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Assessing TB-related comorbidities, risks and disability in China

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A new study in China has found that it is possible and valuable to assess people with tuberculosis (TB) for symptoms, comorbidities, risk factors and disability at the start and end of TB treatment.

The research, carried out in 11 health facilities in mainland China, showed the prevalence of certain conditions was less frequent at the end compared with the beginning of treatment. The study has published in the Tropical Medicine and Infectious Disease journal.

Many people with TB have comorbidities, risk determinants and disability that co-exist at diagnosis, during and after TB treatment.

The study team assessed:

  • the burden of these problems at the start and end of TB treatment
  • whether referral mechanisms for further care were functional.

There were 603 patients registered with drug-susceptible TB who started TB treatment: 84% were TB symptomatic, 14% had diabetes, 14% had high blood pressure, 19% smoked cigarettes, 10% drank excess alcohol, and in 45% the 6-minute walking test (6MWT – which measures functional capacity) was abnormal. Five patients were identified with mental health disorders.

There were 586 (97%) patients who successfully completed TB treatment six months later. Of these, 18% were still TB symptomatic, 12% had diabetes (the remainder with diabetes failed to complete treatment), 5% had high blood pressure, 5% smoked cigarettes, 1% drank excess alcohol, and 25% had an abnormal 6MWT.

Lin Yan, senior advisor at the International Union Against Tuberculosis and Lung Disease (The Union), said: “We found referral mechanisms for the care of people with comorbidities and risk factors worked well. Except for those with mental health disorders and functional disability, where fewer patients were found to be in receipt of care compared with the others.”

The Union’s Centre for Operational Research sponsored the project, Anthony Harries was the principal investigator and Lin Yan was The Union coordinating officer on the ground in China supervising the project at the implementing sites.

Anthony, senior advisor at The Union, said: “Moving forward, more programmatic-related studies need to be conducted in other countries to build the evidence base for care of TB-related conditions and disability.

“Also, more needs to be done to simplify the assessment tools and resources need to be mobilised to strengthen referral mechanisms and provision of care through the routine health services.”

Anthony Harries, Lin Yan and colleagues have published an editorial in latest issue of the International Journal of Tuberculosis and Lung Disease, which sets out why it is important to address comorbidities, determinants and disability at the start and end of TB treatment. The five key reasons are:

  1. Improving TB treatment outcomes
  2. Reducing the risk of recurrent TB after completion of treatment
  3. Identifying pulmonary dysfunction and impaired quality of life in those with pulmonary TB to trigger referrals to pulmonary rehabilitation, which appears to be effective in improving quality of life, exercise tolerance and lung function
  4. Improving mental health – the most common reported disability, affecting nearly one-quarter of people with TB
  5. Assessing comorbidities to reduce mortality – People treated for TB have a three-fold higher risk of death in the follow-up period than those who have never had TB

The research study was funded from a grant from the UNICEF, UNDP, World Bank and World Health Organization through the Special Programme for Research and Training in Tropical Diseases (TDR).



Notes to editor

About The Union

Established in 1920, the International Union Against Tuberculosis and Lung Disease (The Union) is committed to creating a healthier world for all, free of tuberculosis and lung disease.
The Union is the world’s first global health organisation and a global leader in ending TB. Its members, staff, and consultants work in more than 140 countries.
The Union strives to end suffering due to tuberculosis and lung diseases, old and new, by advancing better prevention and care. It seeks to achieve this by the generation, dissemination, and implementation of knowledge into policy and practice.
The Union aims to ensure that no one is left behind, people are treated equally and we have a focus on vulnerable and marginalised populations and communities.

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