TB multimorbidity: a global health challenge demanding urgent attention

Siddiqi, Kamran; Stubbs, Brendon; Lin, Yan; Elsey, Helen; Siddiqi, Najma

doi:10.5588/ijtld.20.0751

Cited by 16 publications

(24 citation statements)

References 38 publications

(52 reference statements)

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“…Future studies should employ larger sample size in different settings to validate our findings. Additionally, future research should review the course of depression and anxiety and its association with smoking cessation during TB treatment [31]. Statements…”

Section: Discussionmentioning

confidence: 99%

Depressive symptoms are associated with cigarette smoking among tuberculosis patients in Botswana

Jones‐Patten

Wang

Molebatsi

et al. 2021

Preprint

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Background: Researchers have increasingly recognized the adverse effects of smoking on tuberculosis (TB) outcomes. Smoking may be a maladaptive coping mechanism for depression and anxiety among TB patients; however, this association has not yet been investigated. Design/Methods: We conducted a cross-sectional study among newly diagnosed TB patients between January and December 2019 in Gaborone, Botswana, and evaluated factors associated with cigarette smoking. Using the Patient Health Questionnaire-9 and the Zung Self-Rating Anxiety scale, we collected depression and anxiety scores, respectively; scores of ≥10 indicate depression and scores of ≥36 indicate anxiety. We performed Poisson regression analyses with robust variance to examine whether depression and anxiety were associated with smoking. Results: One hundred and eighty participants with TB were enrolled from primary health clinics. Among all enrollees, depression was reported in 46 (27.1%) participants, while anxiety was reported in 60 (44.4%) participants. Overall, 45 (25.0%) participants reported current smoking, and the median number of cigarettes per day was 10. Depressive symptoms were associated with a higher prevalence of smoking (aPR: 1.82; 95% CI = 1.11, 3.01) after adjusting for sex, HIV status, food insecurity, anxiety, and income. The association between anxiety symptoms and cigarette smoking did not reach statistical significance (aPR 1.26; 95% CI: 0.78-2.05). Conclusions: We found the association between depressive symptoms and smoking among TB patients in Botswana to be significant and the association between anxiety symptoms and cigarette smoking insignificant. Future studies should further investigate these associations when addressing TB care.

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Section: Discussionmentioning

confidence: 99%

Depressive symptoms are associated with cigarette smoking among tuberculosis patients in Botswana

Jones‐Patten

Wang

Molebatsi

et al. 2021

Preprint

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“…By self-report, 22% were current smokers and 36% past smokers, with median total pack-years of 10 [interquartile range [IQR] 2. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. More individuals in Negros Occidental were current or ex-smokers (64%, p<0.004 by region) and there were more current smokers in Cebu (28% p<0.001 by region).…”

Section: Prevalence Of Ncd Risk Factors: Smoking and Alcohol Behavioursmentioning

confidence: 99%

“…In the Philippines undernutrition and diabetes are estimated to be the leading population level risk factors for TB, estimated to affect 13.3% and 7.1% of adults [3,11]. There is an increasing recognition of the burden and impact of multimorbidity (the co-existence of 2 or more medical conditions) [12] for TB and other health outcomes, but also of opportunities within TB programmes for increasing screening and uptake of NCD health services [13]. However, despite many NCDs and TB sharing nutrition-related risk factors and management strategies, consideration of nutrition screening and linkage with nutrition services for TB and NCDs is rarely considered.…”

Section: Introductionmentioning

confidence: 99%

Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort

Cox

Edwards

Faguer

et al. 2021

PLOS Glob Public Health

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Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c ≥6.5% and/or on medication; hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or on medication; anaemia (moderate/severe), haemoglobin <11g/dL; and, undernutrition (moderate/severe) body-mass-index <17 kg/m2. The most common comorbidities were undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and anaemia 13.5% (121/899). Fifty-eight percent had ≥1 comorbid condition (496/847), with 17.1% having ≥2; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c≥8.0%) was common (N = 50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55–3.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39–0.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01–20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40–2.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97–2.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.

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“…This could be achieved through increased integration of TB and noncommunicable disease services. 23 Recent re-engineering of primary healthcare in South Africa has seen the introduction of municipal ward-based primary healthcare outreach teams of community health workers (CHWs). CHWs work in an integrated, teambased manner, supported by nurses, and take responsibility for health education and promotion, counselling and support for a range of health conditions.…”

Section: Introductionmentioning

confidence: 99%

“…This could be achieved through increased integration of TB and non-communicable disease services. 23 …”

Section: Introductionmentioning

confidence: 99%

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa

et al. 2022

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ObjectiveTo investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking.DesignMulticentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care.Setting27 primary care clinics in South Africa.Participants574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use.InterventionsThe intervention, delivered by lay health workers (LHWs), consisted of three brief motivational interviewing (MI) sessions, augmented with short message service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking.Outcome measuresThe primary outcome was successful versus unsuccessful TB treatment at 6–9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral therapy (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records.ResultsBetween 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR 0.9, 95% CI 0.64% to 1.27%). There was no evidence of an effect at 3 and 6 months, respectively, on continuous smoking abstinence (OR 0.65, 95% CI 0.37 to 1.14; OR 0.76, 95% CI 0.35 to 1.63), TB medication adherence (OR 1.22, 95% CI 0.52 to 2.87; OR 0.89, 95% CI 0.26 to 3.07), taking ART (OR 0.79, 95% CI 0.38 to 1.65; OR 2.05, 95% CI 0.80 to 5.27) or AUDIT scores (mean score difference 0.55, 95% CI −1.01 to 2.11; −0.04, 95% CI −2.0 to 1.91) and adjusting for baseline values. Cure rates were not significantly higher (OR 1.16, 95% CI 0.83 to 1.63).ConclusionsSimultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes.Trial registration numberISRCTN62728852.

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TB multimorbidity: a global health challenge demanding urgent attention

Cited by 16 publications

References 38 publications

Depressive symptoms are associated with cigarette smoking among tuberculosis patients in Botswana

Depressive symptoms are associated with cigarette smoking among tuberculosis patients in Botswana

Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa

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