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

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, 2 nd , 8 th and 24 th 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.