Bi-directional tuberculosis - diabetes screening in Pakistan

Objectives

Pakistan has a population of over 180 million people, and 6,7 million of them are adults diagnosed with diabetes. An additional 3.5 million adults are thought to be undiagnosed.

At the same time, Pakistan is currently ranked fourth amongst high tuberculosis (TB) burden countries with an estimated prevalence is 342 cases per 100,000 people. As with diabetes, nearly half of all TB cases remain undiagnosed.

While considerable progress has been made in improving case detection, strengthening laboratory capacity and ensuring treatment success of TB patients, the rising burden of diabetes threatens to reverse several of the gains made in TB control.



Objectives

The goal of the project is to scale up and improve a bi-directional pilot programme for screening, diagnosis and treatment of tuberculosis-diabetes (TB-DM) patients through engagement of the private health sector of Karachi.

Approach

Activities will target healthcare providers and patients in nine low-income and lower-middle-income townships of Karachi.

The project will build on a pilot programme for screening TB and diabetes patients. This is done by a social enterprise comprising of Sehatmand Zindagi (SZ) centres, which consists of three private Lung Health facilities, and Indus Hospital Research Centre (IHRC) which is a privately operated hospital with a comprehensive diabetes clinic.



The project activities include:

Refinement of guidelines and training manuals for screening and case-management of TB-DM with reference to the ’WHO-Union Collaborative Framework’ and various other international guidelines.

Establishing of a team of mobilisers to involve physicians from private sector clinics with subsequent training of physicians to be conducted.

Roll out of routine diabetes diagnosis and risk-based screening of TB and diabetes by private physicians, and referral of those patients found at risk for both diseases to SZ centres and IHRC for further evaluation and care with subsequent back referral to private physicians.

Conducting analysis at SZ centres and at IHRC to assess appropriate timing for screening TB patients for diabetes. Each enrolled patient will also receive educational counselling.

Evaluating project outcome through meetings with national and provincial stakeholders and involving media coverage.

Results at completion

710 private doctors and 1330 other health professionals trained on bi-directional screening for TB-DM, treatment of TB-DM, insulin management, and referral network established
6,313 TB patients tested for diabetes through HbA1c
3,825 diabetes patients tested for TB through digital chest X-ray and Xpert MTB/RIF
500 camps held with over 27000 people were screened for diabetes
1 referral system established for management of diabetes, diabetic complications and insulin
Advocacy meeting held with National TB Program, Diabetic Association of Pakistan, Pakistan Chest Society and Sindh Provincial TB Program in Sind on implementation of bi-directional screening for TB-DM in the public sector