Forecasting Tunisian type 2 diabetes prevalence to 2027: validation of a simple model.

BACKGROUND: Most projections of type 2 diabetes (T2D) prevalence are simply based on demographic change (i.e. ageing). We developed a model to predict future trends in T2D prevalence in Tunisia, explicitly taking into account trends in major risk factors (obesity and smoking). This could improve assessment of policy options for prevention and health service planning. METHODS: The IMPACT T2D model uses a Markov approach to integrate population, obesity and smoking trends to estimate future T2D prevalence. We developed a model for the Tunisian population from 1997 to 2027, and validated the model outputs by comparing with a subsequent T2D prevalence survey conducted in 2005. RESULTS: The model estimated that the prevalence of T2D among Tunisians aged over 25 years was 12.0% in 1997 (95% confidence intervals 9.6%-14.4%), increasing to 15.1% (12.5%-17.4%) in 2005. Between 1997 and 2005, observed prevalence in men increased from 13.5% to 16.1% and in women from 12.9% to 14.1%. The model forecast for a dramatic rise in prevalence by 2027 (26.6% overall, 28.6% in men and 24.7% in women). However, if obesity prevalence declined by 20% in the 10 years from 2013, and if smoking decreased by 20% over 10 years from 2009, a 3.3% reduction in T2D prevalence could be achieved in 2027 (2.5% in men and 4.1% in women). CONCLUSIONS: This innovative model provides a reasonably close estimate of T2D prevalence for Tunisia over the 1997-2027 period. Diabetes burden is now a significant public health challenge. Our model predicts that this burden will increase significantly in the next two decades. Tackling obesity, smoking and other T2D risk factors thus needs urgent action. Tunisian decision makers have therefore defined two strategies: obesity reduction and tobacco control. Responses will be evaluated in future population surveys.

Experiences and perceptions of health professionals towards the quality of care for people living with HIV in Tunisia: a qualitative study.

Introduction: human immunodeficiency virus (HIV) infection continues to be a public health issue, especially in low- and middle-income countries, including Tunisia. In 2020, 32% of people living with HIV were on treatment. Management of HIV infection remains a real challenge for both patients and care providers. Our study aimed to describe the perceptions and attitudes of health professionals toward care for people living with HIV (PLHIV). Methods: a qualitative study was carried out between 2020 and 2021. Interviews with key informants were conducted in order to identify the strengths and weaknesses of the care for PLHIV, as well as their suggestions for improvement. Eight key informants in HIV care from different profiles were interviewed: healthcare providers from a specialized university hospital, the Ministry of Health, and civil society representatives working in the field of HIV. Interviews were transcribed and analyzed thematically using "QDA Miner" software. Results: the frequency of PLHIV who have interrupted medical follow-up was perceived as worrisome, and increasing. Along with individual factors, non-adherence to treatment was also attributed to systemic factors related to stock shortages, geographical inaccessibility, and shortfall in human resources. Stigmatization of PLHIV in healthcare facilities outside the specialized hospital was also highlighted. This has been linked to gaps in the training of care providers on the modes of the virus transmission. Conclusion: health professionals face many challenges in the care of PLHIV. There is an urgent need to improve treatment availability and accessibility, strengthen social assistance for PLHIV and fight against stigmatization, especially in healthcare settings.