학술논문
Effect of Tuberculosis (TB) and Diabetes mellitus (DM) integrated healthcare on bidirectional screening and treatment outcomes among TB patients and people living with DM in developing countries: a systematic review.
Document Type
Academic Journal
Author
Nyirenda JLZ; Division of Infectious Diseases, Department of Internal Medicine II, University Hospital Freiburg. Medical Faculty. University of Freiburg, Freiburg, Germany.; Public Health Department, Faculty of Applied Sciences, University of Livingstonia, Mzuzu, Malawi.; Bockey A; Division of Infectious Diseases, Department of Internal Medicine II, University Hospital Freiburg. Medical Faculty. University of Freiburg, Freiburg, Germany.; Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.; Wagner D; Division of Infectious Diseases, Department of Internal Medicine II, University Hospital Freiburg. Medical Faculty. University of Freiburg, Freiburg, Germany.; Lange B; Department for Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.; German Centre for Infection Research, Braunschweig, Germany.
Source
Publisher: Taylor & Francis Country of Publication: England NLM ID: 101583421 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-7732 (Electronic) Linking ISSN: 20477724 NLM ISO Abbreviation: Pathog Glob Health Subsets: MEDLINE
Subject
Language
English
Abstract
A systematic review (Prospero CRD42017075562) including articles published between 1 January 1990 and 31 October 2021 was performed to synthesize evidence on the effect of integrating tuberculosis (TB) and diabetes mellitus (DM) healthcare on screening coverage and treatment loss to follow-up as compared to non-integrated care services for TB and DM in low- to middle-income countries (LMICs). Searches were performed in PubMed, Web of Science, WHO Global Index Medicus, and Cochrane Central Library. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and we adopted Cochrane data collection form for Randomized Controlled Trials (RCTs) and non-RCTs. Due to heterogeneity and limited data of studies included, meta-analysis was not performed. Of 6902 abstracts, 10 studies from South America, Asia, and Africa were included. One study from Zimbabwe showed 57% increase in DM screening among TB patients in integrated care as compared to non-integrated care; 95% CI: 54.1, 59.8. Seven studies with before-after comparison groups reported increased screening coverage during implementation of integrated healthcare that ranged from 10.1% in Mexico to 99.1% in China. Three studies reported reduction in loss to follow-up among TB patients in integrated care; two in China showed 9.2%, 95% CI: -16.7, -1.7, and -9.5%, 95% CI: -18.4, -0.7 differences, while a study from Mexico showed -5.3% reduction, 95% CI: -9.8, -0.9.With few and heterogenous included studies, the synthesized evidence is weak to establish effect of TB/DM integrated care. Therefore, further robust studies such as randomized clinical trials and well-designed observational studies are needed.