Including mental health treatment in HIV and TB care could end pandemics sooner, report finds

·4-min read
An activist lights a candle during the International AIDS Candlelight Memorial in Belgrade, Serbia, 16 May 2021 - Shutterstock/ANDREJ CUKIC
An activist lights a candle during the International AIDS Candlelight Memorial in Belgrade, Serbia, 16 May 2021 - Shutterstock/ANDREJ CUKIC

Integrating mental health services into HIV and tuberculosis programmes would help wipe out the diseases at a much faster rate, groundbreaking new research has found.

A report from United for Global Mental Health, supported by the Elton John Aids Foundation, confirmed the longstanding suspicion that bringing the services together could cut the number of infections, with estimates that as many as 14 million TB cases could be avoided.

HIV continues to be a major global public health issue having claimed 33 million lives so far, while TB is one of the top 10 causes of death worldwide.

But estimates based upon UNAIDS data project that integrating mental health and psychological support services would speed up the reduction of HIV infections by between 10 and 16 per cent, and TB by between 12 and 20.

This would mean almost one million people avoiding contracting HIV - the equivalent to the total number of new infections currently predicted for 2026.

Meanwhile, the 14 million figure for TB is more than the total number of global TB infections in any given year.

United For Global Mental Health says this is because mental health is a risk factor for exposure to both diseases and can negatively impact on the course of treatment, and that living with HIV and/or TB is a significant risk factor for developing a psychiatric illness.

“This works in three main ways,” said Sarah Kline, CEO of United For Global Mental Health. “One is that by integrating services, you are obviously able to identify and support people who are potentially undergoing what we would call risky behaviour such as substance abuse or unsafe sex, and may be making themselves more vulnerable to infection.

“For many there’s also a huge amount of stigma, real or perceived, in TB and HIV infections and indeed for mental health, so if you can try and reduce that and encourage people through counselling they may be more likely to come forward for testing, which then identifies people who are already infected,” she told the Telegraph.

“And then there’s also adherence to treatment,” she added. “The treatment course for multi strain TB is very difficult and people struggle to sustain the treatment, so often people need encouragement and support.”

While integrating the services would have an initial cost, the research also found that this will soon be far outweighed by the gains made from reducing community transmission and drug resistance, as well as the social and economic costs to households “affected by these multimorbidities”.

As the world enters its final push to end the respective pandemics by 2030, the organisation is calling for “decisive action” that would deliver “huge returns for society” and “transform the lives of those affected”.

The report cites a case study in Zimbabwe, which faces a critical shortage of mental health specialists with only 12 psychiatrists serving a population of 15.3 million.

However, an initiative called the Friendship Bench helps tackle this issue by training community health workers to provide free talking therapy - and studies have shown the programme is particularly effective in encouraging young people who are HIV positive to stick to treatment.

This is partly because of the "empathetic nature" of the health workers - known locally as Ambuya Utano or 'Grandmothers' - is a key factor in demystifying the disease and treatment and "encouraging young people to socialise with peers and free them of guilt".

“What we’re saying is that basic things can be done at a relatively low cost and because of their impact they’re basically cost neutral,” Ms Kline explained.

While the Friendship Bench in Zimbabwe is a good example of a community-based response, Ms Kline says these should be supported and added to by a more systemic approach to investment and infrastructure.

“Peer-to-peer support may already exist plus basic support in counselling, and they can be connected to a health system where people know who to refer to. It doesn’t have to be that everyone goes to a psychiatrist - a lot of the support is psychosocial.”

United For Global Mental Health has urged donors and global institutions around the world - including the Global Fund to Fight AIDS, TB and Malaria - to introduce a holistic approach to care, which would view mental health as an “essential part of their strategy rather than a sub-sector of the health system or an add-on”. This must be done immediately through full integration of services backed up by adequate finance, the organisation said.

“This new research from United for Global Mental Health demonstrates if we integrate mental health services in HIV and TB programmes we can accelerate the end of these diseases at no extra cost,” said Anne Aslett, CEO of the Elton John Aids Foundation.

“As the world meets this week to determine the future approach to HIV, we hope and strongly encourage organisations such as the Global Fund and the President’s Emergency Plan for Aids Relief to show continued leadership by ensuring mental health sits at the centre of their strategy and investments. It will save millions of lives,” she said.

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