Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.

<h4>Background</h4>Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint managemen...

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Autores principales:	Martín Castellanos-Joya, Guadalupe Delgado-Sánchez, Leticia Ferreyra-Reyes, Pablo Cruz-Hervert, Elizabeth Ferreira-Guerrero, Gabriela Ortiz-Solís, Mirtha Irene Jiménez, Leslie Lorena Salazar, Rogelio Montero-Campos, Norma Mongua-Rodríguez, Renata Baez-Saldaña, Miriam Bobadilla-del-Valle, Jesús Felipe González-Roldán, Alfredo Ponce-de-León, José Sifuentes-Osornio, Lourdes García-García
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e4ca2273138d4c988f035f1c8c4d256e
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spelling	oai:doaj.org-article:e4ca2273138d4c988f035f1c8c4d256e2021-11-25T06:00:24ZResults of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.1932-620310.1371/journal.pone.0106961https://doaj.org/article/e4ca2273138d4c988f035f1c8c4d256e2014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0106961https://doaj.org/toc/1932-6203<h4>Background</h4>Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management.<h4>Objective</h4>To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico.<h4>Design</h4>Prospective observational cohort.<h4>Setting</h4>15 primary care units in 5 states in Mexico.<h4>Participants</h4>Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics.<h4>Intervention</h4>The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management.<h4>Main outcome measures</h4>Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB.<h4>Results</h4>Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β) = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups.<h4>Conclusions</h4>Joint management of TB and DM is feasible and appears to improve clinical outcomes.Martín Castellanos-JoyaGuadalupe Delgado-SánchezLeticia Ferreyra-ReyesPablo Cruz-HervertElizabeth Ferreira-GuerreroGabriela Ortiz-SolísMirtha Irene JiménezLeslie Lorena SalazarRogelio Montero-CamposNorma Mongua-RodríguezRenata Baez-SaldañaMiriam Bobadilla-del-ValleJesús Felipe González-RoldánAlfredo Ponce-de-LeónJosé Sifuentes-OsornioLourdes García-GarcíaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e106961 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Martín Castellanos-Joya Guadalupe Delgado-Sánchez Leticia Ferreyra-Reyes Pablo Cruz-Hervert Elizabeth Ferreira-Guerrero Gabriela Ortiz-Solís Mirtha Irene Jiménez Leslie Lorena Salazar Rogelio Montero-Campos Norma Mongua-Rodríguez Renata Baez-Saldaña Miriam Bobadilla-del-Valle Jesús Felipe González-Roldán Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes García-García Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
description	<h4>Background</h4>Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management.<h4>Objective</h4>To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico.<h4>Design</h4>Prospective observational cohort.<h4>Setting</h4>15 primary care units in 5 states in Mexico.<h4>Participants</h4>Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics.<h4>Intervention</h4>The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management.<h4>Main outcome measures</h4>Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB.<h4>Results</h4>Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β) = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups.<h4>Conclusions</h4>Joint management of TB and DM is feasible and appears to improve clinical outcomes.
format	article
author	Martín Castellanos-Joya Guadalupe Delgado-Sánchez Leticia Ferreyra-Reyes Pablo Cruz-Hervert Elizabeth Ferreira-Guerrero Gabriela Ortiz-Solís Mirtha Irene Jiménez Leslie Lorena Salazar Rogelio Montero-Campos Norma Mongua-Rodríguez Renata Baez-Saldaña Miriam Bobadilla-del-Valle Jesús Felipe González-Roldán Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes García-García
author_facet	Martín Castellanos-Joya Guadalupe Delgado-Sánchez Leticia Ferreyra-Reyes Pablo Cruz-Hervert Elizabeth Ferreira-Guerrero Gabriela Ortiz-Solís Mirtha Irene Jiménez Leslie Lorena Salazar Rogelio Montero-Campos Norma Mongua-Rodríguez Renata Baez-Saldaña Miriam Bobadilla-del-Valle Jesús Felipe González-Roldán Alfredo Ponce-de-León José Sifuentes-Osornio Lourdes García-García
author_sort	Martín Castellanos-Joya
title	Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
title_short	Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
title_full	Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
title_fullStr	Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
title_full_unstemmed	Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
title_sort	results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in mexico.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/e4ca2273138d4c988f035f1c8c4d256e
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Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.

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