A qualitative Study of TB Health Workers’ and Stakeholders’ Conceptualisation, Screening and Treatment of Mental Distress Experienced by TB Patients in Zambia

Abstract

BackgroundThere is an increased recognition to integrate mental health services into routine TB care. For a successful integration TB health workers and stakeholders need to be receptive to mental health services being delivered in tandem with TB services. Additionally, policy makers need to understand the current practices by TB health workers around treatment of mentally distressed TB patients. In this qualitative study we aimed to understand how TB health workers and other TB stakeholders viewed mental distress linked to TB and how they screened and treated mental distress in their patients. MethodsThe study draws on qualitative data collected in 2018 as part of the Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for active TB trial (TREATS). TREATS was conducted in 8 urban communities in Zambia. The data was collected through 17 focus group discussions with local health committees (n=96) and TB stakeholders (n=57), and in-depth interviews with TB health workers (n=9). Thematic analysis was conducted. ResultsTB stakeholders and health workers had an inadequate understanding of mental ill health and commonly described mental distress experienced by TB patients using the stigmatizing term “madness” . Mental distress was also described as “ overthinking”, which participants attributed to psychosocial drivers of distress and inadequate knowledge of TB by TB patients rather than a condition that would benefit from a mental health intervention. ConclusionsTB stakeholders and health care workers in Zambia are cognisant of the mental health implication of TB on TB patients. There are no standard screening or treatment options for mental distress in TB patients. TB health workers in Zambia could benefit from mental health training which should aim to increase knowledge about mental health and chronic illness while shifting negative attitudes around mental illnessTrial registration number: NCT03739736