P-201. Mental Health Interventions in TB Care: A Systematic Scoping Review in the SAARC Region

TL;DR

This review explores mental health interventions integrated into tuberculosis care in the SAARC region, showing they improve both mental health and TB outcomes.

Contribution

The study provides a systematic scoping review of mental health interventions in TB care across SAARC countries, highlighting integration strategies and outcomes.

Findings

Mental health interventions in TB care improved mental health outcomes like anxiety and depression.

TB outcomes such as treatment completion and adherence also improved with integrated mental health care.

Interventions included counseling, pharmacological treatments, and breathing exercises delivered by various health workers.

Abstract

One in four people with tuberculosis (TB) face mental health (MH) challenges. Poor MH hinders TB health-seeking, treatment success, and post-treatment outcomes. We reviewed approaches to provide MH care for people with TB in the South Asian Association for Regional Cooperation (SAARC) region, where 37% of people with TB live.

We searched three databases (Medline, Embase, Global Health) for studies implementing an explicit mental health service or intervention to people undergoing TB screening, diagnosis and/or treatment in a SAARC country from 2000-2024. Extracted data were narratively synthesized.

2304 unique records were retrieved and yielded 17 eligible studies from India (n=10), Pakistan (n=6), and Nepal (n=1). Eight studies were among people with MDRTB. Interventions included MH counselling (n=15, varied schedule, content, framework, and delivery approach), pharmacological intervention (n=9, anti-depressants, anxiolytics, withholding MDRTB drugs) and breathing exercises (n=1). Interventions were implemented at clinics providing TB services (n=15) with off-site activities (n=5) and/or referrals to mental health centres (n=4); one was entirely via telehealth. MH professionals (psychiatrists, psychologists, n=9), nurses (n=1), social workers (n=3), pharmacists (n=1), and other cadres (peer supporters, patient navigators, lay counsellors, DOTS facilitators, n=9) were engaged in intervention delivery. Mental health was assessed using standardized tools (n=14); five studies assessed substance use. All studies reporting post-intervention mental health outcomes (n=7) (anxiety, depression) and TB outcomes (n=10) (case notifications, treatment completion, adherence, failure, loss-to-follow-up, drug resistance, death) reported improved outcomes. Improved patient satisfaction (n=2), quality of life (n=2), cardio-pulmonary measures (n=1), and reduced stigma (n=1) were also reported. Seven studies implemented cointerventions: nutrition (n=5), economic support (n=7), and vocational rehabilitation (n=2).

Effective people-centred TB care requires addressing TB-comorbidities. We found MH interventions can be integrated in TB care settings to support achievement of improved TB and MH outcomes

All Authors: No reported disclosures

Figures