Implementation of a psychosocial support package for people receiving treatment for multidrug-resistant tuberculosis in Nepal: A feasibility and acceptability study

Ian F. Walker*, Sudeepa Khanal, Joe P. Hicks, Bikash Lamichhane, Anil Thapa, Helen Elsey, Sushil C. Baral, James N. Newell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Background and objectives People receiving treatment for multidrug-resistant tuberculosis (MDR-TB) have high rates of depression. Psychosocial support in general, and treatments for depression in particular, form an important but neglected area of patient-centred care, and a key pillar in the global End TB strategy. We assessed the feasibility and acceptability of a psychosocial support package for people receiving treatment for MDR-TB in Nepal. Methods This feasibility study used a mixed quantitative and qualitative approach. We implemented the intervention package in two National Tuberculosis Programme (NTP) MDR-TB treatment centres and 8 sub-centres. We screened patients monthly for depression and anxiety (cut-off 24 and 17 respectively on the Hopkins Symptom Checklist) and also for low social support (cut-off 3 on the Multidimensional Scale of Perceived Social Support). Those who screened positive on either screening tool received the Healthy Activity Program (HAP), which uses brief counselling based on behavioural activation theory. Other aspects of the psychosocial package were information/education materials and group interactions with other patients. Results We screened 135 patients, of whom 12 (9%) received HAP counselling, 115 (85%) received information materials, 80 (59%) received an education session and 49 (36%) received at least one group session. Eight group sessions were conducted in total. All aspects of the intervention package were acceptable to patients, including the screening, information, group work and counselling. Patients particularly valued having someone to talk to about their concerns and worries. We were able to successfully train individuals with no experience of psychological counselling to deliver HAP. Conclusion This psychosocial support package is acceptable to patients. The information materials we developed are feasible to deliver in the current NTP. However, the structured psychological counselling (HAP), is not feasible in the current NTP due to time constraints. This requires additional investment of counsellors in TB clinics.

Original languageEnglish
Article numbere0201163
JournalPLoS ONE
Volume13
Issue number7
DOIs
Publication statusPublished - Jul 2018
Externally publishedYes

Bibliographical note

Funding Information:
This study was funded by COMDIS-HSD, a research consortium funded by UK aid from the UK government (Department for International Development): however, the views expressed do not necessarily reflect the UK government’s official policies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study was funded by COMDIS-HSD, a research consortium funded by UK aid from the UK government: however, the views expressed do not necessarily reflect the UK government’s official policies. The funder had no bearing on the study findings nor did they approve or censor the manuscript.

Publisher Copyright:
© 2018 Walker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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