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

Daftary, Amrita; Mitchell, Ellen M.H.; Reid, Michael; Fekadu, Endalkachew; Goosby, Eric

doi:10.4269/ajtmh.18-0591

Cited by 27 publications

(27 citation statements)

References 53 publications

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“…Historically, attention and investments in TB have prioritized biomedical models of care [ 42 ]. Today, countries, including Cambodia, have committed to reaching 90% of the key and vulnerable populations [ 43 ] with essential TB services and ending TB stigma and all forms of discrimination [ 2 ]. Therefore, measuring and addressing TB stigma that prevents people from seeking and accessing care should be prioritized.…”

Section: Discussionmentioning

confidence: 99%

“…Stigma is a major determinant of health [ 1 ] and a barrier to ending tuberculosis (TB) globally [ 2 ]. It is a complex matter involving institutional and societal attitudes and personal experience characterized by adverse social judgment either perceived, anticipated, or experienced by people with TB [ 3 ].…”

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confidence: 99%

“…There is growing recognition that TB stigma interrupts the cascade of TB care due to its detrimental effect on getting a timely diagnosis, treatment uptake and adherence, and the psychological well-being of people affected by TB [ 5–7 ]. Therefore, systematically measuring and addressing stigma affecting people with TB should be a global priority to meet the goal of ending TB by 2030 [ 2 ].…”

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confidence: 99%

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Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Teo

Tan

Smyth³

et al. 2020

Open Forum Infectious Diseases

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Background Stigma is a significant barrier to healthcare and a factor that drives the global burden of tuberculosis (TB). However, there is a scarcity of information on TB stigma in developing countries. We aimed to characterize, measure, and explore the determinants of TB stigma among people with TB in Cambodia. Methods We conducted a mixed-methods study between February and August 2019 using a triangulation convergent design—a cross-sectional survey (n = 730) and nested in-depth interviews (n = 31) among people with TB. Quantitative data were analyzed using descriptive statistics and generalized linear regression models. Qualitative transcripts were thematically analyzed. Results A total of 56% and 51% of participants experienced self-stigma and perceived stigma by the community, respectively. We found rural dwellers, knowledge of how TB is transmitted, and knowledge that anybody can get TB were associated with higher levels of self-stigma and perceived stigma by the community. Higher scores on knowledge of TB symptoms were inversely associated with both self-stigma and community stigma. Thematic analyses revealed accounts of experienced stigma, acts of intentional distancing and hiding TB diagnosis from others, and feelings of embarrassment and shame. Conclusions Tuberculosis stigma was prevalent, suggesting a need for the incorporation of stigma-reduction strategies in the national TB responses. These strategies should be contextualized and developed through community engagement. Future research should continue to measure the levels and dimensions of TB stigma among people with TB through behavioral surveillance using standardized tools.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Teo

Tan

Smyth³

et al. 2020

Open Forum Infectious Diseases

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“…(4) It is therefore important to address LTBI related stigma. (5,6) There is abundant evidence showing that insufficient knowledge about TB and negative social attitudes towards TB causes stigmatization.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Spruijt¹,

Haile²,

Hof

et al. 2020

Preprint

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Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods We interviewed adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment. We used a thematic analysis to identify, analyse and report patterns in the data. ResultsDespite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.Consequently, patients conceal their disease, do not comply with treatment and isolate themselves.We lack insights in the burden of LTBI related stigma among target groups for TB prevention activities in low TB incidence countries. (7,8) Scambler (2009) defined stigma as "a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or a group."(9) Stigma can be classified in three categories (7, 10): (1) enacted stigma, in which a person experiences exclusion and/or discrimination. For example, TB patients are regularly rejected by family, friends or communities, resulting from fear of TB.(11); (2) felt stigma, in which a person has feelings of shame, fear, and guilt regarding their (potentially) stigmatized disease. For example, labelling immigrants as high-TB-risk groups can induce feelings of discrimination.(11) (3) anticipated stigma, in which a person perceives, fears and/or expects stigmatization because of their disease. For example, Chinese immigrants in Canada believed that society would exclude those with an LTBI diagnosis.(8) Out of fear of exclusion, they would conceal their LTBI diagnosis and treatment to people in their social network. Besides suffering of the individual, stigma can also negatively affect public health: fear of TB and related stigma can cause ...

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“…It is therefore important to address LTBI related stigma. (11,12) However, we lack insights in the burden of LTBI related stigma among target groups for TB prevention activities in low TB incidence countries. (14,15) Scambler (2009) de ned stigma as "a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience, perception or reasonable anticipation of an adverse social judgement about a person or a group."…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Spruijt¹,

Haile²,

Hof

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands.Methods: We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016-May 2018). We used a thematic analysis to identify, analyse and report patterns in the data.Results: Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion: The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

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

Cited by 27 publications

References 53 publications

Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

Knowledge, attitudes, beliefs, and stigma related to latent tuberculosis infection: a qualitative study among Eritreans in the Netherlands

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