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Depression is a common and treatable mental health condition, associated with immunosuppression, which is often unrecognized and undiagnosed in individuals with TB and results in poor treatment outcomes, including treatment failure, loss to follow-up and death (17).
Mental health care is one of the health services to be integrated with TB services as outlined in the End TB Strategy and the WHO Framework for collaborative action on tuberculosis and comorbidities (2, 30).
TB disproportionately affects people living in poverty and other socially vulnerable populations, which amplifies their risk for mental health conditions. Providers of TB care can undertake various actions to influence both the impact of disease-specific triggers on poor mental health and social determinants of mental health. In particular, social support, including education and facilitating access to psychological and material support, is critical to mitigate the impact of poverty, TB, its treatment, and the related stigma and discrimination, on people’s mental health (28).
Mental disorders¹ are prevalent in all countries (8). Nearly 1 billion people worldwide are living with a mental disorder, which has become the leading cause of years of living with disability. The risk factors for developing a mental disorder are multi-faceted and may include any combination of individual factors (psychological or biological), family or community factors (such as poverty or violence), and structural factors (such as inequality or environmental emergencies) (11).
Comorbidity: A concurrent disease or health condition in a person with TB.
ASSIST Alcohol, Smoking and Substance Involvement Screening Test
AUDIT Alcohol Use Disorders Identification Test
GAD generalized anxiety disorder
GAD-7 Generalized Anxiety Disorder Assessment-7
HIV human immunodeficiency virus
MDR-TB multidrug-resistant TB
This section of the operational handbook was prepared by Ernesto Jaramillo, Farai Mavhunga, Marzia Calvi and Annika Sweetland (consultant) from the World Health Organization (WHO) Global Tuberculosis Programme Department (GTB), and Aiysha Malik and Mark van Ommeren from the WHO Department of Mental Health and Substance Use (MSD), under the overall direction of Tereza Kasaeva, Director of the GTB department and Dévora Kestel, Director of the MSD Department.
Bruker-Hain Diagnostics has two real-time nucleic acid amplification tests (NAATs), the FluoroType MTB to detect Mycobacterium tuberculosis complex (MTBC) and the FluoroType MTBDR, to detect MTBC, and resistance to rifampicin (RIF) and isoniazid (INH) in tuberculosis (TB). The MTB test (VER 1.0) targets the IS6110 DNA insertion element for MTBC detection, while the MTBDR test (VER 2.0) targets the rpoB gene for detection of MTBC and RIF resistance, and the inhA promoter and katG gene for detection of INH resistance.
The Xpert MTB/XDR detects Mycobacterium tuberculosis complex (MTBC) DNA and genomic mutations associated with resistance to isoniazid (INH), fluoroquinolones (FQs), ethionamide (ETH) and second-line injectable drugs (amikacin [AMK], kanamycin and capreomycin) in a single cartridge. Xpert MTB/XDR tests are run on Cepheid's GeneXpert instruments, using 10-colour modules that differ from the 6-colour modules traditionally used for Xpert MTB/RIF and Xpert MTB/RIF Ultra (Xpert Ultra) testing.
