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Adopting a Holistic Approach to Tackle TB Comorbidities


Fighting off a disease like TB is challenging, as it is often comes coupled with issues of stigmatization, discrimination and other health related issues.. It is estimated that 51 % of TB patients suffer from comorbid conditions like depression and anxiety due to the fear of social isolation and stress caused by prolonged treatments. Likewise, diabetes, another comorbid condition of TB, suppresses the human immune system and severely affects TB treatment outcomes.

An integrated TB care program is necessary so that TB patients can be given educational information on comorbidities and provided access to mental health and diabetes services in the same facilities.  This practice at TB clinics can be useful in providing patients a smooth and holistic recovery approach that is also cost effective.

Our Approach

IRD, in partnership with the Indus Health Network (IHN) has developed 6 Integrated Practice Units (IPUs) within existing public and private hospitals in Karachi, Pakistan to provide comprehensive health services for TB comorbidities – Depression, Anxiety and Diabetes.

The program provides a holistic approach to identify, treat and manage comorbidities with the hope of strengthening TB treatment outcomes. Each patient enrolled at these facilities is screened by a health worker for depression and anxiety through a customized mHealth application, after which they are provided TB educational sessions and treatment adherence counselling for the complete duration of their treatment. Patients identified as depressed are rescreened periodically to ensure counseling is effective in alleviating their depression.

Trained mental health counselors and psychologists are available on a dedicated helpline as well as at hospital sites to create a safe space for patients to share their concerns and worries. Patients receive continuous psychological support in order to ensure smooth transition towards their TB recovery.

Apart from mental health services, patients are screened for diabetes and provided a broad range of diabetes support such as educational diabetes sessions, nutritional guidance, eye and foot care, HbA1c testing and free-of-cost medications.


Currently, over 3000 TB positive patients are screened for depression and around 1200 patients have been identified and successfully initiated on treatment for mental health. Additionally, over 250  TB patients have been diagnosed with diabetes and are receiving free-of-cost treatment and support.