Tuberculosis comorbidity with communicable and non-communicable diseases: Integrating health services and control efforts

Ben J. Marais, Knut Lönnroth, Stephen D. Lawn, Giovanni Battista Migliori, Peter Mwaba, Philippe Glaziou, Matthew Bates, Ruth Colagiuri, Lynn Zijenah, Soumya Swaminathan, Ziad A. Memish, Michel Pletschette, Michael Hoelscher, Ibrahim Abubakar, Rumina Hasan, Afia Zafar, Guiseppe Pantaleo, Gill Craig, Peter Kim, Markus MaeurerMarco Schito, Alimuddin Zumla

Research output: Contribution to journalReview articlepeer-review

230 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)436-448
Number of pages13
JournalThe Lancet Infectious Diseases
Issue number5
Publication statusPublished - May 2013


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