On World Mental Health Day, we highlight the growing need to address mental health among people affected by infectious diseases such as tuberculosis (TB) and HIV. Recent studies supported by TDR show the importance of integrating mental health care in the treatment process.
“When I was first diagnosed with TB, I felt heartbroken, depressed and lost as I had to stop working and faced stigma from those around me. But after some weeks of treatment and care, including support for my mental health, my smile came back, and so did my hope.”
-TB patient in Nairobi, Kenya
A recent systematic review of published scientific articles identified mental health disorders as the most common form of disability among TB patients, affecting nearly one-quarter of them. Depression, anxiety and other psychiatric manifestations can be connected to stigma, discrimination, ongoing symptoms and the socioeconomic consequences of TB. Often little or no support is provided for patients with mental health disorders during or at the end of TB treatment.
In fact, large numbers of people who complete tuberculosis treatment engage in harmful behaviours, experience disability and face a higher risk of death. With support from TDR, health workers from Kenya, Uganda, Zambia and Zimbabwe conducted a joint study to investigate whether the assessment and referral of patients for care for various health conditions including possible mental health disorders at the start of TB treatment can decrease these outcomes.
Among 1146 patients, 7% were diagnosed with mental health disorders or probable depression. With early referrals to address these conditions during TB treatment, this declined to 4%.
This study was supported by the Structured Operational Research and Training Initiative (SORT IT), which is led by TDR and implemented with partners to build sustainable operational research capacity and strengthen health systems. It empowers health workers, managers, and policymakers to generate and use evidence that directly improves access and quality of care.
While the SORT IT model has largely been used to address infectious diseases in low- and middle-income countries (LMICs), in the United Kingdom, the Cheshire and Wirral Partnership (CWP) NHS Foundation Trust, with support from the University of Chester and the International Union Against Tuberculosis and Lung Disease, has adapted SORT IT to focus on mental health. Although the UK is a data-rich country, frontline health workers rarely use data to generate insights that inform decision-making. The programme addresses this gap by training senior clinicians and managers to identify barriers to care, integrate mental health into routine services, improve patient pathways and reduce stigma.
Over the past four years, 42 frontline staff from diverse clinical backgrounds have been trained in the CWP Foundation Trust, strengthening institutional capacity for ongoing operational research. The findings from their projects have been published in peer-reviewed journals, contributing to a growing body of knowledge that advances mental health care in the UK and beyond.
This experience illustrates how the SORT IT approach can be applied across health themes and showcases a model of South-North learning that is being expanded through new partnerships.
Mental health and HIV
Researchers at Zambart in Zambia have identified mental health screening as an urgent unmet need among Zambian adolescents living with HIV. Recent findings show that 71% experience at least one common mental disorder (depression, anxiety, post-traumatic stress disorder or substance use), yet many of these disorders remain undiagnosed and untreated.
In a study supported by TDR’s Impact Grants programme, a joint initiative with WHO regional offices, researchers gathered data on screening young people living with HIV for mental health disorders and designed and piloted a digital health application that primary care centres across the country can use to screen for common mental disorders and identify affected young people. The package of project results includes a screening protocol and process, technology for data collection and analysis, and capacity building approaches for clinic and primary care staff and others active in supporting young people living with HIV-AIDS.
The team has prepared manuscripts for publication, some currently in peer review, and communicated to health policymakers the importance of integrating mental health services in routine health care and establishing mental health services in clinics in health facilities.
For more information, please contact Dr Rony Zachariah on SORT IT and Dr Garry Aslanyan on the Impact Grants programme.