Nutritional support : what impact on tuberculosis management in Togo?

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Extract from the article: Le Programme National de Lutte contre la Tuberculose du Togo en collaboration avec le Programme National de Lutte contre la Tuberculose au Bénin, l’Union internationale contre la tuberculose et les maladies respiratoires, la Communauté d'universités

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The National Tuberculosis Control Programme of Togo in collaboration with the National Tuberculosis Control Programme of Benin, the International Union Against Tuberculosis and Respiratory Diseases, the Community of Universities, institutions in the Sorbonne, The Boston Medical Centre and the Boston University School of Medicine in the United States conducted a study entitled « Nutritional Support for Patients with Tuberculosis: Impact on Nutritional Status and Outcomes of TB Treatment (INSTITUT Project) ». This is in order to establish causal links between nutritional status and treatment outcomes (cure, death and failure…) of tuberculosis disease.

This study is funded by the French Development Agency (AFD). It aims to assess the impact of nutritional support on TB treatment outcomes and to estimate the impact of this support on the nutritional status of TB patients at the end of TB treatment in West Africa. This study will be carried out on a sample of 1,050 patients with the contagious form of tuberculosis who will receive care in the TB diagnostic and treatment centres of the National Tuberculosis Control Programmes of Togo and the Benin. The aim of the approach is « to help national TB programmes catalyse change and make a strong case for strong nutritional support for all people with TB in Togo, in Africa and around the world by providing evidence that will be used to plan nutrition support for other TB patients and advocate for mobilizing additional funding to ensure nutrition support in the country », said Dr Mohammed Fall Dogo, Coordinator of the National Tuberculosis Control Programme of Togo and Co-Investigator of this study at the opening ceremony of the training workshop for TB actors and focal points.

This workshop was held in Lomé from 10 to 14 July 2023. It brought together about twenty participants with a team of facilitators composed of resource persons of PNLT Togo and Benin, a representative of the Union of France and researchers of the University of Boston (USA) with the aim of training the various actors involved in the implementation of the INSTITUT project in Togo on the protocol and the tools of the study.

Undernutrition is the leading risk factor for TB worldwide, with a fraction attributable to the population estimated at 19% (compared to 7.6% for HIV and 3.1% for diabetes). Immunological deficits associated with undernutrition can be reversible through nutritional rehabilitation. However, the fight against undernutrition is lagging behind efforts to identify and treat Human Immunodeficiency Virus (HIV) and diabetes in Tuberculosis (TB) patients and at-risk populations. Covid-19, natural disasters and conflict have exacerbated food insecurity around the world, disproportionately in countries with high TB burden. The United Nations estimates that an additional 118 million people suffered from hunger in 2020. Climate change will also have a greater impact on nutrition, as droughts, floods, hurricanes, forest fires and other natural disasters affect both agriculture and food distribution systems. In addition, ongoing conflicts, accompanied by an increase in internal and external forced migration and the disruption of food production, threaten the food security of vulnerable populations.

Undernutrition (including macronutrient and micronutrient deficiencies) resulting from undernutrition and disease-related undernutrition is widespread among people living with HIV (PHAs) and often puts their lives at risk. Poor nutritional status is associated with an increased severity of tuberculosis disease, as evidenced by higher bacillary loads in sputum, with greater lung involvement and a greater risk of cavitation. The pharmacodynamics of TB drugs may also be affected in undernourished individuals, as the uptake of some drugs may be reduced and the toxicity of others increased. For these reasons, early nutritional status of TB treatment is an important predictor of mortality.

Indeed, a large study conducted in India showed that the gain of one unit of initial body mass index (BMI) was associated with a 22% (95% CI 10-32) reduction in mortality. In addition, the inability to gain weight during the intensive phase of treatment is a marker of treatment failure, relapse and mortality. Although the relationship between undernutrition and tuberculosis is bidirectional, the association between undernutrition and poor outcomes remains robust even after adjusting for confounding factors.

Source: PNLT