The challenge of fragmented care for tuberculosis and chronic respiratory conditions
Tuberculosis (TB) continues to be a significant global health threat, with over ten million people falling ill with the disease and 1.25 million deaths reported every year. The burden is heaviest in low- and middle-income countries (LMICs). Despite advances in treatment, TB remains deeply disruptive, driving families into poverty, forcing children out of school, and causing persistent health challenges. Even after successful treatment, many survivors experience ongoing difficulties. LMICs now also face a rising tide of non-communicable chronic respiratory conditions including asthma, chronic obstructive pulmonary disease (COPD), post-TB lung diseases and bronchiectasis, that further strain under-resourced health systems and devastate patients, families, and communities.
Pulmonary TB (PTB) disease and chronic respiratory diseases (CRDs) are closely linked in LMICs. They are both diseases that thrive in situations of marginalisation and deprivation, with shared risk factors and clinical presentations, and are both deeply stigmatised. Despite this overlap, TB and CRD services are delivered separately in LMICs. TB care is provided via well-resourced and administered vertical National TB Programmes, but respiratory care is provided via less well defined and poorly resourced integrated health systems. The lack of integrated approaches to TB-respiratory care means that TB patients receive inadequate respiratory support, whilst those with CRDs are largely undiagnosed, and may receive recurrent courses of antibiotics and TB treatment for incorrectly diagnosed respiratory symptoms. Previous stakeholder engagement work in Africa has highlighted the need for integrated TB and respiratory care to improve patient outcomes, but there are no models of how this might be achieved, and this is identified by stakeholders as a key barrier to implementation.
Towards a framework for implementation and evaluation of integrated tuberculosis-respiratory care
This research programme seeks to address the urgent need for integrated TB and respiratory care in LMICs. In this 4-year National Institute for Health and Care Research funded grant we will use transdisciplinary research with mixed-methods approaches from clinical epidemiology, health systems, ethnography and, health economics to develop a framework for the implementation and evaluation of integrated TB-CRD care in three urban African settings – Nairobi in Kenya, Arusha in Tanzania, and Lagos in Nigeria.
The objectives are:
- Clinical Objective Describe the types, frequency, and exposures of non-TB chronic respiratory diseases amongst adults presenting to primary care facilities with respiratory symptoms, and to map clinical outcomes
- Health Economic Objective Quantify patient and health system costs associated with non-TB respiratory disease treatment pathways and develop value-based frameworks for evaluating service delivery.
- Qualitative Objective Understand perceptions, experiences, and care preferences related to respiratory diseases among patients, communities, and healthcare providers, and co-develop tools to support person-centred respiratory health
- Health Systems Objective Engage with stakeholders to develop a framework for integrated TB-respiratory care at study sites, and to map existing health system components for TB and respiratory care.
Through this transdisciplinary research approach we will engage key stakeholders and build sustainable research capacity at each site to enhance TB and respiratory disease care.
Athena’s role
Athena is involved as co-investigator leading the social science work across ITARA.
