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Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa.

Alisjahbana, B; McAllister, SM; Ugarte-Gil, C; Panduru, NM; Ronacher, K; Koesoemadinata, RC; Zubiate, C; Riza, AL; Malherbe, ST; Kleynhans, L; et al. Alisjahbana, B; McAllister, SM; Ugarte-Gil, C; Panduru, NM; Ronacher, K; Koesoemadinata, RC; Zubiate, C; Riza, AL; Malherbe, ST; Kleynhans, L; Lopez, S; Dockrell, HM; Ruslami, R; Ioana, M; Walzl, G; Pearson, F; Critchley, JA; Moore, DAJ; van Crevel, R; Hill, PC (2021) Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa. Trans R Soc Trop Med Hyg, 115 (6). pp. 634-643. ISSN 1878-3503 https://doi.org/10.1093/trstmh/traa100
SGUL Authors: Critchley, Julia

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Abstract

BACKGROUND: Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. METHODS: DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. RESULTS: A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. CONCLUSIONS: These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Transactions of the Royal Society of Tropical Medicine & Hygiene following peer review. The version of record Bachti Alisjahbana, Susan M McAllister, Cesar Ugarte-Gil, Nicolae Mircea Panduru, Katharina Ronacher, Raspati C Koesoemadinata, Carlos Zubiate, Anca Lelia Riza, Stephanus T Malherbe, Leanie Kleynhans, Sonia Lopez, Hazel M Dockrell, Rovina Ruslami, Mihai Ioana, Gerhard Walzl, Fiona Pearson, Julia A Critchley, David A J Moore, Reinout van Crevel, Philip C Hill, on behalf of the TANDEM Consortium, Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa, Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 115, Issue 6, June 2021, Pages 634–643 is available online at: https://doi.org/10.1093/trstmh/traa100
Keywords: diabetes mellitus, screening, tuberculosis, 0605 Microbiology, 1108 Medical Microbiology, 1117 Public Health and Health Services, Tropical Medicine
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Trans R Soc Trop Med Hyg
ISSN: 1878-3503
Language: eng
Dates:
DateEvent
June 2021Published
28 October 2020Published Online
10 September 2020Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
305279Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
PubMed ID: 33118039
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112579
Publisher's version: https://doi.org/10.1093/trstmh/traa100

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