{
  "abstract": "Introduction Pulmonary tuberculosis (PTB) and chronic respiratory diseases (CRDs) are closely linked. Affected groups present with similar symptoms and share many risk factors (eg, 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 (eg, asthma, chronic obstructive pulmonary disease, post-TB lung disease) among 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 among patients and providers, and to identify and address challenges around respiratory health and care. Lastly, existing TB and CRD healthcare 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.",
  "authors": [
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Jamilah Meghji"
    },
    {
      "affiliations": [
        "Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands"
      ],
      "name": "Nora Engel"
    },
    {
      "affiliations": [
        "Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya",
        "Kenyatta National Hospital, Nairobi, Kenya"
      ],
      "name": "Wanjiku Kagima"
    },
    {
      "affiliations": [
        "Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya",
        "Strathmore University, Nairobi, Kenya"
      ],
      "name": "Idah Kinya"
    },
    {
      "affiliations": [
        "Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands",
        "Kibong’oto Infectious Diseases Hospital, Sanya Juu, Kilimanjaro, United Republic of Tanzania"
      ],
      "name": "Yusufu Kionga"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Maia Lesosky"
    },
    {
      "affiliations": [
        "Kibong’oto Infectious Diseases Hospital, Sanya Juu, Kilimanjaro, United Republic of Tanzania"
      ],
      "name": "Alphonce Liyoyo"
    },
    {
      "affiliations": [
        "Kibong’oto Infectious Diseases Hospital, Sanya Juu, Kilimanjaro, United Republic of Tanzania",
        "Centre for Health Economics, Warwick Medical School, Coventry, UK"
      ],
      "name": "Jason Madan"
    },
    {
      "affiliations": [
        "Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria"
      ],
      "name": "Stellah Mpagama"
    },
    {
      "affiliations": [
        "Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria"
      ],
      "name": "Joy Obase Ehrim"
    },
    {
      "affiliations": [
        "Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria",
        "Department of Microbiology, University of Lagos, Lagos, Nigeria"
      ],
      "name": "Adewale Ogundare"
    },
    {
      "affiliations": [
        "Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria"
      ],
      "name": "Obianuju Ozoh"
    },
    {
      "affiliations": [
        "Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Fred Orina"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Joshua Parker Allen"
    },
    {
      "affiliations": [
        "Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Elizabeth Kendi Paul"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "James Potts"
    },
    {
      "affiliations": [
        "Kibong’oto Infectious Diseases Hospital, Sanya Juu, Kilimanjaro, United Republic of Tanzania",
        "School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania"
      ],
      "name": "Lilian Tuwabunze"
    },
    {
      "affiliations": [
        "National Heart and Lung Institute, Imperial College London, London, UK"
      ],
      "name": "Nicola Yates"
    },
    {
      "affiliations": [
        "Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Jeremiah Chakaya Muhwa"
    },
    {
      "affiliations": [],
      "name": "on behalf of The ITARA Consortium"
    }
  ],
  "title": "ITARA research programme: Investigating Integrated Tuberculosis And Respiratory care in Africa using transdisciplinary methods",
  "uid": "b66be5da-d562-5d38-aa30-a9638676cf10"
}