The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.

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Background Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. MethodsWe used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 siteyears of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates.Findings Globally, in 2019, among HIV-negative individuals, there were 1•18 million (95% uncertainty interval 1•08-1•29) deaths due to tuberculosis and 8•50 million (7•45-9•73) incident cases of tuberculosis. Among HIV-positive individuals, there were 217 000 (153 000-279 000) deaths due to tuberculosis and 1•15 million (1•01-1•32) incident cases in 2019. More deaths and incident cases occurred in males than in females among HIV-negative individuals globally in 2019, with 342 000 (234 000-425 000) more deaths and 1•01 million (0•82-1•23) more incident cases in males than in females. Among HIV-positive individuals, 6250 (1820-11 400) more deaths and 81 100 (63 300-100 000) more incident cases occurred among females than among males in 2019. Age-standardised mortality rates among HIV-negative males were more than two times greater in 105 countries and age-standardised incidence rates were more than 1•5 times greater in 74 countries than among HIV-negative females in 2019. The fraction of global tuberculosis deaths among HIV-negative individuals attributable to alcohol use, smoking, and diabetes was 4•27 (3•69-5•02), 6•17 (5•48-7•02), and 1•17 (1•07-1•28) times higher, respectively, among males than among females in 2019. Among individuals with HIV and tuberculosi...

Mobile health (mHealth), i.e., the use of portable electronic devices with software applications to provide health services and manage patient information, 1 has the potential to transform health service delivery worldwide. 2 mHealth has a crucial role to play in health care systems, as it can improve communication and enhance the integration of health care processes. 3 Low-and middle-income countries have extensive cellular networks, and the majority of the population has mobile phones. 2 Tuberculosis (TB) remains a major public health problem in India, accounting for 23% of the global TB burden. 4 Despite case-finding efforts by the Revised National TB Control Programme (RNTCP), the country is believed to have up to one third of the estimated three million TB cases that remain unnotified worldwide. 4 Nearly 50% of TB patients are treated in the private sector, where health care providers include specialist physicians as well as unqualified providers. 5 The RNTCP has various schemes for non-governmental organisations and private practitioners (PPs) that allow private health care providers to sign an official memorandum of understanding with the Government to provide RNTCP services, for which PPs are offered incentives. 6,7 However, the involvement of PPs in these schemes is not optimal due to the complicated procedures involved and the RNTCP's delay in providing incentives; furthermore, much of the focus is on allopathic doctors and their health facilities, which are generally located in urban and semi-urban areas. In rural areas, public health services are difficult to access, as the facilities are often located far from the inhabitants and there is poor transport connectivity. In addition, health care personnel capable of providing these services are sometimes lacking at these facilities; similar problems are observed across the country. There are very few qualified private health care providers in rural areas. 8,9 The first point of contact for any kind of ailment are health care providers who often lack formal training or are trained in alternative medicine. 5,10 Nearly 72% of health care in rural areas is provided by the private sector, and nearly 81% of the doctors are unqualified. 11 The provider-to-patient ratio in India is 1:2000. 12 Until now, the RNTCP had not attempted to involve unqualified health care providers/rural health care providers (RHCPs) in TB care, although they are responsible for the management of a significant number of presumptive TB cases and TB patients. These practitioners play an important role in TB control. As the first point of contact for the majority of the rural population, they can be trained to identify presumptive TB cases early and refer them to diagnostic and treatment services, thus preventing delays. They can also be effective providers of directly observed therapy (DOT), as they have earned the confidence and trust of the community they serve. Global efforts have been made to involve all stakeholders in general, but do not specifically address the role of unqualifie...