Effectiveness of integrated tuberculosis and depression treatment led by non-specialist health workers versus standard care among persons with tuberculosis in a low-resource setting: A quasi-experimental non-randomized controlled trial
6 affiliations
- 1RedAid Nigeria, Enugu, Enugu, Nigeria
- 2Global Health Department, DAHW – German Leprosy and Tuberculosis Relief Association, Abuja, Nigeria
- 3Department of Public Health, Federal Ministry of Health& Social Welfare, Abuja, Nigeria
- 4National Tuberculosis, Leprosy and Buruli Ulcer Control Program, Federal Ministry of Health & Social Welfare, Abuja, Nigeria
- 5Stop TB Partnership, Geneva, Switzerland
- 6Department of Mental Health, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
Abstract
This study determined the effectiveness of integrated TB and depression care compared to standard TB care in reducing depressive symptoms over time in persons treated for TB. This was a quasi-experimental, non-randomized controlled trial involving all TB cases with significant depressive symptoms (PHQ score ≥ 5) in ten already existing sites (i.e., eight intervention sites and two control sites) in Nigeria. At the intervention sites, non-specialist health workers (NSHWs) delivered treatment for both TB and depression while the NSHWs in the control sites delivered TB treatment and then referred patients with depression to a specialist in a different setting for treatment. Changes in depression symptom scores were measured at baseline, 2nd, 8th and 24th weeks using Patient Health Questionnaire (PHQ-9). Mixed-ANOVA design was used to determine changes in PHQ-9 scores between-subjects and within-subjects across intervals of follow-up using both the per protocol and intent-to-treat analyses while controlling for covariates such as age, social support, sex, education. There were no significant differences in the PHQ-scores between the two groups (F = 0.95, p = 0.32). In addition, across the intervals of follow-up, PHQ-scores (i.e., depressive symptom scores) decreased significantly with time in both the intervention and control arms (p < 0.001). Furthermore, the interaction between the study arms and time was not significant (F = 0.66, p = 0.57), indicating that the groups were changing over time in a similar way. Participants with marked decrease in depressive symptoms completed their TB treatment and achieved cure when compared to the higher scores seen in those who dropped out or died or were transferred (F = 25.78, p < 0.001). The findings indicated that TB and depression treatment delivered by NSHWs significantly reduced depressive symptoms across intervals of follow-up. In addition, relief from depressive symptoms was significantly associated with completing TB treatment and achieving cure. Clinical Trial Number: PACTR202501828312848.
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BibTeX
@article{murphyokpala2026effectiveness,
title = {{Effectiveness of integrated tuberculosis and depression treatment led by non-specialist health workers versus standard care among persons with tuberculosis in a low-resource setting: A quasi-experimental non-randomized controlled trial}},
author = {Ngozi Murphy-Okpala and Charles Nwafor and Chinwe Eze and Martin Njoku and Okechukwu Ezeakile and Anthony Meka and Ngozi Ekeke and Francis Iyama and Daniel Egbule and Chukwuma Anyaike and Obioma Chijioke-Akaniro and Joseph Chukwu and Beatrice Kirubi and Jacob Creswell and Justus Uchenna Onu},
journal = {PLOS Mental Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pmen.0000636},
url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000636},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effectiveness of integrated tuberculosis and depression treatment led by non-specialist health workers versus standard care among persons with tuberculosis in a low-resource setting: A quasi-experimental non-randomized controlled trial
AU - Ngozi Murphy-Okpala
AU - Charles Nwafor
AU - Chinwe Eze
AU - Martin Njoku
AU - Okechukwu Ezeakile
AU - Anthony Meka
AU - Ngozi Ekeke
AU - Francis Iyama
AU - Daniel Egbule
AU - Chukwuma Anyaike
AU - Obioma Chijioke-Akaniro
AU - Joseph Chukwu
AU - Beatrice Kirubi
AU - Jacob Creswell
AU - Justus Uchenna Onu
PY - 2026
DA - 2026/09/21
JO - PLOS Mental Health
DO - 10.1371/journal.pmen.0000636
UR - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000636
AB - This study determined the effectiveness of integrated TB and depression care compared to standard TB care in reducing depressive symptoms over time in persons treated for TB. This was a quasi-experimental, non-randomized controlled trial involving all TB cases with significant depressive symptoms (PHQ score ≥ 5) in ten already existing sites (i.e., eight intervention sites and two control sites) in Nigeria. At the intervention sites, non-specialist health workers (NSHWs) delivered treatment for both TB and depression while the NSHWs in the control sites delivered TB treatment and then referred patients with depression to a specialist in a different setting for treatment. Changes in depression symptom scores were measured at baseline, 2nd, 8th and 24th weeks using Patient Health Questionnaire (PHQ-9). Mixed-ANOVA design was used to determine changes in PHQ-9 scores between-subjects and within-subjects across intervals of follow-up using both the per protocol and intent-to-treat analyses while controlling for covariates such as age, social support, sex, education. There were no significant differences in the PHQ-scores between the two groups (F = 0.95, p = 0.32). In addition, across the intervals of follow-up, PHQ-scores (i.e., depressive symptom scores) decreased significantly with time in both the intervention and control arms (p < 0.001). Furthermore, the interaction between the study arms and time was not significant (F = 0.66, p = 0.57), indicating that the groups were changing over time in a similar way. Participants with marked decrease in depressive symptoms completed their TB treatment and achieved cure when compared to the higher scores seen in those who dropped out or died or were transferred (F = 25.78, p < 0.001). The findings indicated that TB and depression treatment delivered by NSHWs significantly reduced depressive symptoms across intervals of follow-up. In addition, relief from depressive symptoms was significantly associated with completing TB treatment and achieving cure. Clinical Trial Number: PACTR202501828312848.
SN - 2837-8156
ER -