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Objective To investigate the association between comorbid depression and tuberculosis treatment outcomes, quality of life and disability in Ethiopia. Methods The study involved 648 consecutive adults treated for tuberculosis at 14 primary health-care facilities. All were assessed at treatment initiation (i.e. baseline) and after 2 and 6 months. We defined probable depression as a score of 10 or above on the nine-item Patient Health Questionnaire. Data on treatment default, failure and success and on death were obtained from tuberculosis registers. Quality of life was assessed using a visual analogue scale and we calculated disability scores using the World Health Organization's Disability Assessment Scale. Using multivariate Poisson regression analysis, we estimated the association between probable depression at baseline and treatment outcomes and death. Results Untreated depression at baseline was independently associated with tuberculosis treatment default (adjusted risk ratio, aRR: 9.09; 95% confidence interval, CI: 6.72 to 12.30), death (aRR: 2.99; 95% CI: 1.54 to 5.78), greater disability ([beta]: 0.83; 95% CI: 0.67 to 0.99) and poorer quality of life ([beta]: -0.07; 95% CI: -0.07 to -0.06) at 6 months. Participants with probable depression had a lower mean quality-of-life score than those without (5.0 versus 6.0, respectively; P< 0.001) and a higher median disability score (22.0 versus 14.0, respectively; P< 0.001) at 6 months. Conclusion Untreated depression in people with tuberculosis was associated with worse treatment outcomes, poorer quality of life and greater disability. Health workers should be given the support needed to provide depression care for people with tuberculosis. Objectif Etudier l'association entre la depression et les resultats du traitement contre la tuberculose, la qualite de vie et le handicap en Ethiopie. Methodes L'etude a porte sur 648 adultes consecutifs traites contre la tuberculose dans 14 etablissements de soins primaires. Tous ont ete examines au debut du traitement (periode de reference) puis au bout de 2 et 6 mois. Nous avons defini la depression probable comme l'obtention d'un score de 10 ou plus au Questionnaire sur la sante du patient PHQ-9. Les registres sur la tuberculose ont fourni des donnees sur les defauts, l'echec ou la reussite des traitements ainsi que sur les deces. La qualite de vie a ete evaluee au moyen d'une echelle visuelle analogique et nous avons calcule le score de handicap a l'aide de l'echelle d'evaluation du handicap (Disability Assessment Scale) de l'Organisation mondiale de la Sante. A l'aide d'une analyse de regression de Poisson multivariee, nous avons estime l'association entre une depression probable au debut du traitement, les resultats du traitement et le deces. Resultats Une depression non traitee au debut du traitement etait associee de facon independante avec des defauts de traitement contre la tuberculose (risque relatif ajuste, RRa: 9,09; intervalle de confiance (IC) de 95%: 6,72 a 12,30), le deces (RRa: 2,99; IC 95%: 1,54 a 5,78), une augmentation du handicap ([beta]: 0,83; IC 95%: 0,67 a 0,99) et une moins bonne qualite de vie ([beta]: -0,07; IC 95%: -0,07 a -0,06) au bout de 6 mois. Les participants souffrant probablement d'une depression avaient un score moyen de qualite de vie inferieur a ceux n'en souffrant pas (respectivement 5,0 contre 6,0; P < 0,001) et un score de handicap median plus eleve (respectivement 22,0 contre 14,0; P < 0,001) au bout de 6 mois. Conclusion La depression non traitee chez les personnes atteintes de tuberculose etait associee a de moins bons resultats du traitement, a une moins bonne qualite de vie et a un plus grand handicap. Les professionnels de sante devraient recevoir l'aide necessaire pour proposer une prise en charge de la depression aux personnes atteintes de tuberculose. Objetivo Para investigar la asociacion entre los resultados de la depresion concomitante y el tratamiento de la tuberculosis, la calidad de vida y la discapacidad en Etiopia. Metodos El estudio incluyo 648 adultos consecutivos tratados contra la tuberculosis en 14centros sanitarios primarios.Todos fueron evaluados en la iniciacion del tratamiento (es decir, el principio) y tras 2 y 6 meses. Definimos la posible depresion como una puntuacion de 10 o mas en el Cuestionario de Salud del Paciente de nueve elementos. Los datos del defecto, incumplimiento y exito del tratamiento y de la defuncion se obtuvieron de los registros de la tuberculosis. La calidad de vida se evaluo usando una ampliacion analoga visual y calculamos la puntuacion de discapacidad usando la Ampliacion de Asesoramiento de Discapacidad de la Organizacion Mundial de la Salud. Usando el analisis de regresion de Poisson multivariable, estimamos la asociacion entre la posible depresion al principio y los resultados del tratamiento y la defuncion. Resultados La depresion sin tratar al principio estaba independientemente asociada con el defecto del tratamiento de la tuberculosis (coeficiente de riesgo ajustado, aRR: 9,09; intervalo de confianza, IC, del 95%: 6,72 a 12,30), defuncion (aRR: 2,99; IC del 95%: 1,54 a 5,78), mayor discapacidad [[beta]: 0,83; IC del 95%: 0,67 a 0,99) y calidad de vida mas pobre ([beta]: -0,07; IC del 95%: -0,07 a -0,06) en 6 meses. Los participantes con posible depresion tuvieron una puntuacion de calidad de vida media mas baja que aquellos sin (5,0 frente a 6,0, respectivamente; P Conclusion La depresion sin tratar en las personas con tuberculosis se asocio con los peores resultados del tratamiento, una calidad de vida mas pobre y mayor discapacidad. Deberian darles el respaldo necesario a los trabajadores sanitarios para ofrecer atencion a la depresion para personas con tuberculosis., Introduction Tuberculosis is the principal cause of death due to infectious disease worldwide; (1) it accounts for 2.0% of the global disease burden, as measured in disability-adjusted life-years. (2) In [...]

Universal health coverage is essential for the progress to end threats of the acquired immunodeficiency syndrome epidemic. The current review assesses the publication rate, strategies and barriers for antiretroviral therapy (ART) coverage, equity, quality of care, and financial protection. We searched Web of Science, PubMed, and Google Scholar. Of the available articles, 43.13% were on ART coverage, 40.28% were on financial protection, 10.43% were on quality of care, and 6.16% were on equity. A lack of ART, fear of unwanted disclosure, lack of transportation, unaffordable health care costs, long waiting time to receive care, and poverty were barriers to ART coverage. Catastrophic health care costs were higher among individuals who were living in rural settings, walked greater distances to reach health care institutions, had a lower socioeconomic status, and were immunocompromised. There were challenges to the provision of quality of care, including health care providers' inadequate salary, high workload and inadequate health workforce, inappropriate infrastructure, lack of training opportunities, unclear division of responsibility, and the presence of strict auditing. In conclusion, ART coverage was below the global average, and key populations were disproportionally less covered with ART in most countries. Huge catastrophic health expenditures were observed. UHC contexts of ART will be improved by reaching people with poor socioeconomic status, delivering appropriate services, establishing a proper health workforce and service stewardship. [ABSTRACT FROM AUTHOR]

The affiliation for the second and fourth author is incorrect. Charles F. Gilks and Yibeltal Assefa are not affiliated with #2 but with #1: School of Public Health, The University of Queensland, Brisbane, Australia.By Aklilu Endalamaw; Charles F. Gilks; Fentie Ambaw and Yibeltal AssefaReported by Author; Author; Author; Author [Extracted from the article]

Background. Cross-sectional studies show that the prevalence of comorbid depression in people with tuberculosis (TB) is high. The hypothesis that TB may lead to depression has not been well studied. Our objectives were to determine the incidence and predictors of probable depression in a prospective cohort of people with TB in primary care settings in Ethiopia. Methods. We assessed 648 people with newly diagnosed TB for probable depression using Patient Health Questionnaire, nine-item (PHQ-9) at the time of starting their anti-TB medication. We defined PHQ-9 scores 10 and above as probable depression. Participants without baseline probable depression were assessed at 2 and 6 months to measure incidence of depression. Incidence rates per 1000-person months were calculated. Predictors of incident depression were identified using Poisson regression. Results. Two hundred and ninety-nine (46.1%) of the participants did not have probable depression at baseline. Twenty-two (7.4%) and 26 (8.7%) developed depression at 2 and 6 months of follow up. The incidence rate of depression between baseline and 2 months was 73.6 (95% CI 42.8-104.3) and between baseline and 6 months was 24.2 (95% CI 14.9-33.5) per 1000 person-months respectively. Female sex (adjusted β = 0.22; 95% CI 0.16-0.27) was a risk factor and perceived social support (adjusted β = -0.14; 95% CI -0.24 to -0.03) was a protective factor for depression onset. Conclusion. There was high incidence of probable depression in people undergoing treatment for newly diagnosed TB. The persistence and incidence of depression beyond 6 months need to be studied. TB treatment guidelines should have mental health component. [ABSTRACT FROM AUTHOR]