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Turan JM, Vinikoor MJ, Su AY, Rangel-Gomez M, Sweetland A, Verhey R, Chibanda D, Paulino-Ramírez R, Best C, Masquillier C, van Olmen J, Gaist P, Kohrt BA. Global health reciprocal innovation to address mental health and well-being: strategies used and lessons learnt. BMJ Glob Health 2023; 8:e013572. [PMID: 37949477 PMCID: PMC10649690 DOI: 10.1136/bmjgh-2023-013572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/07/2023] [Indexed: 11/12/2023] Open
Abstract
Over the past two decades there have been major advances in the development of interventions promoting mental health and well-being in low- and middle-income countries (LMIC), including delivery of care by non-specialist providers, incorporation of mobile technologies and development of multilevel community-based interventions. Growing inequities in mental health have led to calls to adopt similar strategies in high-income countries (HIC), learning from LMIC. To overcome shared challenges, it is crucial for projects implementing these strategies in different global settings to learn from one another. Our objective was to examine cases in which mental health and well-being interventions originating in or conceived for LMIC were implemented in the USA. The cases included delivery of psychological interventions by non-specialists, HIV-related stigma reduction programmes, substance use mitigation strategies and interventions to promote parenting skills and family functioning. We summarise commonly used strategies, barriers, benefits and lessons learnt for the transfer of these innovative practices among LMIC and HIC. Common strategies included intervention delivery by non-specialists and use of digital modalities to facilitate training and increase reach. Common barriers included lack of reimbursement mechanisms for care delivered by non-specialists and resistance from professional societies. Despite US investigators' involvement in most of the original research in LMIC, only a few cases directly involved LMIC researchers in US implementation. In order to achieve greater equity in global mental health and well-being, more efforts and targeted funding are needed to develop best practices for global health reciprocal innovation and iterative learning in HIC and LMIC.
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Affiliation(s)
- Janet M Turan
- Sparkman Center for Global Health and Department of Health Policy and Organization, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Michael J Vinikoor
- Research Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Austin Y Su
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mauricio Rangel-Gomez
- Behavioral Science & Integrative Neuroscience Research Branch, Division of Neuroscience and Basic Behavioral Science, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Annika Sweetland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
| | - Dixon Chibanda
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical and Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Chynere Best
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Caroline Masquillier
- Faculty of Medicine and Health Sciences, Department of Family and Population and Health, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Faculty of Medicine and Health Sciences, Department of Family and Population and Health, University of Antwerp, Antwerp, Belgium
| | - Paul Gaist
- Office of AIDS Research, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Brandon A Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Basaraba CN, Stockton MA, Sweetland A, Medina-Marino A, Lovero KL, Oquendo MA, Greene MC, Mocumbi AO, Gouveia L, Mello M, Dos Santos P, Suleman A, Mabunda D, Mandlate F, Xavier A, Fumo W, Massinga L, Khan S, Feliciano P, Kann B, Salem AF, Bezuidenhout C, Mootz JJ, Duarte CS, Cournos F, Wall MM, Wainberg ML. Does It Matter What Screener We Use? A Comparison of Ultra-brief PHQ-4 and E-mwTool-3 Screeners for Anxiety and Depression Among People With and Without HIV. AIDS Behav 2023; 27:1154-1161. [PMID: 36209180 PMCID: PMC10125788 DOI: 10.1007/s10461-022-03852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/01/2022]
Abstract
The burden of depression and anxiety disorders is high in sub-Saharan Africa, especially for people with HIV (PWH). The Patient Health Questionnaire-4 (PHQ-4) and Electronic Mental Wellness Tool-3 (E-mwTool-3) are ultra-brief screening tools for these disorders. We compared the performance of PHQ-4 and E-mwTool-3 for screening MINI-International Neuropsychiatric Interview diagnoses of depression and anxiety among a sample of individuals with and without HIV in two primary care clinics and one general hospital in Maputo City, Mozambique. Areas-under-the-curve (AUC) were calculated along with sensitivities and specificities at a range of cutoffs. For PWH, at a sum score cutoff of ≥ 1, sensitivities were strong: PHQ-4:Depression = 0.843; PHQ-4:Anxiety = 0.786; E-mwTool-3:Depression = 0.843; E-mwTool-3:Anxiety = 0.929. E-mwTool-3 performance was comparable to PHQ-4 among people with and without HIV.
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Affiliation(s)
- Cale N Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, USA.
| | | | - Annika Sweetland
- Columbia University Department of Psychiatry/New York State Psychiatric Institute, New York, USA
| | - Andrew Medina-Marino
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Research Unit, Foundation for Professional Development, Buffalo City Metro, South Africa
| | - Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Ana Olga Mocumbi
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Lidia Gouveia
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Milena Mello
- New York State Psychiatric Institute, New York, USA
| | - Palmira Dos Santos
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Antonio Suleman
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Dirceu Mabunda
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Flávio Mandlate
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Amalio Xavier
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Luciana Massinga
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Paulino Feliciano
- Universidade Eduardo Mondlane School of Medicine, Maputo, Mozambique
| | - Bianca Kann
- New York State Psychiatric Institute, New York, USA
| | | | - Charl Bezuidenhout
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | | | | | - Francine Cournos
- Clinical Psychiatry (in Epidemiology), Columbia University, New York, USA
| | - Melanie M Wall
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, USA
- New York State Psychiatric Institute, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
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O’Grady MA, Mootz J, Suleman A, Sweetland A, Teodoro E, Anube A, Feliciano P, Bezuidenhout C, Dos Santos PF, Fumo W, Gouveia L, Pinsky I, Mello M, Kann B, Wainberg ML. Mobile technology and task shifting to improve access to alcohol treatment services in Mozambique. J Subst Abuse Treat 2022; 134:108549. [PMID: 34210568 PMCID: PMC8702577 DOI: 10.1016/j.jsat.2021.108549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unhealthy alcohol use (UAU) is a major public health challenge, particularly in low- and middle-income countries. Mozambique is the fourth poorest country in the world where half of the population lives below the poverty line. UAU is frequent among drinkers in Mozambique; however, resources and infrastructure to treat UAU are very limited. This paper examines how task-shifting and a provider-facing mobile health application are being used to improve access to care. In this paper, the feasibility, acceptability and appropriateness of a provider-facing mobile health application being used under a task-shifting model to identify UAU and provide a four-session brief motivational interviewing intervention are described. METHOD The study used a sequential exploratory mixed-methods design with a QUAL → quan structure. First, 15 psychiatric technicians and primary care providers in Mozambique's Nampula Province participated in semi-structured interviews. These interviews were recorded and transcribed. Then, 45 providers completed a 12-item quantitative survey on tablets. Quantitative analysis used descriptive statistic calculation and qualitative analysis used thematic analysis. RESULTS Nonspecialized providers found the mobile health app to be acceptable, appropriate, and feasible when delivering a 4-session brief motivational intervention under a task-shifting model. Central benefits of the technology were enhanced standardization and efficiency of sessions as well as feelings of legitimacy when interacting with patients. Main concerns were feasibility of implementing the intervention due to time constraints of workload and internet connectivity issues. CONCLUSIONS Provider-facing technology shows promise in supporting task-shifting models that can expand alcohol intervention services and increase access to care in low- and middle-income countries. Providers without specialized training in behavioral health interventions can provide critical services to patients with UAU and provider-facing mobile health applications may help bring such models to scale.
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Affiliation(s)
- Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, Corresponding Author: Megan A. O’Grady, Assistant Professor, Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-6325; ; 860-679-5483
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Antonio Suleman
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Annika Sweetland
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Eugénia Teodoro
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Anibal Anube
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Paulino Feliciano
- Department of Psychiatry and Mental Health, Psychiatric Hospital of Nampula, Mozambique
| | - Charl Bezuidenhout
- Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | | | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Ilana Pinsky
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milena Mello
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Bianca Kann
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY
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Castro-Silva KMD, Carvalho AC, Cavalcanti MT, Martins PDS, França JR, Oquendo M, Kritski AL, Sweetland A. Prevalence of depression among patients with presumptive pulmonary tuberculosis in Rio de Janeiro, Brazil. ACTA ACUST UNITED AC 2018; 41:316-323. [PMID: 30365672 PMCID: PMC6476682 DOI: 10.1590/1516-4446-2018-0076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/01/2018] [Indexed: 01/14/2023]
Abstract
Objective: To estimate the prevalence of major depressive episode (MDE) in patients with presumptive pulmonary tuberculosis (pre-PTB, defined by cough lasting ≥ 3 weeks) and compare it between patients with pulmonary tuberculosis (PTB) and without PTB. Methods: Patients with pre-PTB (n=260) were screened for depression using the Patient Health Questionnaire (PHQ-9). Those individuals with scores ≥ 10 were subsequently assessed with the depression module of the Mini International Neuropsychiatric Interview (MINI-Plus) to confirm diagnosis. Associations of categorical variables with PTB and MDE were calculated using the chi-square test and OR. Results: PTB was confirmed in 98 patients (37.7%). A high proportion of both groups (active PTB and no PTB) screened positive for depression (60.2 vs. 62.1%, respectively). Among 159 patients who screened positive for depression, a subset of 97 (61.0%) were further evaluated with the MINI-Plus; current MDE was confirmed in 54.6% (53/97). On univariate and multivariate analysis, female sex was the only factor associated with the diagnosis of current MDE (p = 0.04). Conclusion: The prevalence of MDE was high among individuals with prolonged respiratory symptoms, independent of PTB diagnosis. This is consistent with other studies of depression in primary care in Brazil.
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Affiliation(s)
- Karina M de Castro-Silva
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Anna C Carvalho
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Maria T Cavalcanti
- Departamento de Psiquiatria, Faculdade de Medicina, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Pedro da S Martins
- Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - José R França
- Departamento de Psiquiatria, Faculdade de Medicina, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Maria Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Rede Brasileira de Pesquisas em Tuberculose (REDE-TB), Rio de Janeiro, RJ, Brazil
| | - Annika Sweetland
- Department of Psychiatry, Columbia College of Physicians & Surgeons, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
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Affiliation(s)
- Annika Sweetland
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Maria Oquendo
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Priya Wickramaratne
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Myrna Weissman
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
| | - Milton Wainberg
- Department of Psychiatry, Columbia College of Physicians and SurgeonsNew York, NY, USA,New York State Psychiatric InstituteNew York, NY, USA
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Collins PY, Elkington KS, von Unger H, Sweetland A, Wright ER, Zybert PA. Relationship of stigma to HIV risk among women with mental illness. Am J Orthopsychiatry 2008; 78:498-506. [PMID: 19123772 DOI: 10.1037/a0014581] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Urban women with severe mental illness (SMI) are vulnerable to stigma and discrimination related to mental illness and other stigmatized labels. Stigma experiences may increase their risk for negative health outcomes, such as HIV infection. This study tests the relationship between perceived stigma and HIV risk behaviors among women with SMI. The authors interviewed 92 women attending community mental health programs using the Stigma of Psychiatric Illness and Sexuality Among Women Questionnaire. There were significant relationships between personal experiences of mental illness and substance use accompanying sexual intercourse; perceived ethnic stigma and having a riskier partner type; and experiences of discrimination and having a casual or sex-exchange partner. Higher scores on relationship stigma were associated with a greater number of sexual risk behaviors. The findings underscore the importance of exploring how stigma attached to mental illness intersects with other stigmatized labels to produce unique configurations of HIV risk. HIV risk reduction interventions and prevention research should integrate attention to stigmatized identities in the lives of women with SMI.
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Affiliation(s)
- Pamela Y Collins
- Department of Epidemiology, Columbia University, New York, NY 10032, USA.
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Acha J, Sweetland A, Guerra D, Chalco K, Castillo H, Palacios E. Psychosocial support groups for patients with multidrug-resistant tuberculosis: Five years of experience. Glob Public Health 2007; 2:404-17. [DOI: 10.1080/17441690701191610] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Drobac PC, del Castillo H, Sweetland A, Anca G, Joseph JK, Furin J, Shin S. Treatment of Multidrug-Resistant Tuberculosis during Pregnancy: Long-Term Follow-Up of 6 Children with Intrauterine Exposure to Second-Line Agents. Clin Infect Dis 2005; 40:1689-92. [PMID: 15889370 DOI: 10.1086/430066] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 01/24/2005] [Indexed: 11/03/2022] Open
Abstract
Treatment of gestational multidrug-resistant tuberculosis (MDR-TB) is controversial. We describe follow-up of 6 children exposed to second-line antituberculous agents in utero. Each child (average age, 3.7 years) underwent comprehensive clinical evaluation. One child had MDR-TB diagnosed. There was no evidence of significant late-presentation toxicity among the children. The results suggest that aggressive management of gestational MDR-TB may benefit both mother and child.
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Affiliation(s)
- Peter C Drobac
- Department of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Vega P, Sweetland A, Acha J, Castillo H, Guerra D, Smith Fawzi MC, Shin S. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2004; 8:749-59. [PMID: 15182146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management. SETTING A community-based non-governmental health organization in Lima, Peru. OBJECTIVE To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort. METHODS A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999. RESULTS Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case. CONCLUSION Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.
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Affiliation(s)
- P Vega
- Neuropsychiatric Service, Department of Medicine, Ministry of Health, Lima, Peru
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