Halting the dual Tuberculosis & Diabetes Epidemic

Project summary

Emergence of dual tuberculosis (TB)/diabetes mellitus (DM) epidemic threatens health and progress in sub-Saharan Africa. Interventions for these and other epidemics are managed in disease vertical programmes while various communicable and non-communicable diseases co-exist, and interact. To address the systemic bottlenecks in communicable and noncommunicable disease care in Tanzania; we propose an Adaptive Diseases control Expert Programme in Tanzania (acronym-ADEPT), focusing on the TB/DM co-epidemic. The project will study if and how integrated TB/DM diagnosis and novel technologies optimize management in client-friendly clinics including at primary health care (PHC) levels, may be developed and implemented, and if successful, inform policy and practice. The main outcomes include successful implementation of TB/DM management at all levels incl. PHC, as evidenced by increase of early detection of either disease, decrease of unfavourable treatment outcomes. Four Tanzanian institutes; Kibong’oto Infectious Diseases Hospital, Mbeya Medical Research Centre, Shree Hindu Mandal Hospital and Kilimanjaro Clinical Research Institute will implement the project. Section of Global Health, University of Copenhagen, Denmark will lead the programme and support capacity building in the applied research of dual TB/DM disease, in collaboration with the International Reference Laboratory of Mycobacteriology at Statens Serum Institut, supporting mycobacterial diagnostics, research, development, and quality assurance. Additional partners are University of Virginia, sub-contracted for support on therapeutic drug monitoring (TDM), and database design, and Groningen University, The Netherlands sub-contracted to provide technical expertise to adapt TDM to the field-friendly technique. Research capacity building includes 2 PhDs and 1Postdoc. The project budget is 10,000,000 DKK and will start on 2nd quarter of 2018 through 3rd quarter of 2023.

Outputs

Midterm report:
This project aimed to develop a model that will strengthen health systems to enable integration of technologies and innovations to personalize treatment of patients with dual communicable and non-communicable diseases using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic respectively as a case study in Tanzania. We designed the model with three key domains (i) implementation of collaborative TB/DM services, (ii) learning system with implementation research and clinical audit and (iii) training at varying levels including frontline health care providers, doctoral and postdoctoral trainees. The protocol model was submitted and was published in BMJ Open. The pilot of the model was implemented in three regions in Tanzania and a Model Blueprint has been developed and is processed for signature and endorsement at the Ministry of Health. Two PhD trainees are conducting research studies in this project and have developed and submitted at least 1 manuscript for publications. PhD trainees are working on other dataset to generate more manuscripts. The consortium tests therapeutic drug monitoring to optimize the clinical management of dual TB/DM in routine settings. The assay validation work is continuing. Doctoral and postdoctoral fellows presented this work in various conferences. The 2021 annual consortium meeting discussed the results and reflected on major research questions that provided the scientific directions and key areas for capacity development.