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Mental Health and Tuberculosis: How Public Health Departments Strapped for Resources Can Support TB


In an online booklet published late last year, USAID offers guidance in incorporating current evidence and best practices for addressing the relationship between mental health and tuberculosis. It shares a particularly inspiring account of “The Friendship Bench,” an innovative approach to assisting people in Zimbabwe with common mental disorders.


The idea came from Dixon Chibanda, one of only a handful of psychiatrists in the country of 13 million, who set out to answer a question: “Can lay health worker–delivered psychological intervention improve symptoms of depression and anxiety?”


The USAID guide explains, “Chibanda developed a task-shifting model where community health workers are trained in a problem-solving approach of up to six tightly structured sessions (with an optional six-session, peer-support follow up). The patient and counselor meet on a bench in a discrete area near the clinic to discuss their problems and identify solutions.”


To determine the effectiveness of his model, he set up a randomized clinical trial of 573 patients with common mental disorders and symptoms of depression. He found the group who received the intervention had significantly lower symptom scores after six months compared with a control group who received enhanced usual care.


Chibanda and his team were focused on HIV patients and the study does not specifically address TB, but it nevertheless provides an example of how low-resource communities can extend professionally-guided support to patients challenged by mental health issues in their treatment. His conclusion is that lay health workers can provide effective guidance in a clinical setting.


Based on Chibanda’s findings, could directly observed therapy (DOT) for TB be a platform for inserting a friendship bench-type approach to addressing mental health? Public health departments with limited resources serving communities with populations at risk may choose to consider it. However, while the approach minimizes the need for expensive resources, its use would still require freeing up case manager time to train and then to incorporate additional conversation into the DOT session.


Technology can help by automating many of the time-intensive, manual tasks required with testing, documenting, reporting and managing TB cases. For example, ezEMRx’s platform includes tools that free up time around all these tasks, allowing the labor usually required for DOT to be reduced. When a case manager needs to document a patient’s DOT, the platform allows tasks like handwriting and filing documentation paperwork to be eliminated. Instead, staff need only to make a few clicks on the patient’s online form.


Those few clicks further enable automatic completion of reporting requirements to the CDC and in the case of testing, to state and federal registries. The platform is programmed to detect and notify case workers when an entry is likely in error, prompting them to correct the problem early, before it requires time-demanding rework.


Public health departments serve an important role in ensuring one TB case doesn’t become several hundred. ezEMRx is proud to serve the people on the frontlines of the battle against infectious disease.

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