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Sweetland AC, Galea J, Shin SS, Driver C, Dlodlo RA, Karpati A, Wainberg ML. Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis 2020; 23:600-605. [PMID: 31097069 DOI: 10.5588/ijtld.18.0530] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
<sec id="st1"> <title>SETTING</title> A global survey of National Tuberculosis Program (NTP) directors. </sec> <sec id="st2"> <title>OBJECTIVES</title> To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines. </sec> <sec id="st3"> <title>DESIGN</title> Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire. </sec> <sec id="st4"> <title>RESULTS</title> Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma. </sec> <sec id="st5"> <title>CONCLUSIONS</title> NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide. </sec>.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - J Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, California
| | - C Driver
- Vital Strategies, New York, New York, USA
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - M L Wainberg
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
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Bradley KA, Rubinsky AD, Lapham GT, Berger D, Bryson C, Achtmeyer C, Hawkins EJ, Chavez LJ, Williams EC, Kivlahan DR. Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population. Addiction 2016; 111:1975-1984. [PMID: 27349855 DOI: 10.1111/add.13505] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/27/2016] [Accepted: 06/16/2016] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). DESIGN Cohort study. SETTING Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. PARTICIPANTS A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). MEASUREMENTS Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. FINDINGS Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not (P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use (P-values all < 0.05). CONCLUSIONS When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL.
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Affiliation(s)
- Katharine A Bradley
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. .,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA. .,Group Health Research Institute, Seattle, WA, USA. .,Department of Health Services, University of Washington, Seattle, WA, USA. .,Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Anna D Rubinsky
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,The Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Gwen T Lapham
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Group Health Research Institute, Seattle, WA, USA
| | - Douglas Berger
- General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher Bryson
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Carol Achtmeyer
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,General Medicine Services, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Eric J Hawkins
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Laura J Chavez
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Emily C Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Daniel R Kivlahan
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Waszkiewicz N, Szajda SD, Szulc A, Zwierz K. Binge drinking and tuberculosis prevention. Tuberculosis (Edinb) 2015; 95:89-90. [PMID: 25697755 DOI: 10.1016/j.tube.2014.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/31/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Białystok, 16-070 Choroszcz, Poland.
| | | | - Agata Szulc
- Department of Psychiatry, Medical University of Warsaw, Poland
| | - Krzysztof Zwierz
- Medical College of the Universal Education Society, Łomża, Poland
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Wissow LS, Tegegn T, Asheber K, McNabb M, Weldegebreal T, Jerene D, Ruff A. Collaboratively reframing mental health for integration of HIV care in Ethiopia. Health Policy Plan 2014; 30:791-803. [PMID: 25012090 DOI: 10.1093/heapol/czu058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. METHOD We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. RESULTS In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. CONCLUSIONS An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time.
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Affiliation(s)
- Lawrence S Wissow
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Teketel Tegegn
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Kassahun Asheber
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Marion McNabb
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Teklu Weldegebreal
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Degu Jerene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Andrea Ruff
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
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Shin S, Livchits V, Connery HS, Shields A, Yanov S, Yanova G, Fitzmaurice GM, Nelson AK, Greenfield SF. Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia. Addiction 2013; 108:1387-96. [PMID: 23490304 PMCID: PMC3710528 DOI: 10.1111/add.12148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 11/27/2022]
Abstract
AIMS To test the feasibility and effectiveness of brief counseling intervention (BCI) and naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia. DESIGN Using a factorial randomized controlled trial design, patients were randomized into: naltrexone (NTX), brief behavioral compliance enhancement therapy (BBCET), treatment as usual (TAU) and BCI. SETTING AND PARTICIPANTS In the Tomsk Oblast, hospitalized TB patients diagnosed with alcohol use disorders (AUDs) by the DSM-IV were referred at the start of TB treatment. Of the 196 participants, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease) and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%); 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day. MEASUREMENTS Primary outcomes were 'favorable' TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as four drinks per day and five drinks per day for women and men, respectively, and TB adherence, measured as percentage of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on 'intention-to-treat' was performed for multivariable analysis. FINDINGS Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n = 111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P = 0.02). CONCLUSIONS In Tomsk Oblast, Russia, tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes.
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Affiliation(s)
- Sonya Shin
- Harvard Medical School, Brigham and Women’s Hospital, Division of Global Health Equity, 75 Francis Street, Boston, MA 02115, USA.
| | - Viktoria Livchits
- Partners in Health Representative Office in Russian Federation, Trekhprudny per., 11/13 103001, Moscow, Russia
| | - Hilary Smith Connery
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,McLean Hospital, 115 Mill Street, Belmont, MA, 02478 USA
| | - Alan Shields
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Department of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115,Mapi Consultancy, 180 Canal Street, Suite 503, Boston, MA 02114
| | - Sergei Yanov
- Tomsk Oblast Clinical Tuberculosis Hospital, Timiryazevo, Novaya Str 1. Russian Federation, Tomsk 634009
| | - Galina Yanova
- Tomsk Oblast Clinical Tuberculosis Hospital, Timiryazevo, Novaya Str 1. Russian Federation, Tomsk 634009
| | - Garrett M. Fitzmaurice
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,McLean Hospital, 115 Mill Street, Belmont, MA, 02478 USA
| | - Adrianne K. Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Shelly F. Greenfield
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,McLean Hospital, 115 Mill Street, Belmont, MA, 02478 USA
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Jenkins HE, Ciobanu A, Plesca V, Crudu V, Galusca I, Soltan V, Cohen T. Risk factors and timing of default from treatment for non-multidrug-resistant tuberculosis in Moldova. Int J Tuberc Lung Dis 2013; 17:373-80. [PMID: 23407226 DOI: 10.5588/ijtld.12.0464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The Republic of Moldova, in Eastern Europe, has among the highest reported nationwide proportions of tuberculosis (TB) patients with multidrug-resistant tuberculosis (MDR-TB) worldwide. Default has been associated with increased mortality and amplification of drug resistance, and may contribute to the high MDR-TB rates in Moldova. OBJECTIVE To assess risk factors and timing of default from treatment for non-MDR-TB from 2007 to 2010. DESIGN A retrospective analysis of routine surveillance data on all non-MDR-TB patients reported. RESULTS A total of 14.7% of non-MDR-TB patients defaulted from treatment during the study period. Independent risk factors for default included sociodemographic factors, such as homelessness, living alone, less formal education and spending substantial time outside Moldova in the year prior to diagnosis; and health-related factors such as human immunodeficiency virus co-infection, greater lung pathology and increasing TB drug resistance. Anti-tuberculosis treatment is usually initiated within an institutional setting in Moldova, and the default risk was highest in the month following the phase of hospitalized treatment (among civilians) and after leaving prison (among those diagnosed while incarcerated). CONCLUSIONS Targeted interventions to increase treatment adherence for patients at highest risk of default, and improving the continuity of care for patients transitioning from institutional to community care may substantially reduce risk of default.
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Affiliation(s)
- H E Jenkins
- Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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