Instituto Nacional de Saúde, Maputo, Mozambique.
Global Health Institute, University of Antwerp, Wilrijk, Belgium.
BMC Public Health. 2024 Mar 7;24(1):738. doi: 10.1186/s12889-024-18256-9.
Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC).
A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022.
A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services.
This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening.
鉴于目前缺乏关于结核病 (TB) 和 2 型糖尿病 (T2D) 联合管理和控制的国际指南，世界卫生组织 (WHO) 和国际防痨和肺病联合会 (The Union) 于 2011 年推出了一个政策框架，以应对结核病-2 型糖尿病合并症负担的日益增加。本综述旨在绘制现有关于实施联盟-世卫组织框架的证据，明确或双向结核病-2 型糖尿病健康计划作为在中低收入国家（LMIC）患者中共同管理的倡议。
根据对 PubMed 和 Web of Science 电子数据库中关于联盟-世卫组织框架和 LMIC 中结核病和 2 型糖尿病双向干预的同行评议文章的系统搜索，进行了快速综述。该搜索仅限于英语文章，时间范围为 2011 年 8 月 1 日至 2022 年 5 月 20 日。
共有 16 个 LMIC 的 24 篇文章符合纳入标准。其中 4 篇描述了联盟-世卫组织框架的实施，20 篇描述了结核病和 2 型糖尿病的双向干预。按照联盟-世卫组织的建议，双向活动被认为是有价值的、可行的和有效的。对结核病-2 型糖尿病合并症的有限了解和认识被确定为确保服务有效整合的一个障碍。
本综述表明，根据联盟-世卫组织框架的建议实施双向结核病和 2 型糖尿病活动（筛查和管理）是有价值的、可行的和有效的，特别是在面临结核病-2 型糖尿病合并症的国家。此外，显然在旨在提供实施合作活动成本证据的研究方面仍然存在差距。需要整合结核病和 2 型糖尿病服务，应通过成熟的结核病方案来实现。这种两个垂直项目的整合，可以确保以患者为中心、护理的连续性，并最终有助于加强卫生系统。
