Columbia University, New York, NY, USA.
Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Health Promot Pract. 2024 Nov;25(6):1032-1039. doi: 10.1177/15248399231183400. Epub 2023 Jul 21.
Tuberculosis (TB) and depression is common and is associated with poor TB outcomes. The World Health Organization End TB Strategy explicitly calls for the integration of TB and mental health services. Interpersonal Counseling (IPC) is a brief evidence-based treatment for depression that can be delivered by non-mental health specialists with expert supervision. The goal of this study was to explore potential barriers and facilitators to training non-specialist providers to deliver IPC within the TB Control Program and primary care in Itaboraí, Rio de Janeiro state. Data collection consisted of six focus groups (n = 42) with health professionals (n = 29), program coordinators (n = 7), and persons with TB (n = 6). We used open coding to analyze the data, followed by deductive coding using the Chaudoir multi-level framework for implementation outcomes. The main structural barriers identified were poverty, limited access to treatment, political instability, violence, and social stigma. Organizational barriers included an overburdened and under-resourced health system with high staff turnover. Despite high levels of stress and burnout among health professionals, several provider-level facilitators emerged including a high receptivity to, and demand for, mental health training; strong community relationships through the community health workers; and overall acceptance of IPC delivered by any type of health provider. Patients were also receptive to IPC being delivered by any type of professional. No intervention-specific barriers or facilitators were identified. Despite many challenges, integrating depression treatment into primary care in Itaboraí using IPC was perceived as acceptable, feasible, and desirable.
结核病（TB）和抑郁症很常见，且与结核病治疗结果不佳有关。世界卫生组织终止结核病战略明确呼吁整合结核病和精神卫生服务。人际心理治疗（IPC）是一种针对抑郁症的简短循证治疗方法，可以由非精神卫生专家在专家监督下提供。本研究的目的是探索在里约热内卢州伊塔博雷亚伊的结核病控制项目和初级保健中培训非专业提供者提供 IPC 的潜在障碍和促进因素。数据收集包括六个焦点小组（n = 42），参与者包括卫生专业人员（n = 29）、项目协调员（n = 7）和结核病患者（n = 6）。我们使用开放式编码分析数据，然后使用 Chaudoir 多层次框架进行实施结果的演绎式编码。确定的主要结构障碍包括贫困、治疗机会有限、政治不稳定、暴力和社会耻辱。组织障碍包括负担过重和资源不足的卫生系统，以及高员工流动率。尽管卫生专业人员压力大、精疲力竭，但仍出现了一些提供者层面的促进因素，包括对精神卫生培训的高度接受和需求；通过社区卫生工作者建立的强大社区关系；以及对任何类型的卫生提供者提供的 IPC 的总体接受。患者也接受任何类型的专业人员提供的 IPC。没有发现干预特定的障碍或促进因素。尽管面临许多挑战，但在伊塔博雷亚伊的初级保健中整合抑郁症治疗并使用 IPC 被认为是可接受、可行和可取的。
