30 Chapter 2 stigma, treatment fatigue, relocation or treatment costs. Another reason could be down referral of patients once they are stable on treatment from tertiary health facilities to lower-level facilities such as clinics. The development of cavitary lung lesions indicates a severe abnormality in the immune response during TB infection and could be associated with hyperglycaemia [30, 38]. Two studies reported poor treatment outcomes (relapse, death, or loss to follow-up) in patients with DM or hyperglycaemia at enrolment and one-year post-treatment followup [21, 33]. This is consistent with a 2019 systematic review that showed the odds of death (OR 1.88, 95%CI 1.59–2.21) and relapse (OR 1.64, 95%CI 1.29–2.08) were higher in patients with DM receiving TB treatment compared to normoglycaemic TB patients [39]. Similarly, a 2022 multi-centre prospective cohort study from Brazil showed that poor TB treatment outcomes were associated with baseline dysglycaemia and higher HbA1c values [40]. From the studies, it is seen that glucose values improved over time with good TB treatment outcomes. A 2021 study from Ghana shows that though more patients with normoglycaemia had a sputum conversion at two months compared to those with hyperglycaemia, this difference became insignificant at six months, indicating that the observed dysglycaemia at the onset of treatment was temporary [41] and had no association with treatment outcomes. This implies that good treatment outcomes can often be achieved in DM patients with adequate glucose control. This review assessed studies that included HIV-positive participants to ascertain if HIV status affected DM-TB association, but the findings were mixed, tending toward a reduction in hyperglycaemia or no difference based on HIV status (Table 4). This could be because we had only six studies reporting this, and it was not the primary outcome of our study. Despite this, conflicting findings have been reported on the effect of HIV on TB/DM or hyperglycaemia. Studies conducted in Tanzania and Nigeria [42-44] indicate a stronger association among HIV-negative participants, while another study conducted in South Africa [45] indicates a stronger association among people living with HIV. Further research is required to convincingly describe this association as the different blood glucose measurement approaches and medications taken by people living with HIV can influence outcomes [36]. Strengths and Limitations A key strength of this scoping review is the rigorous methodological approach adopted at the different stages to ensure reproducibility, minimal errors and that the included studies met the inclusion criteria. The review team accessed four electronic databases to ensure relevant studies were not excluded. We also expanded the search to cover a period when HIV cases gradually increased and, more recently, to cover the period of the
RkJQdWJsaXNoZXIy MTk4NDMw