How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines

BMC Health Services Research

Research

Mishal Khan¹  Marco Liverani²  Lauren Oliveira Hashiguchi³  Mary C. Castro⁴  Sharon E. Cox⁵  Tansy Edwards⁶ 

[1] Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, WC1E 7HT, London, UK;Aga Khan University, National Stadium Road, 74800, Karachi, Pakistan;Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, WC1E 7HT, London, UK;School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, 852-8523, Nagasaki, Japan;National Institute of Nursing Research, National Institutes of Health, 31 Center Drive, 20892-2178, Bethesda, MD, USA;Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, WC1E 7HT, London, UK;School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, 852-8523, Nagasaki, Japan;Nutrition Center Philippines, Muntinlupa City, Manila, Philippines;School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, 852-8523, Nagasaki, Japan;Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel St, WC1E 7HT, London, UK;United Kingdom Health Security Agency, 61 Colindale Avenue London NW9 5EQ, Collindale, UK;School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, 852-8523, Nagasaki, Japan;MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St, WC1E 7HT, London, UK;

关键词: Diabetes;    Tuberculosis;    TB-DM;    Co-morbidity;    Integrated care;    Self-care;    Philippines;    Southeast Asia;   

DOI  :  10.1186/s12913-023-10015-7

 received in 2023-03-06, accepted in 2023-09-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPeople with diabetes mellitus (DM) have an estimated two- to three-times greater risk of adverse tuberculosis (TB) treatment outcomes compared to those without DM. Blood glucose control is a primary aim of managing DM during TB treatment, yet TB programmes are not generally adapted to provide DM services. The purpose of this study was to understand perceptions and the lived experiences of diabetic patients in TB treatment in the Philippines, with a view to informing the development of disease co-management strategies.MethodsThis mixed methods study was conducted within a prospective cohort of adults newly-starting treatment for drug-sensitive and drug-resistant TB at 13 public TB clinics in three regions of the Philippines. Within the subset of 189 diabetic persons who self-reported a prior DM diagnosis, or were diagnosed by screenings conducted through the TB clinic, longitudinal blood glucose data were used to ascertain individuals’ glycaemic control (controlled or uncontrolled). Univariable logistic regression analyses exploring associations between uncontrolled glycaemia and demographic and clinical factors informed purposive sampling of 31 people to participate in semi-structured interviews. All audio-recorded data were transcribed and thematic analysis performed.ResultsParticipants — both with controlled and uncontrolled blood glucose — were knowledgeable about diabetes and its management. However, a minority of participants were aware of the impact of DM on TB treatment and outcomes. Many participants newly-diagnosed with DM at enrolment in TB treatment had not perceived any diabetic symptoms prior and would have likely not sought clinical consult otherwise. Access to free glucose-lowering medications through TB clinics was a key enabling resource. However, participants expressed fear of side effects and interrupted access to glucose-lowering medications, and a preference for phytotherapy. Many participants felt that physical and financial impacts of TB and its treatment were challenges to DM management.Conclusions and recommendationsResults of this study indicate that public TB clinics can provide diabetic patients with additional health care resources and education to address co-morbidity. TB programmes might consider identifying patients with complicated DM, and offering diabetic monitoring and management, as DM and diabetic complications may compound the burden of TB and its treatment.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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