Early interventions reduce multimorbidity and TB disability in Kenya, Uganda, Zambia, and Zimbabwe

Abstract

BACKGROUND: We provided early screening and referrals for multimorbidity and absenteeism and assessed changes in these parameters from TB treatment start to completion in health facilities across Kenya, Uganda, Zambia, and Zimbabwe. METHODS: A cohort study in 26 health facilities within national TB programmes. RESULTS: Follow-up was conducted in 1,146 (77%) of 1,497 patients; assessments took a median time of 30 min (interquartile range: 24-36). Symptom prevalence declined from 96% to 9%. Comorbidities (HIV, diabetes/hyperglycaemia, hypertension/high blood pressure) remained stable, while mental health disorders/probable depression decreased from 7% to 4%. Multimorbidity fell markedly; disability (inability to walk 400 m in 6 min) decreased from 20% to 4%; and those with ≥3 multimorbidity conditions decreased from 20% to 8%. Work/school absenteeism declined from 73% to 10%. Overall, referrals for care exceeded 85%, except for silica exposure (23%), smoking (57%), and recreational drug use (46%). Within-facility referrals were nearly 100%, except for silica exposure and disability (∼35%). CONCLUSION: Early interventions for multimorbidity led to major reductions in symptoms, risk factors, disability, and absenteeism, advocating for integration of patient-centred care throughout the TB care pathway. This multi-country study provides a promising roadmap for progress towards achieving this goal.