People affected by TB are often also affected by other medical conditions such as HIV/AIDS, diabetes, hepatitis, chronic lung disease, neurological disease, substance use disorders and other mental health problems. Some of these illnesses and disabilities may by themselves contribute to an increased risk of death among people with TB while on treatment and afterwards. When creating TB palliative care services, the prevalence of serious comorbidities in the target population and the associated types of suffering should be estimated and preparations should be made to address them. Mental health disorders may worsen when TB patients learn of a poor prognosis. Therefore, all TB patients in need of palliative care should undergo an assessment for mental health disorders.
Alcohol use disorder and injection drug use are risk factors for poor DS-TB and DR-TB treatment outcomes and many other problems (113–115). Treatment of alcohol use disorder and opioid use disorder can and should be integrated with comprehensive TB care and treatment (116, 117). WHO guidance on task-shifting, training and supervision of human resources for palliative care is provided elsewhere (104). Task-shifting to enable effective community-based treatment of alcohol use disorder has also been demonstrated (118, 119).