PROTID

The challenge

Type 2 diabetes is responsible for more than one in ten adult deaths globally. Furthermore, its prevalence is predicted to increase, particularly in sub-Saharan Africa, as Western lifestyles become more common.

Type 2 diabetes also has implications for infectious diseases, particularly tuberculosis (TB). It increases the risk of TB disease threefold and doubles the risk of death from TB. Risks are reciprocal, with TB infections exacerbating the impact of diabetes, for example, leading to more cardiovascular complications.

TB infections are extremely common and often undiagnosed, so household and social contacts are at risk of acquiring infection. New TB cases could be reduced by the use of highly effective preventive antibiotic treatments in high-risk groups, which could include people with type 2 diabetes.

The project

Funded through the EDCTP2 programme, a key aim of the PROTID project was to assess the impact of TB preventive treatment in people living with type 2 diabetes. Project activities were severely hampered by the COVID-19 pandemic, which disrupted recruitment and supply of medicines, and led to project personnel being redeployed to pandemic-related duties. The project has therefore been awarded supplementary Global Health EDCTP3 funding to enable it to complete its trial and data analysis, as well as related project activities.

The project is founded on the world’s largest diabetes and TB cohorts in Uganda and Tanzania. Despite COVID-19 disruptions, the project had already screened 3,000 people, finding that more than half had latent TB (infected, but no symptoms) and 6.1% also had HIV infections. Those with latent TB infection were enrolled in a placebo-controlled trial of antibiotic treatment to prevent progression to active TB disease. The project team is also following those without latent TB infection to confirm that they would not have benefited from TB treatment.

The new funding will enable the project team to complete recruitment and data analysis. In addition, the project team has been assessing the care provided to people living with type 2 diabetes. It has systematically reviewed care guidelines in the region, identifying more than 300 recommendations. A consultation is being organised to generate a consensus on the optimal care for such patients at different stages along the care pathway. Additionally, the project is tracking the care provided to patients in the study cohorts to assess the quality of care and identify gaps in care provision. 

Impact

The PROTID project will generate key data on a potential application of preventive tuberculosis (TB) treatment, which is currently not being fully used in TB control. It will:

• Reveal whether preventive treatment reduces the burden of TB disease in people living with type 2 diabetes.
• Provide policymakers with data on the population impacts of preventive TB treatment in this group of patients and its cost-effectiveness.
• Identify the optimal care pathway for type 2 diabetes in African settings and key gaps in care in East Africa.

The project’s findings will feed into global and national policymaking on both TB control and diabetes management, potentially reducing the burden of TB disease and protecting the health of the increasing number of people with type 2 diabetes.