A public-private model to scale up diabetes mellitus screening among people accessing tuberculosis diagnostics in Dhaka, Bangladesh

Abstract

Background: Data are scarce regarding the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Bangladesh. This study was undertaken to estimate the number needed to screen (NNS) to identify a case of DM among those with TB symptoms and those with confirmed TB disease, and to identify factors predicting treatment outcomes of TB patients with and without DM. Methods: Persons attending public-private model screening centres in urban Dhaka for the evaluation of TB were offered free blood glucose testing in addition to computer-aided chest X-ray and sputum Xpert MTB/RIF. Results: Among 7647 people evaluated for both TB and DM, the NNS was 35 (95% confidence interval (CI) 31-40) to diagnose one new case of DM; among those diagnosed with TB, the NNS was 21 (95% CI 17-29). Among those with diagnosed TB, patients with DM were more likely to have cavitation on chest X-ray compared to those without DM (31% vs 22%). Treatment failure (odds ratio (OR) 18.9, 95% CI 5.43-65.9) and death (OR 2.08, 95% CI 1.11-3.90) were more common among TB patients with DM than among TB patients without DM. DM was the most important predictor of a poor treatment outcome in the classification analysis for TB patients aged 39 years and above. Conclusions: A considerable burden of DM was found among patients accessing TB diagnostics through a public-private model in urban Bangladesh, and DM was associated with advanced TB disease and a high rate of poor treatment outcome.

Impact of patient provider support agency on private sector engagement in Tuberculosis care in Eastern India

“…Only 22% of patients in the private sector in 2020 had unknown or blank Diabetic status as compared to 76% of patients in the 2019 Private sector. A study by Paul et al on the public-private model to scale up DM screening while assessing TB showed 63% were cured with TB & DM 20. Such a design recruited a highly representative sample of urban TB dwellers, similar to our study (77%).…”

Public–Private Mix (PPM) for Tuberculosis (TB) in Urban Health Systems in Least Developed, Low Income and Lower-Middle-Income Countries and Territories – A Systematic Review

“…For eight studies (27, 28, 33, 34, 48, 49, 57, 58, 60, 61, 70, 71, 84, 85, 87, 88), the research was reported across two publications each, which were merged and extracted as one study (Table 1 and Appendix 6). Most studies were from the WHO South-East Asia region (n=36, 65.4%) (30, 33, 36, 37, 40–42, 45, 47, 48, 50, 51, 54–56, 59, 60, 62, 64–67, 69, 74–76, 78–84, 86, 87, 89), followed by Eastern Mediterranean (n=7, 12.7%) (32, 43, 44, 46, 72, 73, 77), Western Pacific (n=6, 10.9%) (27, 31, 35, 52, 57, 70), African (n=4, 7.3%) (38, 39, 53, 68), and American (n=1, 1.8%) (63) regions. One study reported models from across three different countries and regions (29).…”

“…Of the 29 studies reporting treatment success (27, 29, 31, 33, 35–37, 41, 43–45, 51–54, 56, 57, 60, 62, 65, 66, 68, 73, 75, 77, 78, 81, 83, 89), 17 (60.7%) reported rates >=85%. Figure 2 plots the estimates from 21/28 studies (for which 95% CIs were reported or could be estimated), according to PPM model type.…”

The Footprint of Diabetes Mellitus on the Characteristics and Response to Anti-Tuberculous Therapy in Patients with Pulmonary Tuberculosis from Saudi Arabia

“…An earlier study conducted in Riyadh, KSA and another one from Bangladesh endorsed that diabetic patients had pulmonary cavities more often than non-diabetics ( p -values = 0.02 and 0.001, respectively). 32 , 33 This could be ascribed to the immune dysfunction in diabetic patients induced by hyperglycemia. 34…”