Designing integrated care models for mental health and tuberculosis in Pune, India: A formative qualitative study of patient, caregiver and provider perspectives

TL;DR

This study explores how to better integrate mental health care with tuberculosis treatment in Pune, India, by understanding the perspectives of patients, caregivers, and providers.

Contribution

The study provides new insights into designing integrated mental health and tuberculosis care models based on local perspectives and experiences.

Findings

Barriers to integration include limited awareness of mental health and reliance on medication.

Participants suggested regular mental health screening and counseling for TB patients.

Engaging TB survivors to share experiences in group settings was recommended for better care.

Abstract

People with tuberculosis (TB) and TB survivors are at increased risk for mental health (MH) conditions. Better management of conditions like depression can improve adherence to TB treatment, and integrating MH care into TB treatment may reduce the MH treatment gap and improve outcomes. This qualitative study explored design characteristics for integrated MH-TB care in Pune, India. Data collection involved in-depth interviews (n = 25) with TB survivors with lived experience of MH conditions, their family members, and TB and MH providers. Data collection and analysis were guided by the Consolidated Framework for Implementation Research, and journey maps illustrated patient experiences. Participants shared suggestions for integrated care models, advantages and barriers to integration, intervention delivery agents, and local perceptions of MH conditions. Barriers included limited awareness about MH and perspectives about MH treatment, which were limited to consuming medication. Suggestions for integrated interventions included raising awareness about MH conditions and existing MH services among TB providers, regular MH screening and counseling for people with TB, and engaging TB survivors to share their experiences with patients in group settings. These insights highlight the importance of working with people with lived experience and understanding patient journeys to inform intervention implementation and sustainability.

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