1883. Factors Associated with Stigma Toward Isoniazid-Preventative Therapy in a Rural Community of South Africa

Abstract

BackgroundPatients living with HIV should receive isoniazid-preventative therapy (IPT) in order to prevent tuberculosis (TB). In South Africa, IPT implementation has decelerated. Stigma is frequently found to be a barrier to treatment. We sought to understand community members’ perceptions of TB and HIV stigma in order to inform future IPT implementation efforts.MethodsThe study was conducted in the rural KwaZulu Natal province of South Africa. Community members were interviewed anonymously and answers to interview questions were scored to represent stigma. Three different domains of TB knowledge were evaluated: causes, transmission, and treatment and prevention of TB. All three knowledge scores were added to create a total knowledge of TB score. A 7-item scale was used to assess stigma; presence of stigma was defined as 1 or more positive responses on the scale. Descriptive statistics, chi-square tests, linear regression, and Kruskal–Wallis tests were performed.ResultsAmong 104 participants, the mean age was 35 ± 9.3 years, 65% were female, and 26% completed secondary school. Overall, respondents had poor knowledge about the causes (mean = 61, SD = 27) and transmission (mean = 46, SD = 21), and good knowledge of the treatment and prevention (mean = 88, SD = 18) of TB. The vast majority of participants identified the presence of stigma (72%), with a mean score of 1.7, SD = 1.4. Participants were less likely to report stigma with excellent TB knowledge, characterized by accurate responses to at least 95% of the knowledge items (P = 0.025). Factors associated with higher levels of stigma included marital status (P = 0.01), being previously screened for TB (P = 0.008), considering mosquitos as a vector for TB transmission (P = 0.005), worrying about being infected with TB (P = 0.0117), and reporting travel to the clinic to be expensive (P = 0.03). Interest in taking IPT exhibited a trend toward significance with lower levels of stigma (P = 0.057). On multivariable linear regression of stigma, marital status (P = 0.0304) and prior TB screening (P = 0.0149) were significant.ConclusionHIV-related stigma was prevalent among rural South African community members considering IPT. Stigma decreased with higher knowledge levels. Global expansion and implementation of IPT will require interventions to reduce stigma.Disclosures All Authors: No reported Disclosures.