scholarly journals Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

2018 ◽  
Vol 34 (1) ◽  
Author(s):  
Kaio Vinicius Freitas de Andrade ◽  
Joilda Silva Nery ◽  
Ramon Andrade de Souza ◽  
Susan Martins Pereira
Keyword(s):  
Treatment Outcomes ◽  
Social Protection ◽  
Meta Analysis ◽  
Treatment Success ◽  
Qualitative Synthesis ◽  
Middle Income ◽  
High Burden ◽  
Tb Treatment ◽  
Protection Strategies ◽  
Meta Analyses

Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.

scholarly journals A systematic review and meta-analysis of the association between integrated tuberculosis and Human Immuno-deficiency Virus therapy and tuberculosis treatment outcomes among adults in sub-Saharan Africa

2020 ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Noah Fongwen Takah ◽  
Christian Akem Dimala ◽  
Victoria Simms
Keyword(s):  
Treatment Outcomes ◽  
Meta Analysis ◽  
Treatment Success ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
P Value ◽  
Human Immuno Deficiency Virus ◽  
Tb Treatment ◽  
All Cause Mortality ◽  
Sub Saharan

Abstract Background: Despite the scale-up of programmes integrating treatment of tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) in sub-Saharan Africa (SSA), TB treatment outcomes in TB/HIV co-infected patients in the region remain sub-optimal.Objective: To summarize the available evidence on the association between integrated TB/HIV treatment and TB treatment outcomes specifically, successful treatment and all-cause mortality in TB/HIV co-infected adults in SSA.Method: A systematic review of studies published between March 2004 and 10 July 2019 was performed. Seven electronic databases including Medline, Embase and Cochrane were searched to identify interventional and observational quantitative studies reporting on integrated TB/HIV treatment in SSA. Two investigators independently screened the search output, reviewed the eligible studies, and rated the quality of eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Pooled odds ratios (ORs) were derived using random-effects meta-analysis. Heterogeneity across studies was assessed using the I2 statistic. The confidence in the pooled ORs was rated using the GRADE. The final review was reported using the PRISMA.Results: Eleven studies including 4181 participants were retained. The studies were of moderate to good quality, with 10 being quasi-experimental and cohort. Pooling of relevant studies showed that the odds of treatment success with integration was 1.1 times (95% CI: 0.93-1.29; I2=74.5%; p-value for heterogeneity=0.001) the odds of treatment success without integration and the odds of mortality with integration was 1.27 (95% CI 1.02-1.59; I2=87.3%; p-value for heterogeneity<0.0001) times the odds of mortality without integration. On sensitivity analysis, the odds of mortality with integration decreased to 1.06 (95% CI: 0.83-1.34; I2=80.1%; p-value for heterogeneity<0.0001) times the odds of mortality without integration and there was strong evidence of an association between sample size variation and heterogeneity (p=0.01). Good quality studies (4/11) tended to support the effectiveness of integrated treatment in increasing successful outcomes and decreasing mortality. Certainty in the pooled ORs was low.Conclusion: Evidence on the effect of integrated TB/HIV treatment services on treatment success and all-cause mortality in TB/HIV co-infected patients in SSA is inconclusive but the few available good quality studies tend to favour the effectiveness of these services. More robust primary studies are warranted.

scholarly journals Validity of recalled v. recorded birth weight: a systematic review and meta-analysis

2016 ◽  
Vol 8 (2) ◽  
pp. 137-148 ◽  
Author(s):  
S. D. Shenkin ◽  
M. G. Zhang ◽  
G. Der ◽  
S. Mathur ◽  
T. H. Mina ◽  
...  
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Random Effects ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Clinical Population ◽  
Small Range ◽  
Qualitative Synthesis ◽  
Middle Income ◽  
Meta Analyses

Low birth weight is associated with adverse health outcomes. If birth weight records are not available, studies may use recalled birth weight. It is unclear whether this is reliable. We performed a systematic review and meta-analysis of studies comparing recalled with recorded birth weights. We followed the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to May 2015. We included studies that reported recalled birth weight and recorded birth weight. We excluded studies investigating a clinical population. Two reviewers independently reviewed citations, extracted data, assessed risk of bias. Data were pooled in a random effects meta-analysis for correlation and mean difference. In total, 40 studies were eligible for qualitative synthesis (n=78,997 births from 78,196 parents). Agreement between recalled and recorded birth weight was high: pooled estimate of correlation in 23 samples from 19 studies (n=7406) was 0.90 [95% confidence interval (CI) 0.87–0.93]. The difference between recalled and recorded birth weight in 29 samples from 26 studies (n=29,293) was small [range −86–129 g; random effects estimate 1.4 g (95% CI −4.0–6.9 g)]. Studies were heterogeneous, with no evidence for an effect of time since birth, person reporting, recall bias, or birth order. In post-hoc subgroup analysis, recall was higher than recorded birth weight by 80 g (95% CI 57–103 g) in low and middle income countries. In conclusion, there is high agreement between recalled and recorded birth weight. If birth weight is recalled, it is suitable for use in epidemiological studies, at least in high income countries.

scholarly journals Diabetes and poor tuberculosis treatment outcomes: issues and implications in data interpretation and analysis

2017 ◽  
Vol 21 (12) ◽  
pp. 1214-1219 ◽  
Author(s):  
P. Huangfu ◽  
F. Pearson ◽  
C. Ugarte-Gil ◽  
J. Critchley
Keyword(s):  
Treatment Outcomes ◽  
Study Design ◽  
Meta Analysis ◽  
Data Interpretation ◽  
Basic Study ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Time To Event Data ◽  
Tb Treatment

Tuberculosis (TB) remains one of the 10 leading causes of death worldwide, especially in low- and middle-income countries. We conducted a systematic review and meta-analysis including 88 studies examining the association between diabetes mellitus (DM) and TB treatment outcomes. However, we found several common methodological problems among them, including inappropriate adjustments for confounding factors, not using optimal statistical methods for ‘time to event' data, misclassification in exposure (DM) and outcomes (TB treatment outcomes) due to study design and non-standardisation of definitions, misunderstanding of basic study design concept, standardisation of TB treatment outcomes and quality control of publications. Many of these problems would apply more broadly to other ‘risk factors' for poor TB treatment outcomes. These issues need to be addressed and resolved to improve the quality of the studies and provide more accurate results for policy makers in the future to tackle the burden of TB.

scholarly journals Does Phone Messaging Improves Tuberculosis Treatment Success? A Systematic Review and Meta-analysis

2019 ◽  
Author(s):  
Kassahun Dessie Gashu ◽  
Kassahun Alemu Gelaye ◽  
Zeleke Abebaw Mekonnen ◽  
Richard Lester ◽  
Binyam Tilahun
Keyword(s):  
Mobile Phone ◽  
Text Messaging ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Treatment Success ◽  
Experimental Studies ◽  
Qualitative Synthesis ◽  
Tb Treatment ◽  
Care Protocol

Abstract Background: Compliance to anti-TB treatment is crucial in achieving cure and avoiding the emer­gence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success. Methods: All randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process, see Additional file 1. Results: A total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I2=7%, p<0.0002). In the review, performance, detection and attrition biases were reported as major risk of biases. Conclusions: Mobile-phone messaging showed a modest effect in improving anti-TB treatment success; however, the quality of evidence was low. Further controlled studies are needed to increase the evidence-base on the role of mHealth interventions to improve TB care. Protocol registration number: CRD420170744339 http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074439 Key Words: Mobile phone, Treatment success, Text messaging, Tuberculosis

scholarly journals Does Phone Messaging improves Tuberculosis Treatment Success? A Systematic review and Meta-analysis

2019 ◽  
Author(s):  
Kassahun Dessie Gashu ◽  
Kassahun Alemu Gelaye ◽  
Zeleke Abebaw Mekonnen ◽  
Richard Lester ◽  
Binyam Tilahun
Keyword(s):  
Mobile Phone ◽  
Text Messaging ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Treatment Success ◽  
Experimental Studies ◽  
Qualitative Synthesis ◽  
Tb Treatment ◽  
Care Protocol

Abstract Background: Compliance to anti-TB treatment is crucial in achieving cure and avoiding the emer­gence of drug resistance. Electronic health (eHealth) interventions are included in the strategy to end the global Tuberculosis (TB) epidemic by 2035. Evidences showed that mobile messaging systems could improve patient adherence to clinic appointment for diagnosis and treatment. This review aimed to assess the effect of mobile-phone messaging on anti-TB treatment success. Methods: All randomized controlled trial (RCT) and quasi-experimental studies done prior to August 26, 2019 were included in the review. Studies were retrieved from PubMed, EMBASE, Cochrane and ScienceDirect databases including, grey and non-indexed literatures from Google and Google scholar. Quality of studies were independently assessed using Cochrane Risk of Bias Assessment Tool. A qualitative synthesis and quantitative pooled estimation were used to measure the effect of phone messaging on TB treatment success rate. PRISMA flow diagrams were used to summarize article selection process, see Additional file 1. Results: A total of 1237 articles were identified, with 14 meeting the eligibility criteria for qualitative synthesis. Eight studies with a total of 5680 TB patients (2733 in intervention and 2947 in control groups) were included in meta-analysis. The pooled effect of mobile-phone messaging revealed a small increase in treatment success compared to standard of care (RR 1.04, 95% CI 1.02 to 1.06), with low heterogeneity (I 2 =7%, p<0.0002). In the review, performance, detection and attrition biases were reported as major risk of biases. Conclusions: Mobile-phone messaging showed a modest effect in improving anti-TB treatment success; however, the quality of evidence was low. Further controlled studies are needed to increase the evidence-base on the role of mHealth interventions to improve TB care. Protocol registration number: CRD420170744339 http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074439 Key Words: Mobile phone, Treatment success, Text messaging, Tuberculosis

scholarly journals Systematic review of therapeutic outcomes of multi-drug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and Human Immuno-deficiency Virus in low and middle-income countries: a study protocol

2019 ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Desmond Aroke ◽  
Kevin Pene Njefi ◽  
Yves Joel Tochie Noutakdie ◽  
Frank-Leonel Tianyi ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Meta Analysis ◽  
Integrated Treatment ◽  
Hiv Treatment ◽  
Middle Income ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Therapeutic Outcomes ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background: Programs that integrated tuberculosis (TB) and Human Immunodeficiency Virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs.Methods: A systematic review of evidence from published observational and interventional studies will be performed. The evidence will be obtained by searching Medline, Embase, and Global Health electronic databases with date limits being March 2004 and December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using appropriate quality assessment tools. Analysis and synthesis of data on TB treatment outcomes will be performed using random-effects meta-analysis on STATA-15 software. Data on predictors of TB treatment outcomes will be analysed using thematic analysis and synthesised using a descriptive approach and where appropriate, random-effects meta-analysis will be performed to obtain pooled effect sizes. The confidence in cumulative quantitative and qualitative evidence will be assessed using the appropriate versions of the Grading of Recommendations, Assessment, Development and Evaluation approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal.Discussion: This study is expected to highlight the quality of integrated TB/HIV treatment programs and their potential to uphold successful MDR-TB treatment outcomes. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs.Systematic review registration: This review has been submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO)

scholarly journals Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036985
Author(s):  
Shuqin Wen ◽  
Jia Yin ◽  
Qiang Sun
Keyword(s):  
Social Support ◽  
Treatment Outcomes ◽  
Low Income ◽  
Meta Analysis ◽  
Treatment Success ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Middle Income ◽  
Material Support ◽  
Resistant Tuberculosis

ObjectiveTo assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB).DesignWe searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed.SettingLow-income and middle-income countries.ParticipantsDR-TB patients.OutcomesTreatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more.ResultsAmong 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002).ConclusionMaterial support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions.PROSPERO registration numberCRD42019140824.

scholarly journals Systematic review of therapeutic outcomes of multi-drug resistant tuberculosis and their predictors in adults receiving integrated treatment of tuberculosis and Human Immuno-deficiency Virus in low and middle-income countries: a study protocol

2020 ◽  
Author(s):  
Benjamin Momo Kadia ◽  
Desmond Aroke ◽  
Kevin Pene Njefi ◽  
Joel Noutakdie Tochie ◽  
Frank-Leonel Tianyi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Integrated Treatment ◽  
Hiv Treatment ◽  
Middle Income ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background: Programs that integrated tuberculosis (TB) and Human Immunodeficiency Virus (HIV) treatment aim to provide efficient treatment services and maximize successful treatment outcomes through the delivery of both TB and HIV treatment by one provider at the same time and location. However, multi-drug resistant tuberculosis (MDR-TB) is more difficult to treat as compared to drug-sensitive TB, and in low and middle-income countries (LMICs), the potential of programs integrating TB/HIV treatment to sustain favourable MDR-TB treatment outcomes is poorly elucidated. The objective of this review is to perform a systematic collection, critical appraisal and synthesis of existing evidence on therapeutic outcomes of MDR-TB and their predictors among adults receiving integrated treatment for TB/HIV in LMICs. Methods: A systematic review of evidence from published observational and interventional studies will be performed. The evidence will be obtained by searching Medline, Embase, and Global Health electronic databases with date limits being March 2004 and December 2019. Two investigators will independently screen the search output, review the eligible studies, and assess the quality of the eligible studies using appropriate quality assessment tools. Analysis and synthesis of data on TB treatment outcomes will be performed using random-effects meta-analysis on STATA-15 software. Data on predictors of TB treatment outcomes will be analysed using thematic analysis and synthesised using a descriptive approach and where appropriate, random-effects meta-analysis will be performed to obtain pooled effect sizes. The confidence in cumulative quantitative and qualitative evidence will be assessed using the appropriate versions of the Grading of Recommendations, Assessment, Development and Evaluation approach. The final review will be reported following the guidelines of the Preferred Reporting System for Systematic Reviews and Meta-analysis, presented at scientific conferences and published in a peer-reviewed journal. Discussion: This study is expected to highlight the quality of integrated TB/HIV treatment programs and their potential to uphold successful MDR-TB treatment outcomes. Furthermore, the review will indicate patient-related and healthcare-related factors that should be addressed to improve on survival of patients with MDR-TB/HIV co-infection in LMICs. Systematic review registration: This review has been submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO)

scholarly journals Drug-susceptible tuberculosis treatment success and associated factors in Ethiopia from 2005 to 2017: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022111 ◽  
Author(s):  
Mohammed Assen Seid ◽  
Mohammed Biset Ayalew ◽  
Esileman Abdela Muche ◽  
Eyob Alemayehu Gebreyohannes ◽  
Tadesse Melaku Abegaz
Keyword(s):  
Systematic Review ◽  
Treatment Outcome ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Treatment Success ◽  
Systematic Search ◽  
Treatment Success Rate ◽  
Rural Residence ◽  
Tb Treatment

ObjectivesThe main aim of this study was to assess the overall tuberculosis (TB) treatment success in Ethiopia and to identify potential factors for poor TB treatment outcome.DesignA systematic review and meta-analysis of published literature was conducted. Original studies were identified through a computerised systematic search using PubMed, Google Scholar and Science Direct databases. Heterogeneity across studies was assessed using Cochran’s Q test and I2statistic. Pooled estimates of treatment success were computed using the random-effects model with 95% CI using Stata V.14 software.ResultsA total of 230 articles were identified in the systematic search. Of these 34 observational studies were eligible for systematic review and meta-analysis. It was found that 117 750 patients reported treatment outcomes. Treatment outcomes were assessed by World Health Organization (WHO) standard definitions of TB treatment outcome. The overall pooled TB treatment success rate in Ethiopia was 86% (with 95% CI 83%_88%). TB treatment success rate for each region showed that, Addis Ababa (93%), Oromia (84%), Amhara (86%), Southern Nations (83%), Tigray (85%) and Afar (86%). Mainly old age, HIV co-infection, retreatment cases and rural residence were the most frequently identified factors associated with poor TB treatment outcome.ConclusionThe result of this study revealed that the overall TB treatment success rate in Ethiopia was below the threshold suggested by WHO (90%). There was also a discrepancy in TB treatment success rate among different regions of Ethiopia. In addition to these, HIV co-infection, older age, retreatment cases and rural residence were associated with poor treatment outcome. In order to further improve the treatment success rate, it is strategic to give special consideration for regions which had low TB treatment success and patients with TB with HIV co-infection, older age, rural residence and retreatment cases.

scholarly journals Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sanju Gautam ◽  
Nipun Shrestha ◽  
Sweta Mahato ◽  
Tuan P. A. Nguyen ◽  
Shiva Raj Mishra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sri Lanka ◽  
Treatment Failure ◽  
South Asia ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Tb Treatment ◽  
Effect Model ◽  
Pooled Prevalence ◽  
The Impact

AbstractThe escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

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