Comorbidities

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.

Background and Objective:

These Policy Guidelines are aimed at accelerating the provision of priority access to prevention, diagnosis, treatment, care and support to healthcare workers with respect to HIV and TB. As is the case with most complex public health interventions, the various elements are mutually synergistic, and failure to implement one of the recommendations can have deleterious effects on proper implementation of others. Thus it is essential that the various statements be seen as a "package", not simply as a series of recommendations that can be individually considered.

The evidence for this statement was reviewed in-depth for the recent WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households and on infection control generally. and therefore will not be elaborated upon extensively here. These WHO infection control guidelines must be observed in their own right as well as being an essential component of improving health worker access to prevention, treatment, care and support for HIV and TB.