The ITARA research programme: investigating Integrated Tuberculosis and Respiratory care in Africa using transdisciplinary methods
File(s)
Accepted version
Author(s)
Meghji, Jamilah
Type
Journal Article
Abstract
Introduction
Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms, and share many risk factors (E.g. Poverty related factors, smoking, occupational exposures). PTB is itself an independent risk factor for chronic lung disease. However, in many high TB-incidence settings health services for these conditions are provided separately, with little integration of prevention, diagnosis, or care.
Methods and analysis
We describe a transdisciplinary programme of research investigating strategies for integrated TB-CRD care in Arusha, Tanzania, Nairobi, Kenya and Lagos, Nigeria, using clinical, health economic, health systems, and qualitative research methods. A prospective clinical cohort study will describe the burden and impact of non-TB respiratory disease (E.g. Asthma, COPD, post-TB lung disease) amongst adolescents and adults presenting to primary and secondary health facilities with chronic cough, who would normally be managed via TB care pathways. Health economics methods will explore patient costs of non-TB respiratory disease, facility-level costs of integrated TB/respiratory diagnostics, and will develop a modelling framework to estimate the costs and consequences of integration more broadly. In-depth interviews, focus group discussions, observations and participatory methods will be used to explore lived experiences of chronic respiratory symptoms, disease and exposures amongst patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD health care services and systems in our three research sites will be described, and local, national, and policy level understandings of ‘integration’ of TB and CRD care will be explored. Together, the findings of this work will be used to develop context informed model(s) of integrated TB-CRD care, and a theory of change and framework for evaluation in future implementation studies.
Ethics and dissemination
Ethical approval has been obtained from Imperial College London in the UK, the Scientific Ethics Review Unit in Kenya, University of Lagos in Nigeria, and the National Institute of Medical Research in Tanzania. Findings of this study will be presented in research publications and symposia, and will be shared with local communities and stakeholders.
Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms, and share many risk factors (E.g. Poverty related factors, smoking, occupational exposures). PTB is itself an independent risk factor for chronic lung disease. However, in many high TB-incidence settings health services for these conditions are provided separately, with little integration of prevention, diagnosis, or care.
Methods and analysis
We describe a transdisciplinary programme of research investigating strategies for integrated TB-CRD care in Arusha, Tanzania, Nairobi, Kenya and Lagos, Nigeria, using clinical, health economic, health systems, and qualitative research methods. A prospective clinical cohort study will describe the burden and impact of non-TB respiratory disease (E.g. Asthma, COPD, post-TB lung disease) amongst adolescents and adults presenting to primary and secondary health facilities with chronic cough, who would normally be managed via TB care pathways. Health economics methods will explore patient costs of non-TB respiratory disease, facility-level costs of integrated TB/respiratory diagnostics, and will develop a modelling framework to estimate the costs and consequences of integration more broadly. In-depth interviews, focus group discussions, observations and participatory methods will be used to explore lived experiences of chronic respiratory symptoms, disease and exposures amongst patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD health care services and systems in our three research sites will be described, and local, national, and policy level understandings of ‘integration’ of TB and CRD care will be explored. Together, the findings of this work will be used to develop context informed model(s) of integrated TB-CRD care, and a theory of change and framework for evaluation in future implementation studies.
Ethics and dissemination
Ethical approval has been obtained from Imperial College London in the UK, the Scientific Ethics Review Unit in Kenya, University of Lagos in Nigeria, and the National Institute of Medical Research in Tanzania. Findings of this study will be presented in research publications and symposia, and will be shared with local communities and stakeholders.
Date Acceptance
2026-05-28
Citation
BMJ Open
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Copyright Statement
Copyright This paper is embargoed until publication. Once published the author’s accepted manuscript will be made available under a CC-BY License in accordance with Imperial’s Research Publications Open Access policy (www.imperial.ac.uk/oa-policy).
License URL
Publication Status
Accepted