The Union has been providing technical support to the United States Agency for International Development (USAID) Control and Prevention-Tuberculosis (CAP-TB) project in China, a five-year project designed to improve case detection and treatment for multidrug-resistant TB (MDR-TB) in the Greater Mekong Sub-Region of China, Myanmar and Thailand. One of the components of the project, which began in 2011, has been to detect TB earlier in high-risk groups, such as people with diabetes mellitus.
An earlier Union study in China and India demonstrated that bidirectional screening of patients for TB and DM in a hospital setting was both feasible and effective. The goal of this new project, in addition to detecting cases, was to determine if the same screening model would work well in community health settings.
In partnership with USAID’s implementing partner, FHI 360, and Yunnan Provincial Anti-TB Association, 10 community health centres in urban and rural areas of the Xishan District of Yunnan Province were selected and the staff trained to conduct the TB screening. During the project period (June 2013-April 2014), 2,942 patients with diabetes visited these clinics. Of them, two were already known to have TB, and 278 (9.5 percent) proved to have positive TB symptoms and were sent for further treatment. One person was diagnosed with active TB and started on anti-TB treatment. Although this number is small, the rate of diagnosis is nearly three times higher than that found in the general population in Yunnan.
This study, which was based on the WHO-Union Collaborative Framework for the Care and Control of TB and Diabetes (2011), is significant because China has the second largest number of TB cases in the world – with close to 900,000 cases reported to the World Health Organization in 2012 – and an estimated 113.9 million adults with diabetes. With research showing that people with diabetes mellitus are more than three times more likely to develop active TB than people without diabetes, effective cross-screening of these populations is essential to reducing the impact of both diseases.
Funding for the CAP-TB project was provided by USAID. Results of the TB-diabetes study have been accepted for publication in Tropical Medicine and International Health.
Download the WHO-Union Collaborative Framework for the Care and Control of TB and Diabetes (2011).