Feasibility of integrating depression care into tuberculosis services in India

Background Depression is three times more common in Tuberculosis (TB) patients than in the general population and worsens TB outcomes, often goes undetected or untreated. Integrating depression care into existing TB services is essential. Objectives To develop and assess the feasibility of a tailored care pathway that integrates depression screening and management into existing TB services in India. Methods The study was conducted in three TB care facilities in Bengaluru, Karnataka, India, in two phases: (i)Co-design of tailored depression in the TB care pathway through a series of workshops. (ii)Testing the feasibility of the pathway A training manual was developed and used to train TB health workers. The feasibility of the care pathway was assessed by evaluating the proportion of persons with TB attending each facility during the study period who were screened for depression, as well as through a series of feedback workshops to assess acceptability. Results A total of 114/164 (69.51 %) TB patients underwent screening over a six month period, with seven reporting scores of over 2 on the PHQ-2. The feedback workshops identified the acceptability and appropriateness of the tools, as well as areas for improvement in knowledge and understanding. Addressing complex health issues such as suicidality, alcohol and tobacco use and the burden on existing staff due to a higher volume of cases reported as challenges. Conclusions This care pathway warrants further testing to establish its feasibility in a larger context and to understand how to optimise its wider implementation, scale-up and sustainability.