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Each year on March 24, the world commemorates World TB Day.
This date coincides with the day in 1882 when Robert Koch announced his discovery of the mycobacterium tuberculosis, the germ that causes TB.
This infectious disease is transmitted through airborne droplets when an infected person coughs, sings, shouts or sneezes.
TB primarily affects the lungs (pulmonary TB), but other organs in the body such as the pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones or meninges can also be affected (extrapulmonary TB).
TB can be cured; effective anti-TB drugs have been available for almost eight decades. Despite this, TB continues to wreak havoc across the world and in South Africa.
According to a report released by the World Health Organisation (WHO), an estimated 304 000 new TB cases were reported in South Africa in 2021 and 56 000 people succumbed to the disease in the same year.
A WORLD WITHOUT TB
By this target date, a 95% reduction in TB deaths and 90% reduction in new infections – compared with the respective levels in 2015 – is anticipated.
Further to this, the UN’s Stop TB Partnership was mandated to drive activities to end the global TB epidemic.
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In 2015, the partnership launched the 90-(90)-90 targets – to reach at least 90% of people with TB and place them on appropriate treatment, including at least 90% of vulnerable populations such as people living with HIV, and to ensure that at least 90% of people with TB are successfully treated.
Despite commendable progress, persisting high TB infection and death rates are adversely affecting global and national efforts to end the epidemic.
With a treatment success rate of only 78% in 2020, South Africa is sorely challenged to attain the global target of 95%.
TB WITH MENTAL HEALTH ILLNESS
One of the challenges confronting TB control is the frequent comorbidity of TB with mental health illness.
There is compelling evidence linking TB to common mental health problems such as depression, anxiety and alcohol abuse.
The WHO’s End TB strategy thus recommends integrated patient-centred TB care.
This implies that TB care should be provided in close collaboration with other primary healthcare (PHC) programmes such as mental health. However, in many countries – South Africa included – efforts to integrate mental health and TB care are confronted by challenges such as limited capacity, nonrecognition of mental health as a problem, insufficient resources and TB-related social stigma.
Consequently, mental health conditions in TB patients are often undiagnosed, underdiagnosed or misdiagnosed.
Taking depression as a compelling example, a scoping review reported the prevalence of depression as high as 84% among people with TB in studies conducted internationally.
However, little is known about the prevalence of depression among TB patients in South Africa.
Using a nine-item patient health questionnaire, we assessed probable depression among a sample of TB patients attending PHC facilities in the Free State.
We found that almost half (46.1%) of the 208 patients interviewed had probable depression, with 22.6%, 18.8% and 4.8% having mild, moderate and severe symptoms, respectively.
This could possibly be attributed to non-adherence to antiretroviral therapy (ART).
Studies elsewhere have established a significant association between depression and ART non-adherence. We further found that the longer patients were retained on TB treatment, the less likely they were to display symptoms of depression.
IMPORTANCE OF MONITORING TB PATIENTS FOR DEPRESSION
Based on these findings, it is important to monitor TB patients for symptoms of depression – particularly those with comorbid HIV – in PHC settings. At the same time, ensuring that patients stay on treatment by providing adequate support for treatment adherence may help to mitigate depression during TB treatment.
To this end, TB patients attending PHC facilities in South Africa need to be routinely screened for mental health illness.
Given the critical shortage of mental health specialists, screening for mental illnesses could be undertaken by trained and well-supervised non-specialist healthcare cadres such as community health workers.
*Professors Kigozi-Male, Heunis and Engelbrecht are based at the University of the Free Stat’s Centre for Health Systems Research and Development
