TB disability and multimorbidity at the onset of treatment in Kenya, Uganda, Zambia and Zimbabwe.

Background: We evaluated the practicality of integrating assessments on the burden of multimorbidity (including disability) and the effectiveness of referral pathways at the start of TB treatment across Kenya, Uganda, Zambia and Zimbabwe.

Methods: A cohort study conducted within national TB programmes.

Results: Assessments were conducted in 1,683 (92%) of 1,822 patients, taking a median time of 29 minutes (interquartile range:20-37). Regarding comorbidities, 567 (34%) had HIV infection, 141 (8%) had high-blood pressure, 101 (6%) had a mental health disorder and 65 (4%) had diabetes. The three most common risk factors were undernutrition in 622 (37%), probable alcohol dependence in 311 (18%) and cigarette smoking in 275 (16%). Disability (inability to walk 400m in six minutes) was observed in 316 of 1,545 (20%) patients. Overall, 1,305 (78%) patients had at least one comorbidity, risk factor and/or disability. Successful referral ranged from 85-100% for most conditions, except for those with occupational silica exposure and disability, where access to pulmonary rehabilitation services was suboptimal.

Conclusions: A significant proportion of TB patients experienced multimorbidity, including disability, highlighting the need for integrated, patient-centered care and decentralized point-of-care services, particularly for pulmonary rehabilitation. This multi-country study offers a promising pathway towards achieving that goal.