Health System Strengthening

Tuberculosis Preventive Therapy (TPT) Initiation & Health System Strengthening

• Health system strengthening interventions increased TPT initiation among household contacts, especially in LMICs.
• Countries with policies supporting TPT for all age groups had higher initiation rates (up to 78%).
• Cost-effective implementation when tailored to local contexts and sustained with training/support.

TB Diagnosis & Infection Control in Healthcare Facilities

• Transition to auramine-rhodamine fluorescence microscopy improved early TB detection and reduced patient infectiousness.
• The proportion of hospitalized TB cases dropped from 45% to 27%; median non-isolated infectiousness reduced from 12.5 days to 3 days.
• Upgraded ventilation, UV germicidal systems, and early physician alertness enhance TB infection control.
• High-traffic outpatient areas (internal medicine, family medicine) should prioritize TB screening.

Diabetes & Tuberculosis Interaction

• TB-DM patients had lower treatment success rates (74.4% vs. 84.9%) and increased multidrug-resistant TB risk.
• Prediabetes is prevalent among TB patients and affects immune response, potentially worsening TB outcomes.
• Managing dyslipidemia in T2D patients may reduce TB risk; statins might lower active TB incidence.
• BCG vaccination may help modulate lipid metabolism and reduce TB risk in high-risk populations.

TB Diagnosis & Screening in Resource-Limited Settings

• Simple clinical risk scores (age, sex, symptoms, HIV, diabetes) improve early TB identification in clinics with limited diagnostics.
• Combining WHO symptom screening with tuberculin skin tests enhances sensitivity.
• Predictive models incorporating BMI, CD4 count, and ART duration improve TB screening in co-infected populations.
• Immediate, standardized empirical diagnosis needed to prevent TB treatment delays.

TB & Prediabetes

• TB patients with prediabetes face higher risks of treatment failure, recurrence, and modifications.
• The role of prediabetes in TB progression remains unclear, but chronic inflammation and immune dysfunction are potential factors.
• Paradoxically, one study found a 27% lower TB risk in prediabetic individuals, warranting further research.

Practical Recommendations

• Strengthen health system interventions to increase TPT uptake, particularly in LMICs.
• Enhance early TB detection through improved diagnostic tools and physician alertness.
• Implement targeted TB screening and infection control in high-risk hospital areas.
• Improve diabetes management in TB patients to enhance treatment success.
• Use cost-effective clinical risk scores for TB diagnosis in resource-limited settings.
• Further investigate the complex relationship between TB, prediabetes, and metabolic disorders for refined public health strategies.

Curated by Yoseph Leonardo Samodra.

References:

1. Sun H-Y, Wang J-Y, Chen Y-C, Hsueh PR, Chen Y-H, Chuang Y-C, et al. (2020) Impact of introducing fluorescent microscopy on hospital tuberculosis control: A before-after study at a high caseload medical center in Taiwan. PLoS ONE 15(4): e0230067.
2. Pan, S.C., Chen, C.C., Chiang, Y.T., Chang, H.Y., Fang, C.T. and Lin, H.H., 2016. Health care visits as a risk factor for tuberculosis in Taiwan: a population-based case–control study. American journal of public health, 106(7), pp.1323-1328.
3. Oxlade, O., Benedetti, A., Adjobimey, M., Alsdurf, H., Anagonou, S., Cook, V.J., Fisher, D., Fox, G.J., Fregonese, F., Hadisoemarto, P. and Hill, P.C., 2021. Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial. The Lancet Public Health, 6(5), pp.e272-e282.
4. Baik, Y., Rickman, H.M., Hanrahan, C.F., Mmolawa, L., Kitonsa, P.J., Sewelana, T., Nalutaaya, A., Kendall, E.A., Lebina, L., Martinson, N. and Katamba, A., 2020. A clinical score for identifying active tuberculosis while awaiting microbiological results: development and validation of a multivariable prediction model in sub-Saharan Africa. PLoS medicine, 17(11), p.e1003420.
5. Van Wyk, S.S., Lin, H.H. and Claassens, M.M., 2017. A systematic review of prediction models for prevalent pulmonary tuberculosis in adults. The International Journal of Tuberculosis and Lung Disease, 21(4), pp.405-411.
6. Lee, E.H., Lee, J.M., Kang, Y.A., Leem, A.Y., Kim, E.Y., Jung, J.Y., Park, M.S., Kim, Y.S., Kim, S.K., Chang, J. and Kim, S.Y., 2017. Prevalence and impact of diabetes mellitus among patients with active pulmonary tuberculosis in South Korea. Lung, 195, pp.209-215.
7. Segura-Cerda, C.A., López-Romero, W. and Flores-Valdez, M.A., 2019. Changes in host response to mycobacterium tuberculosis infection associated with type 2 diabetes: beyond hyperglycemia. Frontiers in cellular and infection microbiology, 9, p.342.
8. Liang, L. and Su, Q., 2024. Prediabetes and the treatment outcome of tuberculosis: A meta‐analysis. Tropical Medicine & International Health, 29(9), pp.757-767.
9. Ko, T.H., Chang, Y.C., Chang, C.H., Liao, K.C.W., Magee, M.J. and Lin, H.H., 2023. Prediabetes and risk of active tuberculosis: a cohort study from Northern Taiwan. International Journal of Epidemiology, 52(3), pp.932-941.

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