The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis
AuthorsHarries, A D
Chauhan, L S
Baker, M A
Jeon, C Y
Murray, M B
Bygbjerg, I C
Enarson, D A
Billo, N E
AffiliationInternational Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK; China Office, International Union Against Tuberculosis and Lung Disease, Beijing, China; South-East Asia Office, International Union Against Tuberculosis and Lung Disease, Delhi, India; Stop TB Department, World Health Organization, Geneva, Switzerland; Clinical Center on Tuberculosis, Chinese Centers for Disease Control and Prevention, Beijing, China; Clinical Center on Tuberculosis, Chinese Centers for Disease Control and Prevention, Beijing, China; South-East Asia Office, International Union Against Tuberculosis and Lung Disease, Delhi, India; National Centre for Disease Control, Ministry of Health and Family Welfare, Government of India, Delhi, India; Medical Department, Médecins Sans Frontières, Operational Research Unit, Brussels Operational Center, Luxembourg; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; School of Nursing, Columbia University, New York, New York; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA; London School of Hygiene & Tropical Medicine, London, UK; Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; International Union Against Tuberculosis and Lung Disease, Paris, France; World Diabetes Foundation, Gentofte, Denmark
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AbstractThe prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.
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