UPDATE GUIDE AND TOOLS FOR TB-DIABETES COMORBIDITY

Diabetes increases by a factor of two to three the risk of contracting tuberculosis (TB)

TB and diabetes are twice as likely to die during TB treatment and twice as likely to experience a relapse after recovery. Systematic screening for diabetes among TB patients, and conversely for TB among diabetic patients, is therefore essential. The World Health Organization (WHO) recommends integrating TB and diabetes prevention, screening, and care services within a person-centered approach, taking into account the local context and barriers to accessing care, through various integrated service delivery models.

Morocco is among countries with a moderate incidence of TB. Young adults aged 25–34 years and the northern regions are the most affected. The National Strategic Plan for TB Prevention and Control (2024–2030) aims to reduce TB-related mortality by 60% and incidence by 35% compared to 2015. To achieve these targets, it focuses primarily on people living with HIV and other high-risk groups, including people with diabetes, due to their high prevalence and increased risk of co-infection.

According to the International Diabetes Federation (2024), Morocco has approximately 2.88 million people aged 20–79 living with diabetes, representing a standardized prevalence of 11.9%. The

Moroccan League for the Fight against Diabetes reports that 10% of people with diabetes develop pulmonary TB, and diabetes is estimated to account for 11–20% of the country’s TB burden.

The fight against TB and diabetes is integrated into the national health sector strategy through two complementary programs: the National TB Control Program (PNLAT) and the National Program for the Prevention and Control of Diabetes (PNPCD). The 2024–2030 Strategic Plan aims to strengthen the follow-up of patients with TB–diabetes comorbidity and to improve the quality of their care, notably by training pulmonologists and endocrinologists in integrated prevention, screening, and treatment approaches.

In 2014, the PNLAT and PNPCD jointly developed a practical guide for healthcare professionals on TB prevention and control among people with diabetes. This guide recommends systematic TB screening at the time of diabetes diagnosis and during each follow-up visit, as well as systematic diabetes screening for all TB patients not previously diagnosed with diabetes, to promote early

diagnosis and improved management.

This technical assistance will aim to strengthen the national strategy for TB–diabetes comorbidity control and to improve the quality of integrated care in Morocco