TB and HIV stigma compounded by threatened masculinity: implications for TB health-care seeking in Malawi

Chikovore, Jeremiah; Hart, Graham; Kumwenda, Moses; Chipungu, Geoffrey; Desmond, Nicola; Corbett, Elizabeth L.

doi:10.5588/ijtld.16.0925

Cited by 28 publications

(28 citation statements)

References 34 publications

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“…Almost one-third of patients reported ongoing respiratory symptoms at 1 year. Chronic cough is stigmatising in high TB and HIV burden settings,31 and in this study also led to the WHO TB-symptom screening tool remaining positive for many patients, some months after their initial disease episode. Although pTB-survivors are at high risk of recurrent TB disease,32 empirical TB retreatment of pTB-survivors based on chronic symptoms is also widespread 33.…”

Section: Discussionmentioning

confidence: 68%

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Meghji

Lesosky

Joekes

et al. 2020

Thorax

138

145

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BackgroundPost-tuberculosis lung damage (PTLD) is a recognised consequence of pulmonary TB (pTB). However, little is known about its prevalence, patterns and associated outcomes, especially in sub-Saharan Africa and HIV-positive adults.MethodsAdult (≥15 years) survivors of a first episode of pTB in Blantyre, Malawi, completed the St George’s Respiratory Questionnaire, 6-minute walk test, spirometry and high-resolution CT (HRCT) chest imaging at TB treatment completion. Symptom, spirometry, health seeking, TB-retreatment and mortality data were collected prospectively to 1 year. Risk factors for persistent symptoms, pulmonary function decline and respiratory-related health-seeking were identified through multivariable regression modelling.ResultsBetween February 2016 and April 2017, 405 participants were recruited. Median age was 35 years (IQR: 28 to 41), 77.3% (313/405) had had microbiologically proven pTB, and 60.3% (244/403) were HIV-positive. At pTB treatment completion, 60.7% (246/405) reported respiratory symptoms, 34.2% (125/365) had abnormal spirometry, 44.2% (170/385) had bronchiectasis ≥1 lobe and 9.4% (36/385) had ≥1 destroyed lobe on HRCT imaging. At 1 year, 30.7% (113/368) reported respiratory symptoms, 19.3% (59/305) and 14.1% (43/305) of patients had experienced declines in FEV1 or FVC of ≥100 mL, 16.3% (62/380) had reported ≥1 acute respiratory event and 12.2% (45/368) had symptoms affecting their ability to work.ConclusionsPTLD is a common and under-recognised consequence of pTB that is disabling for patients and associated with adverse outcomes beyond pTB treatment completion. Increased efforts to prevent PTLD and guidelines for management of established disease are urgently needed. Low-cost clinical interventions to improve patient outcomes must be evaluated.

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Section: Discussionmentioning

confidence: 68%

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Meghji

Lesosky

Joekes

et al. 2020

Thorax

138

145

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“…22 Similar to HIV, stigma has recently been associated with lower levels of TB testing and treatment seeking, as well as difficulties with TB contact tracing in outbreak investigations. [23][24][25][26][27] These findings demonstrate that stigma represents a common and substantial obstacle to the control of infectious disease outbreaks. If people feel stigmatized, whether externally or internally, their compliance with public health measures may be significantly reduced compared with non-stigmatized groups, which could impede outbreak control efforts.…”

Section: How Does Stigma Impact Individuals and Communities During Anmentioning

confidence: 87%

Addressing Disease-Related Stigma During Infectious Disease Outbreaks

Fischer

Mansergh

Lynch

et al. 2019

Disaster med. public health prep.

131

123

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Outbreaks of emerging infectious disease are a constant threat. In the last 10 years, there have been outbreaks of 2009 influenza A (H1N1), Ebola virus disease, and Zika virus. Stigma associated with infectious disease can be a barrier to adopting healthy behaviors, leading to more severe health problems, ongoing disease transmission, and difficulty controlling infectious disease outbreaks. Much has been learned about infectious disease and stigma in the context of nearly 4 decades of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome pandemic. In this paper, we define stigma, discuss its relevance to infectious disease outbreaks, including how individuals and communities can be affected. Adapting lessons learned from the rich literature on HIV-related stigma, we propose a strategy for reducing stigma during infectious disease outbreaks such as Ebola virus disease and Zika virus. The implementation of brief, practical strategies such as the ones proposed here might help reduce stigma and facilitate more effective control of emerging infectious diseases.

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“…56 Furthermore, stigma's consequences may vary for different groups, individuals, and settings. 15,42,44,57,58 Intersectional ap- proaches that address multiple forms of exclusion are essential. 13 Different types of stigma (anticipated/felt, courtesy, internalised/self and enacted) impact at distinct levels (individual, family, community).…”

Section: Theme I: What Are the Main Drivers And Domains Of Tb Stigma(s)?mentioning

confidence: 99%

Defining the research agenda to measure and reduce tuberculosis stigmas

MacIntyre

Bakker

Bergson

et al. 2017

int j tuberc lung dis

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Crucial to finding and treating the 4 million tuberculosis (TB) patients currently missed by national TB programmes, TB stigma is receiving well-deserved and long-delayed attention at the global level. However, the ability to measure and evaluate the success of TB stigma-reduction efforts is limited by the need for additional tools. At a 2016 TB stigma-measurement meeting held in The Hague, The Netherlands, stigma experts discussed and proposed a research agenda around four themes: 1) drivers: what are the main drivers and domains of TB stigma(s)?; 2) consequences: how consequential are TB stigmas and how are negative impacts most felt?; 3) burden: what is the global prevalence and distribution of TB stigma(s) and what explains any variation? 4): intervention: what can be done to reduce the extent and impact of TB stigma(s)? Each theme was further subdivided into research topics to be addressed to move the agenda forward. These include greater clarity on what causes TB stigmas to emerge and thrive, the difficulty of measuring the complexity of stigma, and the improbability of a universal stigma 'cure'. Nevertheless, these challenges should not hinder investments in the measurement and reduction of TB stigma. We believe it is time to focus on how, and not whether, the global community should measure and reduce TB stigma.

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TB and HIV stigma compounded by threatened masculinity: implications for TB health-care seeking in Malawi

Cited by 28 publications

References 34 publications

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Patient outcomes associated with post-tuberculosis lung damage in Malawi: a prospective cohort study

Addressing Disease-Related Stigma During Infectious Disease Outbreaks

Defining the research agenda to measure and reduce tuberculosis stigmas

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