Defining the research agenda to measure and reduce tuberculosis stigmas

MacIntyre, Karen; Bakker, Mirjam I.; Bergson, S.; Bhavaraju, Rajita; Bond, Virginia; Chikovore, Jeremiah; Colvin, Charlotte; Craig, Gillian; Cremers, Anne Lia; Daftary, Amrita; Engel, Nora; Jaramillo, Ernesto; Kimerling, Michael E.; Kipp, Aaron M.; Krishnaratne, Shari; Mergenthaler, Christina; Ngicho, M.; Redwood, Lisa; Rood, Ente; Sommerland, Nina; Stangl, Anne; Rie, Annelies Van; Brakel, Wim H. van; Wouters, Edwin; Zwerling, Alice; Mitchell, Ellen M. H.

doi:10.5588/ijtld.17.0151

Cited by 38 publications

(43 citation statements)

References 17 publications

(23 reference statements)

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“…The distinction between expressed and experienced stigma may also be of particular importance for policy makers, program funders, and public health officials: education and increased disease-specific knowledge must be provided in ways that mitigate experienced stigma. Expressed stigma itself, however, may not be the major barrier to acceptance of treatment for LTBI in populations similar to Brazil [14], and therefore barriers to treatment acceptance beyond expressed stigma by the general population may need to be addressed simultaneously. Communities across Brazil were knowledgeable about and accepting of treatment for TB and LTBI.…”

Section: Discussionmentioning

confidence: 99%

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Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies

et al. 2020

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Background: Tuberculosis (TB) elimination requires treatment of millions of persons with latent M. tuberculosis infection (LTBI). LTBI treatment acceptance depends on population-wide TB knowledge and low stigma, but limited data are available on the relationship between stigma and knowledge. We assessed knowledge of TB disease and LTBI throughout Brazil and examined their association with TB stigma and incidence. Methods: We performed a nationwide survey with multi-stage probability design through AmericasBarometer from April-May 2017; the sample was representative of Brazil at regional and national levels. Knowledge of and stigma toward TB were assessed by validated survey questions. Results: Survey-weighted responses of 1532 individuals suggest that 57% of the population knew LTBI can occur, and 90% would seek treatment for it. Regarding active TB, 85% knew TB symptoms, 70% reported they should avoid contact with someone with active TB, and 24% had stigma toward persons with TB (i.e., thought persons with tuberculosis should feel ashamed, or deserved their illness). In regression models adjusting for clinical and demographic variables, knowledge of LTBI was associated with increased stigma toward persons with TB (adjusted odds ratio [OR] = 2.13, 95% confidence interval [CI]: 1•25-3.63, for "should feel ashamed"; OR = 1•82, 95% CI: 1•15-2•89, for "deserve illness"). Adjusting for regional TB incidence did not affect this association. Conclusions: High proportions of this representative Brazilian population had knowledge of LTBI and were willing to seek treatment for it. However, such knowledge was associated with TB-specific stigma. Strategies to educate and implement treatment of latent tuberculosis must include efforts to decrease TB stigma.

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Section: Discussionmentioning

confidence: 99%

“…Stigma may reduce willingness to be tested for TB and it may be a barrier to treatment compliance [12,13]. No universal recommendations for addressing TB stigma exist, though two prior studies suggest improved foundational knowledge may be a key component in reducing stigma and accepting treatment [14].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies

et al. 2020

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“…Burdensome legal and social practices that systematically infantilise, impoverish, and expose people with or at risk of tuberculosis must be removed to end stigma. 417,418 Public awareness campaigns that dispel unjustified fears and promote positive messages about tuberculosis, drawing on patient testimonials, can also help reduce stigmatising attitudes. [419][420][421] Furthermore, campaigns that highlight the unfairness of obstacles faced by people with tuberculosis can evoke public support for greater investment in the welfare of stigmatised groups.…”

Section: Strategies To Reduce Stigma and Ensure A Human Rights-based mentioning

confidence: 99%

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

et al. 2019

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growing political momentum to definitively address tuberculosis, could all make ending the pandemic within a generation more feasible than ever before. Moving forward with bold, comprehensive strategies Globally, the priority must be to deliver person-centred and family-centred services to all individuals with tuberculosis who present to care. This approach means ensuring that high-quality diagnostics, treatment, and prevention modalities are available to all, wherever they seek care. Improving quality of tuberculosis care in the private sector is crucial to end tuberculosis in high incidence countries such as India, the country with the highest tuberculosis burden. Modelling shows that optimising private sector engagement in India could avert 8 million deaths from tuberculosis between 2019 and 2045 (appendix p 3). In high drug-resistant tuberculosis burden countries, access to rapid drug susceptibility testing (DST) and second-line drugs is essential to success. In Moldova, where more than 25% of all tuberculosis cases are drug-resistant, improving access to DST and second-line drugs would reduce mortality from drug-resistant tuberculosis by 44% in the coming generation (appendix p 3). Secondly, tuberculosis programme budgets must increase to enable reaching these people and populations at high risk of tuberculosis. In Kenya, for example, where the proportions of HIV and tuberculosis coinfection are high, scaling up access to both antiretroviral therapy and tuberculosis preventive therapy can help save an additional 3 million lives over the next generation (appendix p 3). However, ultimately, the fight against tuberculosis will not be won unless countries also ensure that everyone, not just high-risk groups, can access essential health Key messages The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer the question of how countries with high-burden tuberculosis and their development partners should target their future investments to ensure that ending tuberculosis is achievable. Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care This priority includes rapid drug susceptibility testing and second-line treatment for resistant forms of tuberculosis. Achieving universal, high-quality person-centred and family-centred care-including sustained improvement in the performance of private sector providers-usually should be the top policy and budget priority. Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care Active case-finding and treatment in high-risk populations demands adequate resources to reach and care for these populations. At the same time, reaching certain high-risk populations, such as people co-infec...

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“…It delays TB testing and treatment uptake, undermines contact tracing, and compromises TB prevention, diagnosis, treatment, and success for both adults and children. 6,8,[10][11][12][13][14][15][16][17][18] TB stigma prevents us from reaching many of those with "missed" or unreported disease. Furthermore, for many of those that are diagnosed and treated, TB stigmatization does not abate after cure is achieved.…”

Section: The Roots and Impact Of Tb Stigmamentioning

confidence: 99%

To End TB, First-Ever High-Level Meeting on Tuberculosis Must Address Stigma

Daftary

Mitchell

Reid

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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World leaders gather to consolidate their commitment to ending tuberculosis (TB). Vital to the success of renewed efforts is an overdue recognition of the pervasive and pernicious influence of TB stigma. TB stigma is sustained in structures, policies, traditions, and norms. Innovative modifications to infection control, drug dispensing, and surveillance practices are required to increase demand for TB screening and effective therapeutic alliances among those diagnosed. The authors argue that reducing TB stigma requires a scientific and inclusive process, with prominent roles for TB survivors and a willingness to integrate and learn from other stigmatized conditions.

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Defining the research agenda to measure and reduce tuberculosis stigmas

Cited by 38 publications

References 17 publications

Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies

Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

To End TB, First-Ever High-Level Meeting on Tuberculosis Must Address Stigma

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