Background In South Africa, there are on-going calls to integrate mental health services into existing primary health care (PHC) programmes such as Tuberculosis (TB). Successful service integration and quality service delivery partially depend on healthcare providers’ mental health-related knowledge and attitudes. The aim of this study was to assess PHC nurses’ mental health knowledge and attitudes towards mental health patients and mental health care. Methods This was a cross-sectional survey involving the distribution of self-administered questionnaires among PHC nurses across 47 clinics. Data on socio-demographics, stigma-related mental health knowledge, and nurses’ attitudes towards people with mental health problems and mental health care were subjected to descriptive and multiple regression analyses. Results Out of 205 respondents, the majority were female (n = 178, 86.8%). The nurses’ median age was 50 (interquartile range: 39–56). Their mean mental health knowledge score was 23.0 (standard deviation [sd]: 3.07) out of 30. Nurses were less knowledgeable about the employment (n = 95, 46.3%), recovery (n = 112, 54.6%), and help-seeking behaviour (n = 119, 58.0%) of people with mental health problems. Professional nurses had a significantly higher mean mental health knowledge score than enrolled/assistant nurses (22.8 vs. 21.1, t203 = 4.775, p < 0.001). Regarding attitudes, the nurses’ mean attitude score was 40.68 (sd: 9.70) out of 96. Two in every five nurses (n = 91, 44.4%) scored above the mean attitude score, implying that they were inclined to have negative (stigmatising) attitudes towards people with mental problems and mental health care. Age (p = 0.048), job category (p < 0.001), and prior in-service mental health training (p = 0.029) made a unique contribution to predicting nurses’ attitudes. Conclusion Gaps were established in PHC nurses’ stigma-related mental health knowledge. A significant proportion of nurses had a propensity for negative (stigmatising) attitudes towards mental health patients and mental health care. Efforts towards integration of mental health into TB services in this metropolitan and similar settings should address mental health knowledge deficits and factors influencing nurses’ negative attitudes. In-service training on mental health should be optimised, with attention to older nurses and enrolled/nursing assistants.

Background In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. Methods A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon sign ranked tests. A 5% statistical significance level was considered Results Over the study period, the median values for the annual number of PHC visits was 1.8, 55.3% for unreferred OPD visits, 69.4% for ART commencement, 95.1% and 18.7% for DS-TB confirmation and treatment commencement respectively, and 93.7% for BCG coverage. While BCG coverage increased by 5.85% (p=0.0101), declines were observed in PHC utilisation (10.53%; p=0.0010), unreferred OPD visits (12.05%; p=0.0006), ART commencement (9.53%; p=0.0174), and DS-TB confirmation (5.24%; p≥0.050) and treatment commencement (3.80%; p≥0.050). Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics – as well as the entire quadruple burden of disease – in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning. Conclusions The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a declines in PHC service utilisation, the decreased numbers of new patients commencing ART and lower confirmed DS-TB case and DS-TB treatment commencement rates, we also learned that EPHS delivery in the province was fragile.