PESHAWAR: The Khyber Medical University Peshawar and Keele University UK have jointly launched a programme to offer psychiatric and psychological support to TB patients with depression in Pakistan and Afghanistan to ensure their adherence to the prescribed treatment plans.

The initiative, Cognitive Therapy for Depression in Tuberculosis Treatment (Control), will implement strategies to deal with depression found among around 40 per cent TB patients in the region, who don’t take their full six-month course and endup with MDR-TB, which is five times more dangerous than simple TB, according to Saeed Farooq, the programme head and a professor at Keele University, UK.

Prof Farooq, who is working on the programme along with Dr Zohaib Khan of Khyber Medical University, told Dawn that the treatment MDR-TB was very costly yet mostly ineffective.

“If a person continues with TB treatment, it doesn’t cost much and is effective,” he said, adding that those suffering from MDR-TB, too, require interventions by psychiatrists and psychologists.

KMU, UK’s Keele University collaborate for Rs1.74bn programme

Prof Farooq, a former psychiatrist at Lady Reading Hospital Peshawar, said the Keele University was also supporting 10 PhDs as part of large trials and to implement research on the patients’ adherence to completion of treatment.

He said he recently received the Academic Researcher Award 2024 from the Royal College of Psychiatrists UK for his research proposals, which could be implemented effectively. Toronto-based psychiatrist Dr Farooq Naeem will train six people to act as master trainers in Khyber Pakhtunkhwa.

“My research project worth £4.9 million (Rs1.74 billion) will be completed by 2026,” he said, adding that the grant has been approved by the National Institute of Health Research, UK.

The Keele University professor said worldwide, TB was the 10th leading cause of death, with depression being a major multi-morbidity in patients from most low or middle-income countries.

He said Pakistan was ranked fifth among TB high-burden countries and had the fourth highest MDR-TB prevalence globally.

“Our [Control] programme aims to develop and test psychological intervention for treating depression in Pakistani and Afghan refugee patients with TB, including those of multidrug resistant TB, and to improve their adherence to treatment. It also seeks to test the intervention’s effectiveness and cost effectiveness and examine how it can be implemented in real-world settings in the TB control programmes worldwide,” he said.

Prof Farooq said that it would be the largest randomized controlled trial of testing the effectiveness of a psychological intervention for depression treatment in TB patients. He added that the initiative also had one of the largest capacity building programmes in public mental healthcare, including scholarships awarded by a UK university for students in Khyber Pakhtunkhwa and 12 master’s in health research.

“Research and treatment will go side by side,” he said.

It consists of four work packages, including developing intervention using evidence synthesis based on ethnographic and qualitative methods for incorporating the perspectives of patients and caregivers (family and health professionals), inbuilt pilot randomised controlled trial (RCT) to test and refine intervention with a clear progression criterion to the definitive trial, a RCT to test if the Control intervention is successful in improving the outcomes both for depression and TB, and also whether the Control intervention is cost-effective and a process evaluation to understand the challenges and scale up in TB control programmes.

Prof Farooq, a resident of Haripur district and a graduate of Khyber Medical College, has won a total grant worth around £10 million through which he is engaged in many research programmes. He is also the recipient of the prestigious award for extensive research.

He said under the programme, patients, staff members, and policymakers would be interviewed to explore acceptability and experiences and see how the Control intervention, if successful, could be modified for other chronic infections such as hepatitis C.

The programme leader said capacity building and community engagement were major components of the initiative, which also included Afghan students as their country had bigger TB crisis.

He said common mental disorders, such as depression, were significant multi-morbidities in people with TB in the most low or middle-income countries.

“Pakistan is ranked fifth among countries with high TB burden. Afghanistan has an even worse situation due to the ongoing conflict,” he said.

Prof Farooq said about half of people with TB also had co-morbid depression. He said effective interventions weren’t available to treat depression in people with TB.

“We aim to develop and test a psychosocial intervention for treating depression in TB and improving adherence with antidepressants treatment,” he said.

The Keele University professor said the successful Control programme would uniquely address two major problems in TB control worldwide, including depression and poor treatment adherence.

“This will potentially have enormous public health impact by reducing TB deaths, reducing infection spread and decreasing the risk of MDR-TB,” he said, adding that the initiative will enhance capacity for implementation research in LMIC.

Published in Dawn, December 22nd, 2024