| Abstrakt: |
Background: As a result of shared social and structural risk factors, people in households affected by tuberculosis may have an increased risk of chronic conditions; at the same time, tuberculosis screening may be an opportunity for interventions. We sought to describe the prevalence of HIV, nutritional disorders, and noncommunicable diseases (NCDs) among members of tuberculosis-affected households in 3 African countries. Methods and findings: A part of a multicountry cohort study, we screened for tuberculosis, HIV, nutritional disorders (underweight, anaemia, overweight/obesity), and NCDs (diabetes, hypertension, and chronic lung disease) among members of tuberculosis-affected households aged ≥10 years in Mozambique, Tanzania, and Zimbabwe. We describe the prevalence of these conditions, their co-occurence within individuals (multimorbidity) and household-level clustering. Of 2,109 household contacts recruited, 92% (n = 1,958, from 786 households) had complete data and were included in the analysis. Sixty-two percent were female, median age was 27 years, and 0.7% (n = 14) were diagnosed with co-prevalent tuberculosis. Six percent of household members (n = 120) had previous tuberculosis, 15% (n = 294) were living with HIV, 10% (n = 194) had chronic lung disease, and 18% (n = 347) were anaemic. Nine percent of adults (n = 127) had diabetes by HbA1c criteria, 32% (n = 439) had hypertension. By body mass index criteria, 18% household members (n = 341) were underweight while 29% (n = 549) were overweight or obese. Almost half the household members (n = 658) had at least 1 modifiable tuberculosis risk factor. Sixty-one percent of adults (n = 822) had at least 1 chronic condition, one in 4 had multimorbidity. While most people with HIV knew their status and were on treatment, people with NCDs were usually undiagnosed and untreated. Limitations of this study include use of point-of-care HbA1c for definition of diabetes and definition of hypertension based on single-day measurements. Conclusions: Households affected by tuberculosis also face multiple other health challenges. Integrated approaches to tuberculosis screening may represent an opportunity for identification and treatment, including prioritisation of individuals at highest risk for tuberculosis to receive preventive therapy. Claire J. Calderwood and colleagues examine the prevalence of HIV, malnutrition, and non-communicable diseases among households with a member affected by tuberculosis in East and Southern Africa. Author summary: Why was this study done?: Tuberculosis-affected households are a particular priority group for interventions to address infectious, nutritional, and noncommunicable causes of illness and death. These household members may be at particular risk of these conditions due to underlying structural determinants of health, while the opportunity to intervene presented by tuberculosis screening may enable chronic conditions to be addressed, reducing tuberculosis incidence and improving overall health. Few studies have reported on the prevalence of conditions other than HIV among members of TB-affected households, therefore the burden of infectious, nutritional, and noncommunicable diseases within TB-affected households is unknown. What did the researchers do and find?: As part of a cohort study of people living in tuberculosis-affected households in 3 east/southern African countries, we screened 1,958 adolescents and adults for tuberculosis, HIV, nutritional disorders (including underweight, anaemia, overweight/obesity), and noncommunicable diseases (NCDs; diabetes, hypertension, and chronic lung disease). We found a high prevalence of these conditions and identified a very large gap in access to care for NCDs. While some conditions clustered within households (HIV, undernutrition), others (NCDs) did not. One in 2 tuberculosis household contacts had a modifiable tuberculosis risk factor (HIV, diabetes, chronic lung disease, underweight, current smoker, or potential alcohol misuse) while one in 5 had 2 or more chronic conditions (i.e., multimorbidity), most commonly due to the coexistence of HIV and an NCD. What do these findings mean?: In Africa, households affected by tuberculosis are impacted not only by tuberculosis but by multiple colliding epidemics including HIV, malnutrition, and NCDs. Screening for tuberculosis among household contacts represents an opportunity to intervene, improving the health of a vulnerable community while preventing tuberculosis. There is now clear evidence, including that from this study, to justify such an approach. Implementation research including health economic evaluations are now needed to support guideline development and scale up. [ABSTRACT FROM AUTHOR] |
