It has been ascertained that diabetes significantly increases the risk of developing active tuberculosis (TB). In addition, diabetes affects TB treatment outcomes by increasing fatality rates and the risk of recurrent TB, particularly in patients with poor blood sugar control. Similarly, diabetes control is worsened when the patient also suffers from TB. This creates a downward spiral with one disease reinforcing the adverse effects of the other. Thus, patients with a co-morbidity of these two diseases are more seriously ill and run a much higher risk of relapse, treatment failure and death.India and China represent countries with some of the highest burdens of diabetes in the world. At the same time, TB remains a significant contributor to morbidity and mortality in both countries, where each year between 1.3 and 1.9 million new cases of TB are reported. Both countries implement the WHO TB DOTS strategy and have almost 100% coverage. However, the worsening diabetes epidemic may have a negative impact TB control efforts.Integrating bidirectional screening into existing TB and diabetes programmes will allow earlier detection of co-morbidities, leading to better health outcomes as well as less risk of TB transmissions within health facilities. This is also in line with the Collaborative Framework for Care and Control of Tuberculosis and Diabetes, developed by WHO and The International Union Against TB and Lung Diseases (the Union), launched in September 2011, see the document here: http://www.worlddiabetesfoundation.org/files/collaborative-framework-care-and-control-tuberculosis-and-diabetes-0The aim of this project is to investigate the links between diabetes and tuberculosis through the implementation of bidirectional screening in selected health facilities in India and China.
The project is coordinated by the International Union in collaboration with the Indian National TB Control Programme, selected diabetes clinics in India, the Chinese National TB Programme, and China Diabetes Association. It builds upon a collaboration established in 2009 between WDF, the Union and WHO with the purpose of exploring the link between diabetes and tuberculosis.This project will further investigate and highlight the links between the two diseases through national stakeholder meetings and training of health care providers. The procedures of carrying out routine bidirectional screening in health care facilities are not established, and this project will address these knowledge gaps. The data collected during the project is meant to facilitate a shift in the international health agenda as well as a more profound recognition of the link between diabetes and TB.An initial stakeholder meeting between the Union, WHO, WDF and national diabetes and tuberculosis authorities will be held in both countries, with the aim of reviewing the WHO/Union Collaborative Framework with a view to establish pilot initiatives for bidirectional screening.The next step for the project will build capacity among health workers in selected clinics to enable them to implement and report on bidirectional screening of TB and DM, which is an important part of the Collaborative Framework. The capacity building will be provided to 16 selected clinics in the two countries. The project is embedded within existing health care structures and involves national health authorities.20 health care providers from each country will be trained using a two-phased approach. The first part of the training will consist of a five-day module on how to perform routine bidirectional screening in health facilities in India and China. A further aim of the training is to enable the health care providers to monitor, record and report screening results, thereby creating patient cohorts. The second part consists of a five-day module, teaching the participants how to analyse and interpret the results of the cohorts and how to write scientific papers and communicate the findings. Thus building further evidence on the double burden and provide answers to some of the unanswered questions through operational research.At project completion, a national stakeholder meeting will be hosted in each country to disseminate and promote the findings of the project. The ultimate aim is to influence national and international practice and policies to make bidirectional screening a routine part of diabetes and TB care.
- 2 national stakeholder meetings between the Union, WHO, WDF and national diabetes and tuberculosis authorities held in India and China- 1 refresher national stakeholder meeting held in China - 1 refresher national stakeholder meeting held in India- 30 HCPs from China and 40 HCPs from India trained in bidirectional screening of DM and TB- 17 HCPs from China and 20 HCPs from India trained in data analysis and writing scientific papers on DM and TB