{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T05:43:40Z","timestamp":1773899020856,"version":"3.50.1"},"reference-count":35,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Tuberculosis (TB) remains a major public health challenge in sub-Saharan Africa (SSA), with stigma, mental health issues, and alcohol use significantly affecting treatment outcomes. Stigma delays TB diagnosis, reduces treatment adherence, and disrupts care continuity. Mental health conditions, such as depression and anxiety, further undermine adherence, whereas alcohol use accelerates TB disease progression and leads to poor treatment outcomes. Current TB care models in SSA lack integrated support for psychosocial and behavioral health needs. This article advocates for a comprehensive care model that integrates mental health screening, counseling, psychosocial support, alcohol use disorder screening, and harm reduction strategies into TB programs. Effective implementation requires collaboration among TB care providers, mental health specialists, and alcohol use counselors supported by research, provider training, and community engagement. By addressing stigma, mental health, and alcohol use, this model can enhance treatment adherence and outcomes, advancing the WHO\u2019s End TB Strategy in SSA.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0048","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T14:31:38Z","timestamp":1753799498000},"page":"720-723","source":"Crossref","is-referenced-by-count":1,"title":["Addressing Stigma, Mental Well-Being, and Alcohol Use among People with Tuberculosis in Sub-Saharan Africa: A Call for an Integrated Care Model"],"prefix":"10.4269","volume":"113","author":[{"given":"Jonathan","family":"Izudi","sequence":"first","affiliation":[{"name":"Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;"},{"name":"Directorate of Graduate Training, Research, and Innovation, Muni University, Arua, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Bajunirwe","sequence":"additional","affiliation":[{"name":"Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adithya","family":"Cattamanchi","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis, Institute for Global Health Sciences, University of California, San Francisco, California;"},{"name":"Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nora","family":"West","sequence":"additional","affiliation":[{"name":"Center for Tuberculosis, Institute for Global Health Sciences, University of California, San Francisco, California;"},{"name":"Division of Pulmonary and Critical Medicine, San Francisco General Hospital, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Global Tuberculosis Report 2024","year":"2024"},{"key":"b2","series-title":"Front Public Health","first-page":"855515","article-title":"Mental health status and its impact on TB treatment and its outcomes: A scoping literature review","volume":"10","author":"Agbeko","year":"2022"},{"key":"b3","series-title":"Int J Tuberc Lung Dis","first-page":"73","article-title":"The impact of alcohol use on tuberculosis treatment outcomes: A systematic review and meta-analysis","volume":"24","author":"Ragan","year":"2020"},{"key":"b4","series-title":"Ann Gen Psychiatry","first-page":"30","article-title":"The prevalence of depression among patients with tuberculosis: A systematic review and meta-analysis","volume":"19","author":"Duko","year":"2020"},{"key":"b5","series-title":"Public Health Rep","first-page":"34","article-title":"Tuberculosis and stigmatization: Pathways and interventions","volume":"125","author":"Courtwright","year":"2010"},{"key":"b6","series-title":"Int J Tuberc Lung Dis","first-page":"723","article-title":"Global tuberculosis targets and milestones set for 2016\u20132035: Definition and rationale","volume":"22","author":"Floyd","year":"2018"},{"key":"b7","series-title":"PLoS One","first-page":"e0298268","article-title":"Mental health issues associated with the management of tuberculosis in Homabay, Busia and Kakamega Counties, Kenya","volume":"19","author":"Otieno","year":"2024"},{"key":"b8","series-title":"Int J Infect Dis","first-page":"90","article-title":"Tuberculosis stigma as a social determinant of health: A systematic mapping review of research in low incidence countries","volume":"56","author":"Craig","year":"2017"},{"key":"b9","series-title":"Soc Sci Med","first-page":"116363","article-title":"Geographical, social, and political contexts of tuberculosis control and intervention, as reported by 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China","volume":"10","author":"Jiang","year":"2023"},{"key":"b13","series-title":"Infect Dis Poverty","first-page":"145","article-title":"Quantification and correlates of tuberculosis stigma along the tuberculosis testing and treatment cascades in South Africa: A cross-sectional study","volume":"9","author":"Bresenham","year":"2020"},{"key":"b14","series-title":"Int J Tuberc Lung Dis","first-page":"1279","article-title":"Impact of mental disorders on active TB treatment outcomes: A systematic review and meta-analysis","volume":"24","author":"Lee","year":"2020"},{"key":"b15","series-title":"J Child Psychol Psychiatry","first-page":"345","article-title":"Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents","volume":"56","author":"Polanczyk","year":"2015"},{"key":"b16","series-title":"Subst Abuse Treat Prev Policy","first-page":"2","article-title":"Prevalence and associated factors for alcohol use disorder among tuberculosis 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