Rehabilitation with embedded mental health and diabetes services to address multiple long-term conditions among people with tuberculosis (RESTORE)

Having more than one long-term medical problem (MLTCs; multiple long-term conditions) can seriously reduce the quality and length of people’s lives. Common MLTC include diabetes, heart disease and lung problems. MLTC are usually more common in older people, but in low- and middle-income countries young people also get MLTCs. This is partly driven by infections such as tuberculosis (TB) which, like MLTCs, are more common in people affected by poverty. TB is an infection caused by a bacteria called Mycobacterium tuberculosis (Mtb) which usually affects the lungs. It is common among working-age adults who have weak immune systems due to other health conditions, such as MLTCs. TB is treated with 6-months of antibiotics. Common MLTCs that increase the risk of developing TB and complicate the TB treatment include: · Chronic lung disease (lung damage) from smoking, dust, and other triggers makes it easier for Mtb to cause disease. TB then causes more lung damage. This means that people who are ‘cured’ of TB often have long-term difficulties breathing and working. This can be prevented or improved with exercise and education (called pulmonary rehabilitation) which helps people to live better with chronic lung damage. · Diabetes can be due to genetics, lack of nutritious foods, older age, other health conditions, or a mix of these. People with diabetes are more vulnerable to TB, and TB makes diabetes more difficult to control. Without diagnosis and treatment, people with diabetes and TB quickly develop complications such as vision loss, heart and kidney diseases. · Mental health conditions are common among people with TB, who are the most vulnerable in society. The side effects of TB treatment and stigma and exclusion due to TB make mental health conditions worse. Overall, TB can be considered a red flag which identifies people at high risk of MLTCs. At the same time, the 6-month period when people with TB are taking daily treatment is an opportunity to treat and prevent MLTCs. This will set people up with better health for their future life. We aim to reduce the impact of MLTCs on the long-term health and wellbeing of people with TB in Zimbabwe. We will achieve this using a combination of education, counselling, peer-support, exercise, nutritional support, and diabetes testing and treatment. Care will be community-based and facilitated by people with lived experience of TB. These services have all been proven to work in other settings but have not been used in this way for people with TB before. We will draw on local experts, including community members, to bring services together and integrate them into the existing TB treatment programme. We will then roll out and evaluate our innovative approach in 13 clinics, comparing the quality of life due to health of people with TB in these clinics to people in 13 clinics where the intervention was not rolled out, as part of a randomised controlled trial. Our aim is to test a program of integrated care that will improve the lives of people recovering from TB.