Linkage between tuberculosis and diabetes, Peru

Objectives

Peru has a high incidence of pulmonary tuberculosis (124 per 100,000 habitants) and a growing incidence of multi-drug resistant tuberculosis (MDR-TB). The rise of MDR-TB, years of poverty, and political conflict have driven the overall increases in TB incidence, as well as the ongoing problem of decreasing treatment success.

Around 77% of Peruvians are overweight or obese, and 7% of Peruvians have been diagnosed with diabetes. Peru is starting a epidemiological transition from communicable diseases to non-communicable diseases, hereby facing a double burden of the increasing rate of TB (specially MDR-TB) combined with the rise in diabetes.

Objectives

The goal of the project is to introduce TB-diabetes co-morbidity care in Peru through a pilot intervention in the capital of Lima.

Approach

In close collaboration with the Peruvian Ministry of Health (MoH) and the Pan American Health Organization (PAHO), and within the framework of the National Tuberculosis Programme and National Chronic Diseases Program of Peru, this project will set up a pilot programme on diagnosis, management and care of diabetes among tuberculosis patients. It will take place in primary health care centres with tuberculosis clinics in Lima, using the tuberculosis clinics as an entry point to identify TB patients with diabetes.

The project activities include:

Implementation of an operational study to identify gaps and barriers in detection and care of diabetes among TB patients in the health care system. Data will be collected from several MoH primary health care centres across Lima. The study will provide evidence to MoH in order to strengthen linkage of detection and care of TB and diabetes. A follow-up study will be done to track the impact of the interventions.
Elaboration of training materials in tuberculosis and diabetes will also be based on operational study findings; these materials will include an on-line course in diabetes for tuberculosis personnel.
Screening for diabetes among tuberculosis patients, people undergoing investigation for tuberculosis, and tuberculosis household contact in clinics in Lima. Targeted tuberculosis patients will be above 35 years old and have diabetes risk factors. Positive cases will be referred to free Ministry of Health diabetes services.
Roll out of advocacy through scientific meetings on tuberculosis-diabetes and arrangement of a tuberculosis-diabetes conference to share study results.

Results at completion

‘Cascade-of-care’ study of tuberculosis-diabetes care conducted
On-line course on diabetes for tuberculosis personnel developed
500 packages of educational material in tuberculosis-diabetes printed
436 tuberculosis HCPs trained in diabetes and TB-diabetes care, with possible expansion
436 tuberculosis HCPs participated in scientific meetings on tuberculosis-diabetes
436 tuberculosis HCPs participated in tuberculosis-diabetes conference
1050 tuberculosis patients and tuberculosis household contacts screened for diabetes
Monitoring and evaluation on project implementation and impact relating to changes in clinical measures (HbA1c) conducted