Table 2 Bi-directional interventions of TB and T2D

Achanta, 2013 [33]

India

Rural

Public

Cross-sectional

TB patients

TB prevalence was 5.1%; Screening of TB patients for T2D can be effectively implemented within the existing framework of health care delivery; Age was a factor significantly associated with the prevalence of T2D

Facilitators: The study was implemented without any additional resources within the existing health care system and with minimum training needs; Screening of patients was well accepted in the community;

Feasibility of screening for T2D among TB patients

Dave, 2013 [34]

India

Cross-sectional

TB patients

At 6.5%, the prevalence of T2D in TB patients was low compared with other pilot sites in India; Age ⩾35 years was associated with T2D

Barriers: there was no free supply of oral hypoglycaemic drugs, and some patients had to pay for these as out-of-pocket expenses

Facilitators: Screening was implemented within the routine system with existing staff; With just one day of training, clinical and nursing staff were able to follow the diagnostic algorithm and record appropriate data

Feasibility of screening for T2D among TB patients

Prakash, 2013 [35]

India

Cross-sectional

TB patients

The T2D prevalence was 6.3%. A higher prevalence of T2D was found among patients aged ⩾40 years, patients with pulmonary TB and smokers

Facilitators: Bi-directional screening for TB and T2D implemented using existing resources and staff, thus indicating that this is feasible; Low loss to follow-up due to the close proximity of the TB and T2D clinics

Co-management of TB-T2D comorbidity

Mtwangambate 2014 [36]

Tanzania

Prospective cohort

T2D patients

The prevalence of TB among adults with T2D was sevenfold higher than that reported in the general population

Barriers: High rates of non-productive cough

Facilitators: Low-cost, ‘cough-triggered’ TB case-finding strategy that may serve as a reasonable first step for improving TB screening among adults with T2D in resource-limited settings

Feasibility of screening for TB among T2D patients

Viney, 2015

Republic of Kiribati

Case–control

TB cases and controls

The T2D prevalence in cases (101, 37%) was significantly greater than in controls (94, 19%); Screening for T2D in the TB clinic is a worthwhile public health intervention, provided that patients with T2D can access T2D care

Co-management of TB-T2D comorbidity

Workne, 2016 [37]

Ethiopia

Exploratory Qualitative

HCW, programme managers, stakeholders

Main themes identified: 1. Unavailability of system for continuity of T2D care; 2. Inadequate knowledge and skills of HCW; 3. Frequent stockouts of T2D supplies; 4. Patient’s inability to pay for T2D services;

Barriers: Less attention given to T2D care

Facilitators: Presence of a well-established TB control programme up to the community level

Co-management of TB-T2D comorbidity

Sarker, 2016 [38]

Bangladesh

Cross-sectional

TB patients

The prevalence of T2D was 12.8%; The prevalence of diabetes was higher in rural areas than urban areas among the TB patients with diabetes (58.0% VS 42.0%)

Barriers: Funding is a challenge for the incorporation of T2D care among individuals with active TB

Facilitators: The large number of TB patients screened – feasibility

Co-management of TB-T2D comorbidity

Trinidad, 2016 [39]

Republic of the Marshall Islands

Prospective cohort

T2D patients

The observed rate of TB disease among those who completed TB screening was more than 20 times higher than that reported for the general population in 2012

Barriers: The tuberculin skin test (TST) does not perform well in a patient with active TB disease and can miss up to 30% of prevalent cases

Facilitators: They used TST which is the only currently available test for the diagnosis of latent TB

Feasibility of screening for TB among T2D patients

Fwoloshi, 2018 [40]

Zambia

Cross-sectional

TB patients

Only 4.7% of individuals with TB were found to have T2D—lower than the reported prevalence of T2D in similar cohorts of TB patients in sub-Saharan Africa but similar to the estimated prevalence of T2D in Lusaka

Barriers: it is not known whether the newly diagnosed T2D study participants merely had transient hyperglycemia or whether it was type 1 and not T2D

Facilitators: screening implemented using existing resources and staff

Feasibility of screening for T2D among TB patients

Ncube, 2019 [41]

Zimbabwe

Cross-sectional

TB patients

TB case load (low TB notifying sites) were likely to screen more patients for T2D; Screening increased gradually per quarter over the study period; There were, however, notable losses along the screening cascade

Barriers: There were notable losses along the screening cascade, the reasons for which will need to be explored in future studies

Facilitators: It was carried out in a programme setting using routinely collected data

Feasibility of screening for T2D among TB patients

Asante-Poku, 2019 [5]

Ghana

Cross-sectional

TB patients

The prevalence of T2D was 9.4%; Diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mycobacterium tuberculosis sensu stricto (Mtbss)

Barriers: Funding is a challenge

Facilitators: it was possible to screen for T2D and identify mycobacterium different lineage

Co-management of TB-T2D comorbidity

Soe, 2020 [42]

Myanmar

Cross-sectional-

TB patients

Data from the TB–T2D bi-directional shows that there are several gaps in screening and linkage to care

Barriers: Non-screening and suboptimal screening in certain townships

Facilitators: The study was done using data collected under routine programmatic conditions

Co-management of TB-T2D comorbidity

Basir, 2019 [43]

Pakistan

Cross-sectional

Individuals screened for presumptive TB and T2D

The yield of pre-T2D and T2D identified in TB patients in this programme was higher (12.4%) than the T2D prevalence in the general population of Pakistan (6.9%);

Barriers: User-fees for the X-ray and distance to the TB centres limited the number of diabetics undergoing TB screening

Facilitators: Screening for T2D among TB patients presented fewer operational challenges

Co-management of TB-T2D comorbidity

Majumdar, 2019 [44]

India

Mixed-methods

TB & T2D patients

HCW

TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres

Barriers: Low patient awareness, poor knowledge of guidelines, lack of staff and inadequate training were barriers to screening

Facilitators: The positive attitude of healthcare providers and programme staff

Co-management of TB-T2D comorbidity

Segafredo, 2019 [45]

Angola

Cross-sectional

TB patients

The crude prevalence of T2D among TB patients was close to 6%, slightly higher in males (6.3%) compared to females (5.7%). Age adjusted prevalence was 8%. Impaired fasting glucose (> 6.1 to < 7.0 mmol/L) was detected in 414 patients (7%)

Barriers: Absence of national guidelines or protocols for the integrated diagnosis and management of TB and T2D

Facilitators: Feasible to screen for T2D within the directly observed therapy (DOTs) centres

Feasibility of screening for T2D (and Hypertension) among TB patients

Ekeke, 2020 [46]

Nigeria

Cross-sectional

T2D patients

Overall prevalence of TB was 0.8% (800 per 100 000)

Barriers: Methods of screening, recording, and reporting T2D and TB co-morbidity in routine health care settings are not well determined

Facilitators: The number of positive cases identified following screening, yield of TB cases and the number needed to screen to make diagnosis of a TB case were encouraging

Feasibility of screening for TB among T2D patients

Paul, 2020 [47]

Bangladesh

Prospective cohort

TB patients

The screening for T2D among people with symptoms of TB, was effective and applicable to an ambulatory population seeking healthcare in a mix of public and private clinics

Facilitators: The public–private partnership design allowed recruitment of a highly representative sample of urban dwellers in Dhaka

Feasibility of screening for T2D among TB patients

Hewage, 2021 [48]

Sry Lanka

Cross-sectional

T2D patients

The proportion of TB detected by active screening among all T2D clinic attendees was 0.001 (6/4548)

Facilitators: Authors used an algorithm designed to direct study units into different care pathways based on pathophysiological explained risk factors for TB among the T2D patients

Feasibility of screening for TB among T2D patients

Arini, 2022 [49]

Indonesia

Qualitative

Healthcare workers

Operational constraints in collaborative TB-T2D care and control are more prominent in TB case finding and management

Barriers: Poor collaboration between private and public sector in the management of TB-T2D

Facilitators: private health facilities have the potential to conduct health promotion for TB-T2D, bi-directional screening, treatment, referral, and reporting within an adequate capacity-building programme and logistic supplies

Co-management of TB-T2D comorbidity

Nyirenda, 2022 [50]

Malawi

Retrospective chart review analysis

T2D & TB patients

9.4% of the screened TB patients were living with T2D which is suggesting high prevalence of TB among T2D patients and high T2D among TB patients than in general population; One hospital had an integrated care which has contributed health systems strengthening through capacity building by providing materials and employing of additional healthcare workers at the Integrated NCDs clinic

Barriers: Low screening coverage and low yields; Shortage of treatment cards; Cards with blank spaces which contributed to high proportion of missed data

Facilitators: The introduction of the treatment cards made this study possible

Co-management of TB-T2D comorbidity