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BADAS TB Initiative Program

 

BADAS TB Initiative Program

Tuberculosis and diabetes mellitus are two major public health concerns in Bangladesh. When these two diseases occur together, they create additional challenges for diagnosis, treatment, follow-up, and patient care. Diabetes increases the risk of developing tuberculosis, while tuberculosis may worsen glycaemic control and complicate diabetes management. In a country where both conditions are common, an integrated service approach is essential.
The BADAS TB Initiative Program was developed by the Diabetic Association of Bangladesh to address this dual burden through the BADAS-affiliated diabetes care network. Since 2013, BADAS has worked closely with the National Tuberculosis Control Program and development partners to strengthen the early identification of TB among people with diabetes, improve referral linkage, and build healthcare providers' capacity to care for TB-DM comorbidities.

Key Achievements

Since its inception, the BADAS TB Initiative Program has made a substantial contribution to TB-DM comorbidity control in Bangladesh. The program has supported large-scale screening, presumptive TB identification, diagnostic referral, treatment linkage, and health workforce orientation through the BADAS-affiliated network.

Indicator	Achievement
Total screening	6,417,097
Presumptive TB identified and tested	254,739
Diagnosed TB cases	23,925
Put on treatment	23,652
Doctors and other health workers oriented/trained	9,612

Objectives

• To reduce the dual burden of tuberculosis and diabetes through early case detection, referral, and management support.
• To strengthen the capacity of doctors, nurses, and allied health workers in TB-DM diagnosis and case management.
• To improve awareness among people with diabetes, their families, and the wider community regarding TB-DM comorbidity.

Major Activities

Activity area	Description
Active TB screening	Screening of patients attending BADAS-affiliated diabetic care centers.
Referral linkage	Referral of presumptive TB cases to NTP-linked DOTS and diagnostic facilities.
TB-DM case management support	Clinical evaluation and referral support through center-level physicians.
GeneXpert support	Diagnostic support through BIRDEM General Hospital.
Digital reporting	TAB-based active screening and online reporting for better supervision and data quality.
Capacity building	Training and orientation of doctors, nurses, field staff, and allied health professionals.
Community activity	Diabetic camps among TB patients and community-level TB-DM screening activities.
Coordination and supervision	Coordination with NTP, DOTS centers, and partner organizations, with field monitoring and corrective support.
Research and documentation	Evidence generation, publication support, and documentation on TB-DM comorbidity.

Working Area and National Footprint

The BADAS TB Initiative Program has been implemented through the Diabetic Association of Bangladesh's extensive service network.

The program covers 96 BADAS-affiliated centers in 59 districts, with representation across all major divisions of the country.
Dhaka division has the largest number of covered centers, while the remaining divisions reflect BADAS's presence across the wider affiliated network located in districts.

Program Performance across Project Phases

The BADAS TB Initiative has been strengthened through successive project phases, including TB Care II, Challenge TB, and ACTB. These phases helped institutionalize active TB screening within diabetes care settings and contributed to case detection, referral linkage, and capacity building.

The ACTB phase contributed the most presumptive and diagnosed TB cases among the project phases shown.

Project	Presumptive TB cases	Diagnosed TB cases
TB Care II	18,678	2,224
CTB Phase I	17,887	1,946
CTB Phase II	38,676	3,914
ACTB	179,498	15,841

TB-DM Comorbidity Focus

A major strength of the BADAS TB Initiative is its focus on people with diabetes, who require careful attention for TB symptoms, timely referral, and coordinated care. The program data show that a substantial proportion of diagnosed TB cases were among people with diabetes, reinforcing the relevance of TB screening within diabetes service delivery.

Current Implementation

Under the current Life-Saving Facility and Community-Based Service Delivery Support Project, BADAS is implementing active TB screening through 28 affiliated diabetic care centers across 20 districts. The current model integrates TB symptom screening into diabetes service delivery, uses digital reporting to improve data quality, and maintains referral linkage with NTP-linked laboratories and DOTS service providers for testing, diagnosis, treatment initiation, and follow-up.

Current TB Screening Cascade, January-March 2026

During the January-March 2026 reporting period, BADAS screened 142,266 patients for tuberculosis. Among them, 4,424 presumptive TB cases were identified; 4,368 underwent diagnostic testing; 394 TB cases were detected; and 392 patients were started on treatment.

Projected versus Achieved Performance, January-March 2026

The current project performance exceeded the projected target for presumptive identification, testing, and TB case detection during January-March 2026.

Disease Classification of Diagnosed TB Cases

Among the TB cases detected during January-March 2026, bacteriologically confirmed pulmonary TB was the predominant category, followed by extrapulmonary TB and clinically diagnosed pulmonary TB. The direct involvement of physicians at the center level supported clinical evaluation and appropriate referral.

Mode of TB Diagnosis

During January-March 2026, Xpert was the main mode of TB diagnosis among diagnosed cases, followed by other tests, X-ray, and AFB. The role of GeneXpert and referral-linked diagnostics remains important for timely and reliable TB detection.

GeneXpert Service at BIRDEM

GeneXpert service at BIRDEM General Hospital has been an important diagnostic support component of the BADAS TB Initiative. The service was originally introduced under the USAID-funded TB Care II project and resumed operations in June 2023. During January-March 2026, 1,457 presumptive TB cases were tested through GeneXpert at BIRDEM, of whom 69 were diagnosed with TB.

Research and Evidence Generation

The BADAS TB Initiative Program has supported research and publication on TB-DM comorbidity in Bangladesh. These studies have provided evidence on active TB case-finding among people with diabetes, diabetes screening among people accessing TB diagnostics, TB prevalence among patients with diabetes, and the impact of an integrated TB-DM healthcare model. Through these efforts, BADAS has helped demonstrate that diabetes care platforms can play a meaningful role in TB detection, referral, patient education, and comorbidity management.

Year	Publication title	Journal / Type	DOI / Link
2026	Impact of an integrated TB–diabetes mellitus health care model	The International Journal of Tuberculosis and Lung Disease, 30(5), 228–230	10.5588/ijtld.25.0607
2024	Effects of diabetes mellitus on retreatment of tuberculosis: A multi-centered case-control study from Bangladesh	Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 36, 100450	10.1016/j.jctube.2024.100450
2022	TB prevalence among patients with diabetes in Bangladesh	The International Journal of Tuberculosis and Lung Disease, 26(2), 119–125	10.5588/ijtld.21.0412
2021	Usefulness of GeneXpert MTB/RIF in the diagnosis of extra-pulmonary tuberculosis	BIRDEM Medical Journal, 11(2), 121–124	10.3329/birdem.v11i2.53132
2020	A public-private model to scale up diabetes mellitus screening among people accessing tuberculosis diagnostics in Dhaka, Bangladesh	International Journal of Infectious Diseases, 92, 56–61	10.1016/j.ijid.2020.01.001
2019	Active tuberculosis case finding among diabetic patients: Bangladesh program experience	Journal of Infectious Diseases and Diagnosis, 4(124), 2	10.4172/2576-389X.1000124
2017	Knowledge, attitude, and practice regarding tuberculosis among diabetic patients	BIRDEM Medical Journal, 7(2), 127–131	10.3329/birdem.v7i2.32450
2017	Rifampicin-induced acute interstitial nephritis and exfoliative dermatitis complicating a pulmonary tuberculosis case report	BIRDEM Medical Journal, 7(2), 168–171	10.3329/birdem.v7i2.32458
2012	Pulmonary tuberculosis in patients with diabetes mellitus in Bangladesh	The International Journal of Tuberculosis and Lung Disease, 16(8), 1132–1133	10.5588/ijtld.11.0846

 

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