# The Effectiveness and Cost-Effectiveness of Implementing Evidence-Based Depression Treatment within the TB Care Platform in South Africa: A Hybrid Effectiveness-Implementation Trial

> **NIH NIH R01** · NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC · 2022 · $584,552

## Abstract

ABSTRACT
TB and major depressive disorder (MDD) are the leading infectious cause of death and the leading cause of
disability, respectively. Furthermore, they are commonly co-occurring and negatively synergistic. TB and MDD
comorbidity is associated with a 2.85 greater chance of death and 8.70 higher risk for loss to follow up (LTFU)
from treatment, which has a cascade of negative individual-, community-, societal-, and health system-level
implications. As a treatable condition, MDD is a remediable driver of the TB epidemic. The WHO has called for
a global policy framework for TB and mental health integration, recommending brief psychological interventions
to address mental disorders in primary care settings. Interpersonal counseling (IPC) is a brief version of one
such evidence-based intervention that has demonstrated efficacy and effectiveness in treating MDD when
delivered by non-mental health specialists, including in South Africa. The purpose of this study is to assess the
effectiveness and cost-effectiveness of integrating IPC (for MDD) into the TB care platform to improve TB and
MD outcomes, as well as mitigate TB-related catastrophic costs. As the country with the highest TB burden in
the world, nearly 60% of whom are co-infected with HIV, South Africa is the ideal setting for this study. We
propose a 3-year hybrid type I effectiveness-implementation trial in eight clinics (n~1410 individuals with
TB/MDD) in the Eastern Cape of South Africa to integrate IPC to treat MDD comorbidity within the TB care
platform with the following aims:
Aim 1: To evaluate the effectiveness and implementation outcomes of integrating IPC treatment for
 MDD into the existing TB care platform to improve TB and MDD outcomes
Aim 2: To determine the influence of theoretically based intervention mediators and moderators on TB
 treatment outcomes
Aim 3: To assess the cost-effectiveness of integrating MDD treatment into the TB care platform from
 the patient and health system perspectives
Our team will be led by an Early-Stage Investigator who is a global expert in TB and MDD, supported by senior
investigators with extensive experience conducting TB and MH-related effectiveness, cost-effectiveness, and
hybrid trials (including in South Africa). This research will provide critical clinical, programmatic, and economic
data to inform the WHO global policy framework for TB and mental health integration, and cost-effective clinical
practice to improve TB outcomes, especially in low-resource settings.

## Key facts

- **NIH application ID:** 10494127
- **Project number:** 5R01AI148461-02
- **Recipient organization:** NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
- **Principal Investigator:** Annika Claire Sweetland
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $584,552
- **Award type:** 5
- **Project period:** 2021-09-23 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10494127

## Citation

> US National Institutes of Health, RePORTER application 10494127, The Effectiveness and Cost-Effectiveness of Implementing Evidence-Based Depression Treatment within the TB Care Platform in South Africa: A Hybrid Effectiveness-Implementation Trial (5R01AI148461-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10494127. Licensed CC0.

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