{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:07:21Z","timestamp":1775239641664,"version":"3.50.1"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"STOP TB Partnership","award":["STBP\/TBREACH\/GSA\/W10-10213"],"award-info":[{"award-number":["STBP\/TBREACH\/GSA\/W10-10213"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The concept of integrated service delivery was the focus for the envisaged essential health care under one roof. Despite being the central focus of essential health under one roof and a crucial principle of primary health care, relatively little is known about community perceptions on integrated service delivery in low-and middle income countries. This study was designed to examine community perspectives on integrated service delivery for tuberculosis (TB), mental health (MH) and substance use disorder (SUD) in Nigeria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a community-based cross-sectional study design using qualitative data collection methods. Data was obtained from the participants using a pre-tested focus group discussion (FGD) guide. Data was collected from three states in Nigeria including Anambra, Enugu and Nasarawa states. Twelve FGDs were conducted among 116 participants who were beneficiaries of the integrated service delivery for TB\/MH\/SUD and their relatives. There were four FGDs in each state. The discussions were conducted separately for patients and relatives and for male and female participants. QDA Miner Lit v2.0.6 was used in the thematic analysis of data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Almost all the participants perceived the three disease entities as being linked to one another hence it may not be the best to manage each condition in isolation thus supporting the integrated approach. The participants noted the positive provider attitude of the healthcare workers involved in the program. They were of the opinion that integrated service delivery (ISD) has improved the awareness of the three disease entities among the populace. Most of the participants expressed their willingness to patronize integrated service delivery at the community level from trained lay health workers. This willingness to patronize was predicated on the approval of the program by the government.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Positive provider attitude of health service providers will be a good boost to efforts to improve health service delivery in Nigeria including integrated service delivery. Government has a key role to play in community acceptance of health service delivery programs. The program increased the awareness of the three diseases among the people. Thus, increasing the community awareness of TB, mental health and substance use disorders should be prioritized. Adopting the integrated service delivery approach will be of value. Consideration should be made on the use of lay health workers for the delivery of such services at the community level especially in rural areas. There is a need to incorporate community perspectives on the value, benefits, barriers and acceptability of integrated service delivery into policies guiding TB\/MH\/SUD integration in Nigeria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345182","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:35:47Z","timestamp":1775237747000},"page":"e0345182","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Examining community perspectives on integrated service delivery for tuberculosis, mental health and substance use disorder in Nigeria: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9817-0312","authenticated-orcid":true,"given":"Martin","family":"Njoku","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Nwafor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chinwe","family":"Eze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Okechukwu","family":"Ezeakile","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Meka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngozi","family":"Ekeke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iyama","family":"Francis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Egbule","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Chukwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Esekhaigbe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chijioke","family":"Osakwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4098-4898","authenticated-orcid":true,"given":"Edmund Ndudi","family":"Ossai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chibuike","family":"Agu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Bernard-Asadu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chukwuma","family":"Anyaike","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clement","family":"Adesigbin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Obioma","family":"Chijioke-Akaniro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tunde","family":"Ojo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel C.","family":"Oshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatrice","family":"Kirubi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Creswell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngozi","family":"Murphy-Okpala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"pone.0345182.ref001","unstructured":"World Health Organization. Integrated health services- what and why? Making health systems work. No.1. 2008. https:\/\/terrance.who.int"},{"key":"pone.0345182.ref002","unstructured":"World Health Organization. The End TB Strategy. https:\/\/www.who.int\/teams\/the-end-tb-strategy. Accessed 2025 June 18."},{"key":"pone.0345182.ref003","unstructured":"World Health Organization. Global tuberculosis report. Geneva: WHO. 2024."},{"key":"pone.0345182.ref004","unstructured":"Stop TB Partnership. Nigeria- Digital TB Surveillance Assessment Report. Available at https:\/\/tbassessment.stoptb.org\u2265Nigeria. Accessed 19th June, 2025."},{"issue":"1","key":"pone.0345182.ref005","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40249-019-0619-4","article-title":"Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries","volume":"9","author":"A Janse Van Rensburg","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"pone.0345182.ref006","unstructured":"World Health Organization. Mental health: a state of well-being. http:\/\/www.who.int\/features\/factfiles\/mental_health\/en\/. Accessed 2025 July 21."},{"key":"pone.0345182.ref007","unstructured":"World Health Organization. Comprehensive mental health action plan 2013-2020. Geneva: WHO. 2013."},{"key":"pone.0345182.ref008","unstructured":"Tchealthng com. Nigeria\u2019s mental health crisis: a mind-boggling burden on 40\u2026. https:\/\/www.tchealth.com\u2265thought-pieces\u2265nigerias\u2026. Accessed 2025 July 10."},{"key":"pone.0345182.ref009","unstructured":"Africa Polling Institute. Mental health in Nigeria survey. Africa Polling Institute and EpiAFRIC. 2020. https:\/\/sfricapolling.org\/uploads2020\/01.pdf"},{"key":"pone.0345182.ref010","unstructured":"World Health Organization. Overview (substance abuse). https:\/\/www.afro.who.int\/node. Accessed 2025 July 30."},{"key":"pone.0345182.ref011","unstructured":"World Health Organization WH. Drugs. (psychoactive). https:\/\/www.who.int\/Healthtopics. Accessed 2025 July 30."},{"key":"pone.0345182.ref012","unstructured":"United Nations Office on Drug and Crime. Drug use in Nigeria 2018. Vienna: United Nations Office on Drugs and Crime. https:\/\/unodc.org\/documents\/data-and-analysis\/statistics\/Drugs\/Drug_use_Survey_Nigeria.2019.BOOK.pdf"},{"key":"pone.0345182.ref013","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4172\/2155-6105.1000234","article-title":"Descriptive national survey of substance use in Nigeria","volume":"6","author":"TA Adamson","year":"2015","journal-title":"J Addict Res Ther"},{"issue":"3","key":"pone.0345182.ref014","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1007\/s40429-020-00321-z","article-title":"Directional Effects of Anxiety and Depressive Disorders with Substance Use: a Review of Recent Prospective Research","volume":"7","author":"L Garey","year":"2020","journal-title":"Curr Addict Rep"},{"issue":"4","key":"pone.0345182.ref015","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5588\/pha.19.0049","article-title":"Improving indicators of tuberculosis program cascades by leveraging HIV program strategies","volume":"9","author":"SC Meribe","year":"2019","journal-title":"Public Health Action"},{"key":"pone.0345182.ref016","doi-asserted-by":"crossref","first-page":"44205","DOI":"10.1038\/srep44205","article-title":"Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings","volume":"7","author":"N Ekeke","year":"2017","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0345182.ref017","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5603\/ARM.2020.0072","article-title":"Screening diabetes mellitus patients for tuberculosis in Southern Nigeria: A pilot study","volume":"88","author":"N Ekeke","year":"2020","journal-title":"Advances in Respiratory Medicine"},{"issue":"11","key":"pone.0345182.ref018","first-page":"14","article-title":"Storms and struggles: managing HIV amid natural disasters","volume":"10","author":"EI Obeagu","year":"2023","journal-title":"Int J Curr Res Chem Pharm Sci"},{"key":"pone.0345182.ref019","doi-asserted-by":"crossref","first-page":"100166","DOI":"10.1016\/j.puhip.2021.100166","article-title":"Mental health in Nigeria: A Neglected issue in Public Health","volume":"2","author":"YH Wada","year":"2021","journal-title":"Public Health Pract (Oxf)"},{"key":"pone.0345182.ref020","article-title":"Mental health challenges in Nigeria: Bridging the gap between demand and resources","volume":"11","author":"KP Fadele","year":"2024","journal-title":"Glob Ment Health (Camb)"},{"issue":"3","key":"pone.0345182.ref021","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1097\/YCO.0000000000000591","article-title":"How can schools be integrated in promoting well-being, preventing mental health problems and averting substance-use disorders in urban populations?","volume":"33","author":"L Spanemberg","year":"2020","journal-title":"Curr Opin Psychiatry"},{"issue":"8","key":"pone.0345182.ref022","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s10198-020-01217-5","article-title":"Cost and effects of integrated care: a systematic literature review and meta-analysis","volume":"21","author":"S Rocks","year":"2020","journal-title":"Eur J Health Econ"},{"key":"pone.0345182.ref023","unstructured":"World Health Organization. Integrating health services. https:\/\/www.who.int. 2018. Accessed 2025 January 31."},{"issue":"5","key":"pone.0345182.ref024","article-title":"Exploring providers\u2019 perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria: A qualitative study","volume":"16","author":"PC Eke","year":"2021","journal-title":"PLoS One"},{"issue":"12","key":"pone.0345182.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0316204","article-title":"Exploring the perspectives of healthcare workers and Program managers on the use of Truenat as a new tool for TB and DR-TB diagnosis in Nigeria: A qualitative study","volume":"19","author":"N Nwokoye","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0345182.ref026","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40795-023-00695-z","article-title":"An appraisal of the implementation of the national school feeding programme and its effect on enrolment and attendance in public primary schools in Southeast, Nigeria: perception of heads of schools","volume":"9","author":"CI Agu","year":"2023","journal-title":"BMC Nutr"},{"issue":"2","key":"pone.0345182.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0318274","article-title":"Enhancing programmatic scale-up: Applying the consolidated framework for implementation research to evaluate decentralized drug-resistant tuberculosis services in Southern Nigeria","volume":"20","author":"N Murphy-Okpala","year":"2025","journal-title":"PLoS One"},{"issue":"2","key":"pone.0345182.ref028","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"issue":"1","key":"pone.0345182.ref029","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13033-022-00542-x","article-title":"Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders\u2019 and TB health workers","volume":"16","author":"T Mainga","year":"2022","journal-title":"Int J Ment Health Syst"},{"issue":"1","key":"pone.0345182.ref030","article-title":"Depression care integration in tuberculosis services: A feasibility assessment in Pakistan","volume":"27","author":"SA Afaq","year":"2024","journal-title":"Health Expect"},{"key":"pone.0345182.ref031","doi-asserted-by":"crossref","first-page":"23992026211011314","DOI":"10.1177\/23992026211011314","article-title":"Impact of integrating mental health services within existing tuberculosis treatment facilities","volume":"5","author":"A Pasha","year":"2021","journal-title":"Med Access Point Care"},{"key":"pone.0345182.ref032","doi-asserted-by":"crossref","first-page":"22","DOI":"10.25259\/JPATS_37_2021","article-title":"Factors that influence diagnostic delay among pulmonary tuberculosis patients in Osogbo, Nigeria","volume":"4","author":"SO Olarewaju","year":"2022","journal-title":"JPATS"},{"issue":"1","key":"pone.0345182.ref033","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1186\/s12889-021-10173-5","article-title":"A qualitative meta-synthesis of facilitators and barriers to tuberculosis diagnosis and treatment in Nigeria","volume":"21","author":"C Oga-Omenka","year":"2021","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0345182.ref034","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1186\/s12913-024-11697-3","article-title":"Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems","volume":"24","author":"SB Chilala","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0345182.ref035","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-032027","article-title":"Patients\u2019 perspectives of tuberculosis treatment challenges and barriers to treatment adherence in Ukraine: a qualitative study","volume":"10","author":"O Aibana","year":"2020","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0345182.ref036","first-page":"12","article-title":"Knowledge and awareness of tuberculosis in the urban slums of Lagos, Nigeria","volume":"22","author":"V Adepoju","year":"2022","journal-title":"The Nigerian Health Journal"},{"key":"pone.0345182.ref037","first-page":"107","article-title":"Knowledge and attitude towards mental illness among in school adolescents in Enugu, southeast Nigeria","volume":"27","author":"PN Ogbonna","year":"2024","journal-title":"Afr J Biomed Res"},{"issue":"1","key":"pone.0345182.ref038","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s12913-019-3912-9","article-title":"Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts","volume":"19","author":"KL Lovero","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0345182.ref039","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/0272684X20974547","article-title":"Perception of Substance Abuse Amongst Adolescents and Young Adults in Ikenne Local Government, Ogun State, Nigeria","volume":"42","author":"AD Alabi","year":"2021","journal-title":"Int Q Community Health Educ"},{"key":"pone.0345182.ref040","first-page":"25","article-title":"Patient preference and reasons for choice of healthcare facilities among enrollees of the National Health Insurance Scheme: a case report of a teaching hospital in North-East Nigeria","volume":"81","author":"OE Daramola","year":"2022","journal-title":"Nigerian Medical Practitioner"},{"key":"pone.0345182.ref041","doi-asserted-by":"crossref","first-page":"209","DOI":"10.11604\/pamj.2022.42.209.33317","article-title":"Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study","volume":"42","author":"UU Nwokoro","year":"2022","journal-title":"Pan Afr Med J"},{"key":"pone.0345182.ref042","doi-asserted-by":"crossref","DOI":"10.1093\/inthealth\/ihad073","article-title":"Integrated services for neglected tropical diseases and mental health: pilot study assessing acceptability, feasibility and attitudes in Benue State, Nigeria","volume":"15","author":"T Obindo","year":"2023","journal-title":"Int Health"},{"issue":"1","key":"pone.0345182.ref043","article-title":"Integrating tuberculosis and noncommunicable diseases care in low- and middle-income countries (LMICs): A systematic review","volume":"19","author":"CD Foo","year":"2022","journal-title":"PLoS Med"},{"issue":"3","key":"pone.0345182.ref044","article-title":"Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases","volume":"2010","author":"S Lewin","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0345182.ref045","first-page":"1011","article-title":"Exploring the impact of lay counselling model in terms of competency and diversity of problems in primary health care settings in Pakistan-a mixed method retrospective study","volume":"1","author":"M Baig","year":"2022","journal-title":"Ann Community Med Prim Health Care"},{"issue":"1","key":"pone.0345182.ref046","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1186\/s12913-023-09783-z","article-title":"Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi-country qualitative study","volume":"23","author":"O Todowede","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0345182.ref047","doi-asserted-by":"crossref","first-page":"39","DOI":"10.4103\/ijsp.ijsp_151_23","article-title":"Role of Community Health Workers in Delivering Mental Health Services in Lower-Middle-income Countries: Perspectives from the Maanasi Project","volume":"41","author":"S Gali","year":"2025","journal-title":"Indian Journal of Social Psychiatry"},{"key":"pone.0345182.ref048","unstructured":"World Health Organization. Guidance on community health services: promoting person centered and right based approaches. 2021. https:\/\/www.int\/publications\/i\/item\/9789240025707"},{"issue":"5","key":"pone.0345182.ref049","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1176\/appi.ps.201700292","article-title":"Three nontraditional approaches to improving the capacity, accessibility, and quality of mental health services: an overview","volume":"69","author":"KL Grant","year":"2018","journal-title":"Psychiatr Serv"},{"issue":"1","key":"pone.0345182.ref050","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s44192-025-00177-7","article-title":"A comprehensive review of mental health services across selected countries in sub-Saharan Africa: assessing progress, challenges, and future direction","volume":"5","author":"F Atewologun","year":"2025","journal-title":"Discov Ment Health"},{"issue":"1","key":"pone.0345182.ref051","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12960-023-00814-8","article-title":"Addition of mental health to the lady health worker curriculum in Pakistan: now or never","volume":"21","author":"F Rabbani","year":"2023","journal-title":"Hum Resour Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345182","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T17:35:56Z","timestamp":1775237756000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345182"}},"subtitle":[],"editor":[{"given":"Farrukh Ishaque","family":"Saah","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":51,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345182","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}