title: Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts.
abstract: Recent data for the global burden of disease reflect major demographic and lifestyle changes, leading to a rise in non-communicable diseases. Most countries with high levels of tuberculosis face a large comorbidity burden from both non-communicable and communicable diseases. Traditional disease-specific approaches typically fail to recognise common features and potential synergies in integration of care, management, and control of non-communicable and communicable diseases. In resource-limited countries, the need to tackle a broader range of overlapping comorbid diseases is growing. Tuberculosis and HIV/AIDS persist as global emergencies. The lethal interaction between tuberculosis and HIV coinfection in adults, children, and pregnant women in sub-Saharan Africa exemplifies the need for well integrated approaches to disease management and control. Furthermore, links between diabetes mellitus, smoking, alcoholism, chronic lung diseases, cancer, immunosuppressive treatment, malnutrition, and tuberculosis are well recognised. Here, we focus on interactions, synergies, and challenges of integration of tuberculosis care with management strategies for non-communicable and communicable diseases without eroding the functionality of existing national programmes for tuberculosis. The need for sustained and increased funding for these initiatives is greater than ever and requires increased political and funder commitment.
authors.affiliation: Sydney Emerging Infections and Biosecurity Institute, and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Marais
authors.forename: Knut
authors.initials: K
authors.lastname: Lönnroth
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Lawn
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.forename: Philippe
authors.initials: P
authors.lastname: Glaziou
authors.forename: Matthew
authors.initials: M
authors.lastname: Bates
authors.forename: Ruth
authors.initials: R
authors.lastname: Colagiuri
authors.forename: Lynn
authors.initials: L
authors.lastname: Zijenah
authors.forename: Soumya
authors.initials: S
authors.lastname: Swaminathan
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.forename: Michel
authors.initials: M
authors.lastname: Pletschette
authors.forename: Michael
authors.initials: M
authors.lastname: Hoelscher
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abubakar
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
authors.forename: Afia
authors.initials: A
authors.lastname: Zafar
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Pantaleo
authors.forename: Gill
authors.initials: G
authors.lastname: Craig
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Markus
authors.initials: M
authors.lastname: Maeurer
authors.forename: Marco
authors.initials: M
authors.lastname: Schito
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control; D060085:Coinfection / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D014943:Global Health; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000472:pathogenicity; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D012307:Risk Factors; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control