Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework

Abstract

Background Prevention of tuberculosis (TB)-related stigma is vital to achieving the World Health Organisation’s End TB Strategy target of eliminating TB. However, the process and impact evaluation of interventions to reduce TB-stigma are limited. This literature review aimed to examine the quality, design, implementation challenges, and successes of TB-stigma intervention studies and create a novel conceptual framework of pathways to TB-stigma reduction. Method We searched relevant articles recorded in four scientific databases from 1999 to 2022, using pre-defined inclusion and exclusion criteria, supplemented by the snowball method and complementary grey literature searches. We assessed the quality of studies using the Crowe Critical Appraisal Tool, then reviewed study characteristics, data on stigma measurement tools used, and interventions implemented, and designed a conceptual framework to illustrate the pathways to TB-stigma reduction in the interventions identified. Results Of 14,259 articles identified, eleven met inclusion criteria, of which three were high quality. TB-stigma reduction interventions consisted mainly of education and psychosocial support targeted predominantly toward three key populations: people with TB, healthcare workers, and the public. No psychosocial interventions for people with TB set TB-stigma reduction as their primary or co-primary aim. Eight studies on healthcare workers and the public reported a decrease in TB-stigma attributed to the interventions. Despite the benefits, the interventions were limited by a dearth of validated stigma measurement tools. Three of eight studies with quantitative stigma measurement questionnaires had not been previously validated among people with TB. No qualitative studies used previously validated methods or tools to qualitatively evaluate stigma. On the basis of these findings, we generated a conceptual framework that mapped the population targeted, interventions delivered, and their potential effects on reducing TB-stigma towards and experienced by people with TB and healthcare workers involved in TB care. Conclusions Interpretation of the limited evidence on interventions to reduce TB-stigma is hampered by the heterogeneity of stigma measurement tools, intervention design, and outcome measures. Our novel conceptual framework will support mapping of the pathways to impacts of TB-stigma reduction interventions. Graphical Abstract

Video Observed Therapy (VOT) for People with Tuberculosis (TB): A Scoping Review

“…The quality of records selected for full-text review was evaluated using the Crowe Critical Appraisal Tool (CCAT) 16 . Based on previous research by our study team 6 , a decision was taken to pragmatically categorise CCAT scores (percentage score out of a total of 40 points) as follows: ≥30 points, 75%-100%, high quality; 20 to 29 points, 50%-74%, moderate quality; and <20 points, <50%, low quality.…”

“…In many cases this results in high levels of SAT, especially during weekends when healthcare centres may be closed. Moreover, DOT may be associated with stigma and a loss of autonomy among people with TB 6 .…”

Beyond the Diagnosis: Exploring the Psychosocial Impact of Drug-Resistant Tuberculosis on Patients in Norway

“…TB-stigma contributes to feelings of isolation, shame and fear of discrimination. A review in 2022 concluded that there is limited evidence on interventions aimed at reducing TB stigma (12). The Stop TB Partnership has developed a framework to understand different types of stigma (11).…”

Developing a tool to measure tuberculosis-related stigma in workplaces in Indonesia: An internal validation study

“…There have been several tools to assess TB-stigma ( Stop TB Partnership, 2019 ), but most are those applied to people with TB, the general population, and healthcare workers who care for people with TB ( Nuttall et al, 2022 ). Van Rie's TB-Stigma scale is one of the most used and adapted tools to assess TB-related stigma ( Bergman et al, 2021 ; Van Rie et al, 2008 ).…”

“…To date, there has been no specific tool used to measure stigma towards fellow coworkers in workplaces and, according to our previous review, no intervention developed to address TB-stigma in this specific population ( Nuttall et al, 2022 ). TB-Stigma in the workplace can develop in different ways from the stigma development in the general community, even in healthcare workers' settings.…”