Screening patients with Diabetes Mellitus for Tuberculosis in China.
Harries, A D
AffiliationChina Office, International Union Against Tuberculosis and Lung Disease, Beijing, China Clinical Center on Tuberculosis, China CDC, Beijing, China The Affiliated Hospital of Guiyang Medical College, Guiyang City, Guizhou Province, China Tai'an Central Hospital, Tai'an City, Shandong Province, China Dingxi Number 2 Hospital, Anding District, Gansu Province, China Jinan Central Hospital, Lixia District, Jinan City, Shandong Province, China Shijiazhuang Number 2 Hospital, Shijiazhuang City, Hebei Province, China Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg World Diabetes Foundation, Gentofte, Denmark Stop-TB Department, World Health Organization, Geneva, Switzerland International Union Against Tuberculosis and Lung Diseases, Paris, France London School of Hygiene and Tropical Medicine, London, UK.
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AbstractObjective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Method Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom-based enquiry, and those positive to any symptom were referred for TB investigations. Results In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti-TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in-house training, special assignment of staff for screening and colocation of services. Conclusion This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient-related implications.
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