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Bi-directional TB-diabetes screening in Pakistan


Diabetes weakens human immune system making people three times more susceptible to tuberculosis and can affect its treatment outcomes. Thus the growing burden of diabetes is changing the landscape of TB care and prevention.

In Pakistan, around 7 million people are living with Diabetes and we stand among the top 10 countries with the highest incidence of tuberculosis associated with diabetes

1. It is estimated that 12% of total TB cases in Pakistan are associated with Diabetes in comparison to 15% globally

2. There is a need for a coordinated response to deal with this dual epidemic for early case detection and improved treatment outcome.

Our Approach

IRD Pakistan in collaboration of World Diabetes Foundation is scaling up a “Bi-Directional Pilot Program” for improved Bi-directional screening, diagnosis and treatment of TB – DM in the private-sector, through their implementation partner Community Health Solutions (CHS)  in 9 low and middle income townships of Karachi.

The program aims to engage private health care providers to refine and implement “WHO-Union Collaborative Framework” to enhance TB-DM treatment in low income settings. Under this program, 300 physicians from private clinics will be trained to roll out risk-based screening of TB-DM and referrals to Sehatmand Zindagi (SZ) Centers for further evaluation and care.

Program will also evaluate digital chest X-ray with automated reading as a tool for TB screening amongst diabetics and will determine the appropriate time for screening for diabetes during TB treatment. In addition, advocacy for routine TB-DM screening in both the public and private sectors through stakeholder meetings with National and Provincial TB Control Programs will be conducted to guide national programs, clinicians and others engaged in care of patients and prevention and control of diabetes and TB for a coordinated response to both diseases, at all health delivery system levels.


The program expects to sensitize 300 private health providers for bi-directional TB-DM screening and to screen 3000 TB patients for diabetes and 3000 Diabetics for TB through private sector referrals. Program seeks to develop a referral system to link people to appropriate care and management for TB – diabetes


International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015.

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