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Assessing and managing disability, co-morbidities and risk factors associated with tuberculosis: real-time operational research in China

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In 2021, the Centre for Operational Research at The Union worked with the Johns Hopkins Centre for Tuberculosis in Baltimore, USA, Professor Lin Yan in Beijing, China, and China National TB Programme staff to assess the feasibility and value of conducting post-TB assessments in people completing anti-TB treatment within the routine programmatic setting in China. Each assessment was carried out in just over 20 minutes. Nearly half of the people who completed treatment had on-going symptoms (chiefly cough, shortness of breath and fatigue), 20% were unable to walk 400 meters or more in six minutes (six-minute walking test - 6MWT), 20% had associated diabetes mellitus and 10% were current smokers.

The study highlighted the on-going burden of disability, co-morbidities and risk determinants in people at the end of anti-TB treatment. In the published paper, we argued for the importance of conducting these assessments at the start as well as at the end of anti-TB treatment, ensuring that those with co-morbidities and with risk factors are given appropriate attention and care and providing a pulmonary rehabilitation package to those who are disabled with an abnormal 6MWT.

Funding was obtained in 2022 from the Special Programme for Research and Training in Tropical Diseases (TDR) in Geneva, Switzerland, to undertake the above-mentioned work in 11 health facilities in China, and at the same time to combine this with operational research capacity building for national TB programme staff. Progress has been made. Programme staff received the first round of training in the “what, why and how” of operational research, and 603 registered people with tuberculosis have been recruited to the study. They are being assessed for co-morbidities such as diabetes mellitus, HIV, hypertension and mental health disorders, for risk factors such as smoking, alcohol use, malnutrition and exposure to silica through mining work and finally for disability using the 6MWT. Collating, validating and analysing the data from the 11 facilities on how many patients have disability, co-morbidities and risk determinants has been delayed because of COVID-19 lockdown restrictions in China, but this is now being implemented and data should soon be available.