Community-based, peer-led psychosocial support to address stigma and reduce depression among adults with tuberculosis in Indonesia: A prospective interventional cohort study

We co-developed and evaluated a community-based, peer-led psychosocial support intervention consisting of individual and peer-led group counselling, online group messaging, and community-based "TB-Talks" to address tuberculosis (TB)-Stigma and reduce depression among adults with TB in Indonesia. A non-randomized, single-arm prospective interventional cohort study was conducted in five primary healthcare centres and two public hospitals in Depok and Padang cities from June 2024 to January 2025. All newly-diagnosed individuals with either drug-sensitive (DS-) or drug-resistant (DR-) TB, aged 15 years and above, were consecutively recruited and offered individual counselling at baseline, then monthly peer-led group counselling and online group messaging and TB Talks during six months of treatment. Participants were assessed at baseline, end of intensive phase (Month-2), and continuation phase (Month-6) for TB-stigma, depression, and quality of life (QoL), using locally-adapted and validated tools including the Van Rie TB-Stigma scale, PHQ-9, and EQ5D5L, respectively. In addition, we collated quantitative acceptability, appropriateness and feasibility feedback from participants and stakeholders. A total of 129 people with TB (Depok = 85, Padang = 44) participated, including 55 (43%) women. Most participants had new DS-TB (62%), 19 (15%) recurrent DS-TB, and 30 (23%) DR-TB. At baseline, most participants had moderate-to-severe TB-Stigma (74%; 95%CI = 65-82%) and depression symptoms (57%; 35-72%). Among 112 participants who completed all assessments, moderate-to-severe TB-Stigma decreased to 43% (34-53%) and 21% (13-28%) and depression symptom prevalence decreased to 32% (20-47%) and 15% (6-23%) at Month-2 and Month-6, respectively. Participants' QoL increased from median 0.84 (0.63-1.00, at baseline) to 0.92 (0.83-1.00, Month-2) and 1.00 (0.91-1.00, Month-6). Both study participants and stakeholders perceived that activities in this study were feasible, acceptable, and locally-appropriate. Community-based, peer-led psychosocial support, combining individual and monthly group counselling, has potential to mitigate TB-Stigma and depression while improving QoL among adults with TB in Indonesia.