Abstract
BackgroundTailored 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.MethodsWe 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.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.ConclusionThe 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.
Highlights
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
Low tuberculosis (TB) incidence countries focus on TB prevention through latent TB infection (LTBI) screening and treatment programs, which are tailored to specific populations of interest with a high risk to develop TB, such as immigrants and asylum seekers from high TB incidence countries [1,2,3,4]
We studied LTBI related knowledge, attitudes, beliefs, and stigma among Eritrean asylum seekers and refugees -currently the largest group of people with TB disease in the Netherlands [8, 22]. This qualitative study was part of the TB-ENDPoint project, which studied the implementation, national impact, and cost effectiveness of LTBI screening and treatment among high-TB-risk migrant groups in the Netherlands. This project incorporated three mixed method studies, which evaluated the implementation of LTBI screening and treatment among 1) immigrants [9], 2) asylum seekers -predominantly Eritreans- living in asylum seeker centres [11], and 3) Eritrean refugees living in communities for maximum ten years [10]
Summary
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. Low tuberculosis (TB) incidence countries focus on TB prevention through latent TB infection (LTBI) screening and treatment programs, which are tailored to specific populations of interest with a high risk to develop TB, such as immigrants and asylum seekers from high TB incidence countries [1,2,3,4]. Following the need to increase efforts to reduce the TB incidence and the positive results of three implementation studies on LTBI screening and treatment among high TB risk migrants groups [9,10,11], Dutch policy advisors are debating about expanding the implementation of post-arrival LTBI screening to other subgroups of immigrants and asylum seekers [4]
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