths from HIV/ AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, and malaria mortality rose by an estimated 19·9% since 1990, to 1·17 million deaths in 2010. WHO estimates show that, in 2011, 8·7 million new cases of tuberculosis were recorded and 1·4 million people died from the disease, including 350 000 deaths associated with HIV coinfection.[16] Sub-Saharan Africa, India, and China have the highest number of tuberculosis cases,[16] and multidrug-resistant tuberculosis has become widespread in eastern Europe.[17]. Synergies, and challenges for integration of tuberculosis care and control efforts and make proposals for change
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call