Browsing by Author "Bygbjerg, Ib"

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    Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania
    (John Wiley & Sons, Inc., 2022-08-04) Byashalira, Kenneth; Chamba, Nyasatu; Alkabab, Yosra; Mbelele, Peter; Mpolya, Emmanuel; Ntinginya, Nyanda; Shayo, PendoMartha; Ramaiya, Kaushik; Lillebaek, Troels; Heysell, Scott K; Mmbaga, Blandina; Bygbjerg, Ib; Mpagama, Stellah; Christensen, Dirk
    Objective Diabetes mellitus (DM) has been known to compromise tuberculosis (TB) treatment outcomes. Association data are limited for early hyperglycaemia detection and TB treatment outcomes. Thus, we assessed treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia. Methods A prospective cohort study recruited TB participants receiving anti-TB treatment at health facilities in Tanzania between October 2019 and September 2020. Hyperglycaemia was defined as having pre-existing DM or pre-treatment random blood glucose of ≥7.8mmol/L, in combination categorised as impaired glucose regulation (IGR). Those with IGR were further screened for hyperglycaemia severity using glycated haemoglobin. In case of unknown status, participants were tested for HIV. Time to death was determined at 6 months of TB treatment. Results Of 1,344 participants, 187 (13.9%) had IGR, of whom 44 (23.5%) were HIV co-infected. Overall treatment success was 1,206 (89.7%), and was similar among participants with or without IGR (p>0.05). Time to death for participants with and without IGR was 18 versus 28 days (p=0.870), respectively. Age ≥40 years (p=0.038), bacteriological positive (p=0.039), HIV (p=0.009), or recurrent TB (p=0.017) predicted death or treatment success during TB treatment in adjusted multivariable models. Conclusion IGR did not influence clinical outcomes in TB patients with or without IGR in a programme of early IGR diagnosis and integration TB, HIV and DM care. Early detection and co-management of multi-morbidities among people diagnosed with TB may reduce likelihood of poor treatment outcomes in a programmatic setting.
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    Transforming Nursing Practice to Optimize Care of Patients with Tuberculosis and Associated Comorbidities in the Kilimanjaro Region, Tanzania
    (The Open Nursing Journal, 2025-01-31) Shayo, Pendo Martha; Zewdie, Elyana; Byashalira, Kenneth; Chamb, Nyasatu; Mbelele, Peter; Bygbjerg, Ib; Lillebaek, Troels; Heysell, Scott; Christensen, Dirk; Mpagama, Stellah
    Background: Managing tuberculosis (TB) patients with comorbidities requires a holistic and patient-centered approach. This study evaluated patient-centered care (PCC) experiences among TB patients with multimorbidity under the Adaptive Diseases Control Expert Program in Tanzania (ADEPT), with a focus on the TB/diabetes mellitus (DM) co-epidemic targeted by the program. Methods: A quantitative cross-sectional study was conducted involving TB patients with associated comorbidities receiving care from nurses trained in PCC through the ADEPT program. Patients were assessed for their interpretation of how they received PCC across eight dimensions of care. Results: All 39 participants with TB had at least one comorbidity (100%). The most common multi-morbidities were TB/HIV (59.0%) and TB/DM (12.8%). Evaluation of needs, values, and preferences revealed that participants strongly felt healthcare workers considered these aspects (mean score = 4.53; scale 1 minimum- strongly disagree to 5 maximum- strongly agree). Subsequent analysis showed varying evaluations across dimensions. Patients reported robust endorsement for receiving care that involved family and friends, with mean scores of 4.04, and for access to care, with a mean score of 4.40. However, physical comfort, coordination, continuity of care, education and emotional support received comparatively lower rankings. Conclusion: TB patients with multimorbidity under the ADEPT program experienced PCC. However, certain systemic issues such as physical spaces, coordination, transition of care, and information education did not meet patient's needs in their own assessment, indicating opportunities for further quality improvement. Scaling up the ADEPT program within healthcare systems is likely to enhance care provision for TB patients with multimorbidity through a patient-centered approach.