title: Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico.
abstract: BACKGROUND
  Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management.
  
  
  OBJECTIVE
  To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  15 primary care units in 5 states in Mexico.
  
  
  METHODS
  Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics.
  
  
  METHODS
  The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management.
  
  
  METHODS
  Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB.
  
  
  RESULTS
  Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β)  = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups.
  
  
  CONCLUSIONS
  Joint management of TB and DM is feasible and appears to improve clinical outcomes.
authors.affiliation: Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
authors.forename: Martín
authors.initials: M
authors.lastname: Castellanos-Joya
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Delgado-Sánchez
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Leticia
authors.initials: L
authors.lastname: Ferreyra-Reyes
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Pablo
authors.initials: P
authors.lastname: Cruz-Hervert
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ferreira-Guerrero
authors.affiliation: Dirección del Programa de Salud en el Adulto y en el Anciano, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ortiz-Solís
authors.affiliation: Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
authors.forename: Mirtha Irene
authors.initials: MI
authors.lastname: Jiménez
authors.affiliation: Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
authors.forename: Leslie Lorena
authors.initials: LL
authors.lastname: Salazar
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Montero-Campos
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Norma
authors.initials: N
authors.lastname: Mongua-Rodríguez
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Renata
authors.initials: R
authors.lastname: Baez-Saldaña
authors.affiliation: Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán", México, Distrito Federal, México.
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla-del-Valle
authors.affiliation: Dirección General, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
authors.forename: Jesús Felipe
authors.initials: JF
authors.lastname: González-Roldán
authors.affiliation: Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán", México, Distrito Federal, México.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-de-León
authors.affiliation: Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición "Salvador Zubirán", México, Distrito Federal, México.
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.affiliation: Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-García
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000175:diagnosis*; D019468:Disease Management; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*