Department of Community Medicine, North Delhi Municipal Corporation Medical College, Hindu Rao Hospital, Delhi, India.
Department of Community Medicine, Vardhaman Mahavir Medical College & Safdurjung Hospital, Delhi, India.
PLoS One. 2018 Aug 23;13(8):e0202256. doi: 10.1371/journal.pone.0202256. eCollection 2018.
Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs). Bi-directional screening for TB and diabetes mellitus (DM) is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme.
To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017.
It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data).
Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening.
Integrating screening for NCDs and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.
有证据表明，将结核病（TB）与非传染性疾病（NCD）的预防和管理相结合是合理的。在印度，该国同时面临结核病和非传染性疾病的双重负担，已经在实施针对结核病和糖尿病（DM）的双向筛查。然而，关于在这种筛查项目中加入其他非传染性疾病及其危险因素的可行性，仅有非常有限的项目数据。
评估在新德里两所医学院的 DOTS 中心治疗的≥20 岁结核病患者中，进行两阶段的非传染性疾病和非传染性疾病危险因素综合筛查的产量、可行性和可接受性，时间为 2016 年 10 月至 2017 年 3 月。
这是一项混合方法、三角测量研究，具有定量部分（使用问卷、人体测量和记录审查进行横断面研究）和定性部分（使用访谈数据进行描述性研究）。
在筛查的 403 名患者中，高血压的患病率为 7%（n=28），发现 20 例新病例，糖尿病的患病率为 8%（n=32），确诊 6 例新病例。筛查发现新病例所需的人数分别为高血压 20 人和糖尿病 63 人。最常见的非传染性疾病危险因素包括蔬菜（80%）和水果（72%）摄入不足、饮酒（34%）、使用无烟烟草（33%）和吸烟（32%）。四种或更多危险因素的聚集与年龄增加和男性性别有关（p<0.05）。患者和卫生提供者都认为筛查具有相关性和可接受性。然而，患者认为血液检查的等待时间和费用令人烦恼，而卫生提供者则认为工作量增加、医疗用品不足以及技能和知识不足是实施筛查的主要挑战。
在现有的结核病方案中纳入非传染性疾病的筛查，可以产生高产量，并且患者和卫生提供者认为是可行和可接受的，前提是克服了这些挑战。
