Developing an integrated depression and tuberculosis care pathway using a co-design approach in a low-resource...

Area of Science:

• Public Health
• Global Health
• Mental Health Integration

Background:

• Integrating mental health care into infectious disease services is crucial but underexplored.
• Limited evidence exists on delivering integrated depression screening and care within tuberculosis (TB) services, especially in low-resource settings.

Purpose of the Study:

• To co-design an integrated care pathway for depression case finding and treatment within TB services.
• To develop a pathway deliverable by non-mental health specialists in resource-limited environments.

Main Methods:

• Co-design workshops were conducted with TB patients, carers, and healthcare providers in Bangladesh and Pakistan.
• The Hasso Plattner Institute of Design at Stanford University's co-design methodology was adapted.
• Information from workshops was analyzed to develop the integrated care pathway and implementation materials.

Main Results:

• A culturally adaptable care pathway was co-designed, integrating depression screening into TB care.
• Screening tools (PHQ-9 in Bangladesh; PHQ-2 and PHQ-9 in Pakistan) were utilized.
• Non-specialist healthcare workers (paramedics, lab technologists, DOTS Facilitators) were identified and trained to deliver screening.

Conclusions:

• Stakeholders highly valued the collaborative co-design process.
• The co-design approach facilitated knowledge mobilization and integration of depression screening into routine TB care.
• The developed pathway leverages the expertise of healthcare workers and the lived experiences of TB patients.