In India, The Union has been implementing pilot projects on bidirectional screening of Tuberculosis (TB) and Diabetes Mellitus (DM). One arm of this has been the screening of TB patients for DM in collaboration with the Central TB Division (CTD), Ministry of Health and Family Welfare (MoHFW) and the World Health Organization (WHO). This landmark project, modeled on the Collaborative Framework for Care and Control of TB and diabetes, published by WHO/The Union in August 2011, was key to a new policy introducing screening TB patients for diabetes countrywide.
There has been a growing epidemic of diabetes mellitus (DM) in India as a consequence of rapid urbanisation and increasingly sedentary lifestyles associated with upward socio-economic mobility. There are now an estimated 61 million people with diabetes in India – and this population has a significantly increased risk of developing active TB (two or three times higher than in those without diabetes). Evidence further suggests that diabetes also adversely affects TB treatment outcomes, leading to higher failure and relapse rates.
The pilot project was implemented in 7 tertiary centres and more than 60 peripheral health facilities in 8 tuberculosis units (TU) to study the feasibility and impact of introducing screening of TB patients for DM in India. Protocols for screening, monitoring and recording were developed at a stakeholders' meeting in October 2011, training for staff at chosen facilities was carried out in December 2011 and January 2012, and implementation began in January 2012.
Findings from a mid-term review carried out in August 2012 indicated that screening of TB patients for DM was important and feasible under the existing TB programme settings. It resulted in earlier identification of DM, better management of co-morbidity arising from the two conditions, and it was believed that linking patients to diabetic care could improve treatment outcomes.
The findings effectively served as the basis for a policy decision as India's Revised National Tuberculosis Programme (RNTCP) instituted the intervention of screening TB patients for DM countrywide. Directives were issued in September 2012 to ensure that TB patients are routinely tested for DM and hypertension, and linked to appropriate treatment services where necessary. A record of diabetes screening of TB patients will be reported to the national NCD cell every month, strengthening collaboration between the national TB and NCD programmes.
A similar pilot project to assess the feasibility and challenges of screening DM patients for TB within the health care setting is underway at six DM clinics in tertiary hospitals across India. Bi-directional screening for the two diseases was a recommendation in the recently endorsed National Strategic Plan (NSP) for TB Control (2012-2017). It is hoped that an arrangement for operationalising this will soon be reached as the NCD and TB programmes scale up and expand into hitherto unreached areas and populations.