Impact of integrating mental health services within existing tuberculosis treatment facilities

Aneeta Pasha; Hasha Siddiqui; Shiza Ali; Meredith B Brooks; Naveen R Maqbool; Aamir J Khan

doi:10.1177/23992026211011314

Impact of integrating mental health services within existing tuberculosis treatment facilities

Med Access Point Care. 2021 Apr 27:5:23992026211011314. doi: 10.1177/23992026211011314. eCollection 2021 Jan-Dec.

Authors

Aneeta Pasha^{1

2}, Hasha Siddiqui^{1

3}, Shiza Ali^{1

4}, Meredith B Brooks^{5

6

7}, Naveen R Maqbool^{1

8}, Aamir J Khan^{1

5

9}

Affiliations

¹ IRD Pakistan, Karachi, Pakistan.
² Anthropology, Division of Social Sciences, The University of Chicago, Chicago, IL, USA.
³ Clinical Psychology, Karachi University, Karachi, Pakistan.
⁴ Environmental Economics and Policy, University of California, Berkeley, Berkeley, CA, USA.
⁵ Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
⁶ Center for Global Health Delivery-Dubai, Harvard Medical School, Boston, MA, USA.
⁷ Population Health, School of Public Health, Northeastern University, Boston, MA, USA.
⁸ Family and Child Psychology, University of Chester, Chester, UK.
⁹ International Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

Introduction: Depression and anxiety among tuberculosis (TB) patients can adversely affect TB treatment adherence and completion.

Aim: We studied whether integrating mental health services into existing TB treatment programs would reduce symptoms of depression and anxiety and improve treatment completion among patients with drug-susceptible TB.

Methods: Integrated practice units (IPUs) for TB and mental health were established within six existing TB treatment facilities in Karachi, Pakistan. Patients were screened for depression and anxiety and, if symptomatic, offered a mental health intervention consisting of at least four counseling sessions. We measured changes in reported levels of depression and anxiety symptoms from baseline following completion of counseling sessions, and rates of TB treatment completion.

Results: Between February 2017 and June 2018, 3500 TB patients were screened for depression and anxiety. 1057 (30.2%) symptomatic patients received a baseline adherence session. 1012 enrolled for a mental health intervention received at least 1 counseling session. 522 (51.5%) reported no symptoms after four to six sessions. Symptomatic patients who completed at least four counseling sessions had higher rates of TB treatment completion than those who did not (92.9% vs 75.1%; p < 0.0001).

Conclusion: Mental health interventions integrated within TB programs can help reduce symptoms of depression and anxiety and improve TB treatment completion.

Keywords: Mental health intervention; anxiety; depression; drug-susceptible tuberculosis; task-shifting.