Multidrug-resistant tuberculosis treatment programmes insufficiently consider comorbid mental disorders

Area of Science:

• Global Health
• Infectious Diseases
• Mental Health Research

Background:

• Multidrug-resistant tuberculosis (MDR-TB) treatment is a global health priority aligned with the WHO's End TB strategy.
• Despite investments in diagnostics, the mental distress experienced by MDR-TB patients and their families remains inadequately addressed in many TB programs, particularly in low-income settings.
• Operational research in diverse settings (China, Pakistan, Bangladesh, Nepal, Swaziland) highlights systemic challenges in providing psychosocial support within national MDR-TB programs.

Purpose of the Study:

• To highlight the critical gap in mental health support for multidrug-resistant tuberculosis (MDR-TB) patients and their families within existing TB programs.
• To advocate for the integration of mental health considerations into national MDR-TB strategies and patient care.
• To explore feasible interventions for addressing mental distress in MDR-TB patients.

Main Methods:

• Qualitative insights from operational research on MDR-TB in China, Pakistan, Bangladesh, Nepal, and Swaziland.
• Analysis of the impact of mental distress on treatment adherence.
• Review of WHO's End TB Strategy and Mental Health Gap Action Programme (mhGAP).

Main Results:

• National MDR-TB programs frequently overlook the mental distress of patients and their families, hindering patient-centered care and support.
• Comorbid mental health disorders are suggested to reduce treatment adherence among MDR-TB patients.
• Brief psychological counseling by non-specialist counselors shows feasibility in settings like Nepal.

Conclusions:

• There is an urgent need to integrate mental health support into MDR-TB programs to improve patient outcomes and adhere to WHO's End TB strategy.
• Recommends piloting brief screening tools for common mental disorders and incorporating mhGAP principles into TB treatment guidelines.
• Addressing mental distress is essential for effective patient support and successful MDR-TB treatment globally.