Tuberculosis Stigma Research Articles

The Relationship Between Self-Stigma and Subjective Well-Being in Tuberculosis Patients

Pulmonary tuberculosis (TB) sufferers often face psychosocial problems in the form of stigma. Stigma contributes to psychological morbidity. Morbidity impacts psychological well-being. This research aims to determine the relationship between stigma and subjective well-being in tuberculosis at the Klakah Community Health Center, Lumajang Regency. This study is correlative research with a cross-sectional approach. The population in this study was Tuberculosis Patients at the Klakah Lumajang Community Health Center in 2024. The sample was adjusted based on the Slovin formula to 37 respondents. The side technique used is purposive sampling. Data was collected using the validated The Van Rie tuberculosis stigma scale and The BBC subjective well-being scale questionnaires. Data analysis in this study used Spearman Rho. The results showed that almost half of tuberculosis patients had a high level of Self-Stigma (45.9%), almost half of them had a low level of subjective well-being (43.2%). Data analysis shows that there is a significant relationship between Self-Stigma and subjective well-being in tuberculosis patients (p-value = 0.000; α = 0.05; r = -0.874) which shows a relationship with a strong negative correlation level which means that self- Low stigma will have implications for increasing subjective well-being. The psychosocial health issue of stigma appears to be one of the most important issues that must be addressed to avoid its enormous and negative impact on health promotion.

Facilitators and barriers to initiating and completing tuberculosis preventive treatment among children and adolescents living with HIV in Uganda: a qualitative study of adolescents, caretakers and health workers

IntroductionPeople living with HIV (PLHIV) have a 20-fold risk of tuberculosis (TB) disease compared to HIV-negative people. In 2021, the uptake of TB preventive treatment among the children and adolescents living with HIV at the Baylor-Uganda HIV clinic was 45%, which was below the national target of 90%. Minimal evidence documents the enablers and barriers to TB preventive treatment (TPT) initiation and completion among children and adolescents living with HIV(CALHIV). We explored the facilitators and barriers to TPT initiation and completion among CALHIV among adolescents aged 10-19years and caretakers of children below 18years.MethodsWe conducted a qualitative study from February 2022 to March 2023, at three paediatric and adolescent HIV treatment centers in Uganda. In-depth interviews were conducted at TPT initiation and after completion for purposively selected health workers, adolescents aged 10–19 years living with HIV, and caretakers of children aged below 18years.ResultsThe desire to avoid TB disease, previous TB treatment, encouragement from family members, and ministry of health policies emerged as key facilitators for the children and adolescents to initiate TPT. Barriers to TPT initiation included; TB and HIV-related stigma, busy carer and adolescent work schedules, reduced social support from parents and family, history of drug side effects, high pill burden and fatigue, and perception of not being ill. TPT completion was enabled by combined TPT and ART refill visits, delivery of ART and TPT within the community, and continuous education and counseling from health workers. Reported barriers to TPT completion included TB and HIV-related stigma, long waiting time. Non-disclosure of HIV status by caretakers to CALHIV and fear of side effects was cited by health workers as a barrier to starting TPT. Facilitators of TPT initiation and completion reported by healthcare workers included patient and caretaker health education, counselling about benefits of TPT and risk of TB disease, having same appointment for TPT and ART refill to reduce patient waiting time, adolescent-friendly services, and appointment reminder phone calls.ConclusionThe facilitators and barriers of TPT initiation and completion among CALHIV span from individual, to health system and structural factors. Health education about benefits of TPT and risk of TB, social support, adolescent-friendly services, and joint appointments for TPT and ART refill are major facilitators of TPT initiation and completion among CALHIV in Uganda.

Influence of tuberculosis knowledge on acceptance of preventive treatment and the moderating role of tuberculosis stigma among China’s general population: cross-sectional analysis

BackgroundPreventive treatment of tuberculosis infection (TBI) is considered a crucial strategy to prevent and control tuberculosis (TB). However, the acceptance and completion rates of preventive therapy for TBI are still far from optimistic. Evidence is mounting that TB knowledge and stigma may have a substantial effect on acceptance of TBI treatment. This study aimed to explore the effect of stigma on the relationship between the level of TB knowledge and acceptance of TBI treatment.Methods7017 general population were included in the study. We adjusted for the covariates at the individual. Stepwise logistic regression was used to examine the moderating role of TB stigma and also explore the association between TB knowledge and acceptance of TBI treatment.ResultsThe acceptance rate of TBI treatment among the respondents was 84.38% (n = 5921). Among respondents, a significant positive correlation between acceptance of TBI treatment and TB knowledge (OR = 1.096,95%CI = 1.073,1.118). Additionally, the association between TB knowledge and acceptance of TBI treatment was found to be moderated by TB stigma. In other words, TB stigma was found to weaken the impact of TB knowledge on acceptance of TBI treatment (OR = 0.994,95%CI = 0.991,0.996).ConclusionThe findings of the study indicated that having a high level of awareness about TB can enhance the general population’s acceptability of TBI treatment. TB stigma moderated this association; it weakened the relationship between TB knowledge and individuals’ willingness to accept TBI treatment. To mitigate TB stigma and enhance the intention of individuals with TBI to accept preventive therapy, it is imperative to enhance TB-related health education.

“As a patient I do not belong to the clinic, I belong to the community”: co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa

BackgroundAnticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.MethodsUsing a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.ResultsIntervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.ConclusionsDecreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Cross-cultural reliability of Van Rie TB perceived Stigma Scale among TB survivors in North India

BackgroundAs India progresses towards TB elimination five years ahead of Sustainable Development Goals (SDG), Community-based perceptions of tuberculosis stigma become particularly relevant in the context of TB elimination efforts. This study aims to assess the cross-cultural reliability of ‘Community Perspectives Van Rie TB Stigma Scale’ which can been used for screening and rapid evaluation of prevalent stigma themes in community. MethodsA community based cross-sectional study was conducted in North India among 400 TB survivors to assess the cross-cultural reliability of ‘Community Perspective Van Rie TB stigma Scale’. Cronbach Alpha and McDonald's Omega were used for reliability analysis. ResultsCronbach ɑ value for the Van Rie TB Stigma Scale was 0.826 and McDonald's ω is 0.832 indicative of good reliability of the TB Stigma Scale. ConclusionThe study is one the first studies to assess the cross-cultural reliability of Community Perspective of Van Rie TB Stigma Score in India. The reliability analysis indicates that the ‘Community Perspectives Van Rie TB Stigma Scale’ can be used in the Indian settings for screening of TB associated stigma.

Interpersonal communication approach in addressing TB stigma in Bandung City

Background: Tuberculosis (TB) patients face medical challenges and stigmatization from their surroundings. The Terjang Foundation is actively working to combat societal stigma towards TB patients. Purpose: This research analyzes the Terjang Foundation’s interpersonal communication approach to combating stigma towards TB patients. By understanding and assessing the communication methods employed by the foundation, the study aims to contribute to developing effective strategies for reducing the negative stigma associated with TB. Methods: This research utilizes a qualitative research method with a case study approach. In-depth interviews, field observations, and literature reviews are conducted to gather relevant data and insights. Results: The results of this study indicate that the Terjang Foundation employs five positive attitudes in their interpersonal communication approach to combat stigma towards TB patients: openness, empathy, positivity, equality, and supportiveness. These attitudes contribute to fostering an environment that challenges the negative stigma associated with TB. Continuous and frequent communication is crucial in combating stigma, promoting understanding and empathy, and disseminating accurate information. Empathy and equality emerge as prominent positive attitudes consistently demonstrated in communication. Conclusion: The study concludes that maintaining an ongoing and frequent communication process is essential for combating stigma in interpersonal communication efforts. Implications: The research findings have both practical and theoretical implications. Practically, the study emphasizes the importance of adopting positive attitudes, such as empathy and equality, in interpersonal communication strategies to reduce stigma towards TB patients. These insights can guide organizations, healthcare providers, and policymakers in developing effective communication campaigns and interventions to combat stigma related to TB and other diseases.

The impact of ethical implications intertwined with tuberculosis household contact investigation: a qualitative study.

Household contact investigation (HCI) is an effective and widely used approach to identify persons with tuberculosis (TB) disease and infection, globally. Despite widespread recommendations for the use of HCI, there remains poor understanding of the impact on and value of contact investigation for participants. Further, how HCI as a practice impacts psychosocial factors, including stigma and possible unintended disclosure of illness among persons with TB, their families, and communities, is largely unknown. This exploratory qualitative study nested within a randomized trial (ClinicalTrials.gov: NCT04520113, 17 August 2020) was conducted in South Africa to understand the impacts of HCI on index patients living with TB and their household contact persons in two rural districts in the Limpopo province (Vhembe and Capricorn) and Soshanguve, a peri-urban township in Gauteng province. People with TB and household members of people with TB were recruited to participate in in-depth interviews and focus group discussions using semi-structured guides. We explored individual, interpersonal, and community-level perceptions of potential impacts of household contact investigation to elucidate their perceptions of HCI. Thematic analysis identified key themes. Twenty-four individual interviews and six focus group discussions (n=39 participants) were conducted. Participants viewed HCI as an effective approach to finding TB cases, helpful in educating households about TB symptoms and reducing barriers to health-related services. At the interpersonal level, HCI aided people with TB in safely disclosing their TB status to family members and facilitated family and social support for accountability. The introduction of HIV testing during HCI was reported by some participants as making household members slightly uncomfortable, decreasing interest in household members being tested for TB. HCI negatively impacted community-level TB and HIV-related stigma due to healthcare worker visibility at home. Our data suggests varying impacts of HCI on people with TB, their families and interpersonal relationships, and communities, highlighting the importance of considering approaches that address concerns about community stigma and HIV testing to enhance acceptance of HCI.

“This is an illness. No one is supposed to be treated badly”: community-based stigma assessments in South Africa to inform tuberculosis stigma intervention design

BackgroundThough tuberculosis (TB)-related stigma is a recognized barrier to care, interventions are lacking, and gaps remain in understanding the drivers and experiences of TB-related stigma. We undertook community-based mixed methods stigma assessments to inform stigma intervention design.MethodsWe adapted the Stop TB Partnership stigma assessment tool and trained three peer research associates (PRAs; two TB survivors, one community health worker) to conduct surveys with people with TB (PWTB, n = 93) and caregivers of children with TB (n = 24) at peri-urban and rural clinic sites in Khayelitsha, Western Cape, and Hammanskraal, Gauteng Province, South Africa. We descriptively analyzed responses for each stigma experience (anticipated, internal, and enacted), calculated stigma scores, and undertook generalized linear regression analysis. We conducted 25 in-depth interviews with PWTB (n = 21) and caregivers of children with TB (n = 4). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organized using the Constraints, Actions, Risks, and Desires (CARD) framework.ResultsSurveys revealed almost all PWTB (89/93, 96%) experienced some form of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in the rural setting (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and together as key constraints to impede care, leading to decisions not to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through the understanding that TB can affect anyone and should not diminish self-worth. Risks of stigma, driven by fears related to disease severity and infectiousness, led to care disengagement and impaired psychological well-being. Participants desired counselling, identifying a specific role for TB survivors as peer counselors, and community education.ConclusionsStigma is highly prevalent and negatively impacts TB care and the well-being of PWTB, warranting its assessment as a primary outcome rather than an intermediary contributor to poor outcomes. Multi-component, multi-level stigma interventions are needed, including counseling for PWTB and education for health workers and communities. Such interventions must incorporate contextual differences based on gender or setting, and use survivor-guided messaging to foster stigma resilience.

Ethical Stakes for Past, Present, and Prospective Tuberculosis Isolate Research Towards a Multicultural Data Sovereignty Model for Isolate Samples in Research.

Tuberculosis (TB) is a potentially fatal infectious disease that, in Aotearoa New Zealand (NZ), inequitably affects Asian, Pacific, Middle Eastern, Latin American, and African (MELAA), and Māori people. Medical research involving genome sequencing of TB samples enables more nuanced understanding of disease strains and their transmission. This could inform highly specific health interventions. However, the collection and management of TB isolate samples for research are currently informed by monocultural biomedical models often lacking key ethical considerations. Drawing on a qualitative kaupapa Māori-consistent study, this paper reports on preliminary discussions with groups of Māori, Pacific, and Afghan people in NZ, whose communities have been harmed by TB and TB stigma. Participants' discussions highlight key concerns and meanings that ought to inform the development of guidelines and a more robust consultative process for the governance of how TB isolate samples are collected and used both retrospectively and in future research. We argue for ethical processes to be culturally nuanced and community-generated, flexible and meaningful, and situated in relation to the physical and symbolic effects of TB. We discuss the significance of Indigenous data sovereignty, rights, andkāwanatanga (governorship) in shaping a multicultural data sovereignty model.

Introducing Jaga-rasa Jaga-tangga: A Community Program that Can Reduce Tuberculosis Stigma in Sleman, Indonesia

The low number of cases found compared to the incidence of Tuberculosis (TB) shows that the control of this disease becomes a serious problem. The stigma is suspected to be one of the obstacles to solving the TB problem in Indonesia. This study aims to analyze the ability of the Jaga-rasa Jaga-tangga program to decrease TB stigma in two Public Health Centers (PHCs) in Sleman Regency, Indonesia. This is a quasi-experimental study design with a control method. Both intervention and control groups get health education about TB stigma. The intervention group also gets an education about the Jaga rasa Jaga tangga (take care of your neighbors as well as take care of their feelings) program. The outcome measure was the TB stigma scale that measure before and after the intervention. Data were analyzed using paired t-tests and independent t-tests. 106 respondents were involved in this study divided into intervention and control groups. Age (p=0.006) and social status (p=0.015) are associated with TB stigma in the community. There were significant changes in the TB stigma scale after the intervention (paired =0.305; p=0.001). The Jaga-rasa Jaga-tangga program along with health education reduces TB stigma more effectively than health education only. Further studies are needed to confirm this result.

STRATEGI PENGURANGAN STIGMA TB MEMBUKA JALAN UNTUK PEMBICARAAN KESEHATAN MENTAL

This study aims to analyze strategies for reducing Tuberculosis (TB) stigma and its impact on mental health discussions in Medan, considering the close relationship between TB stigma and mental health issues. A qualitative method was used, involving in-depth interviews, focus groups, document and media analysis, and participatory observations to gain a deep understanding of perceptions, experiences, and the social context related to TB stigma. The results indicate that public education and information, media engagement, social and psychological support, and public policy and advocacy are key strategies in reducing TB stigma. This not only helps reduce TB-related stigma but also opens up space for improved discussions and support for mental health, showing the importance of a comprehensive approach in addressing TB.

MITIGATING THE STIGMA ASSOCIATED WITH TUBERCULOSIS

This article addresses the social stigma associated with tuberculosis (TB) and its influence on patients, their families, and communities, impacting the prevention, diagnosis, and treatment of the disease. It highlights the historical origins of stigma, stemming from a lack of understanding about the transmission and causes of the disease, associated with unfavorable socioeconomic conditions and representations in popular culture. Stigma manifests in various ways, including social isolation, discrimination, negative stereotypes, and delays in diagnosis and treatment. These manifestations have profound impacts on the quality of life and physical and emotional health of patients. To combat stigma, comprehensive strategies are proposed, such as public education, promotion of empathy, community engagement, universal access to healthcare, and psychosocial support. These approaches aim to challenge misconceptions, reduce social isolation, strengthen emotional support, and promote a more compassionate understanding of the disease. The article highlights the importance of treatment adherence and emotional support for patients, emphasizing that support from healthcare professionals, family, and the community is crucial in addressing treatment challenges and promoting better long-term health outcomes. It is concluded that mitigating tuberculosis stigma requires collective and ongoing effort, with an integrated, patient-centered approach. By promoting empathy, understanding, and support, it is possible to create a more inclusive and supportive environment, advancing towards a society where health and well-being are accessible to all.

“A cross-sectional study to assess stigma associated with tuberculosis in patients, family members, and health care staff in central India.”

BackgroundStigma poses significant challenges to tuberculosis control efforts worldwide. India, bearing a substantial burden of tuberculosis cases, grapples with pervasive stigmatizing attitudes towards the disease, hindering timely diagnosis and treatment. This study aims to assess the prevalence and manifestations of tuberculosis-related stigma, shedding light on a critical yet overlooked aspect of tuberculosis management. MethodsAfter obtaining informed consent, 314 participants were taken and stratified equally into three groups: patients, family members, and healthcare workers. A pre-designed questionnaire was used to calculate prevalence and assess tuberculosis stigma across various domains. Data were compiled in MS-Excel and analyzed using EPI-Info 7 by the CDC. ResultsAmong all 314 participants, the prevalence of stigma in this study was 26.75%. A statistically significant correlation was found between stigma experienced and marital status (p = 0.013) and level of knowledge regarding tuberculosis (p < 0.001). Among the patients of tuberculosis, the odds of facing stigma are 13.25 (C.I. 95% 4.14, 42.41) times higher in females and 3 (C.I. 95% 1.005, 8.95) times higher in patients with unsatisfactory knowledge about tuberculosis compared to males and patients with satisfactory knowledge, respectively. ConclusionTuberculosis is stigmatized due to its deviation from societal norms. Societal norms dictate what is deemed acceptable or unacceptable. Females with tuberculosis encounter more stigma than males, and knowledge about tuberculosis affects stigma significantly. Patients mostly experience enacted and perceived stigma, while family members face perceived and secondary stigma. Healthcare workers tend to exhibit secondary stigma.

Stigma, depression, and quality of life among people with pulmonary tuberculosis diagnosed through active and passive case finding in Nepal: a prospective cohort study

BackgroundThe psychosocial consequences of tuberculosis (TB) are key barriers to ending TB globally. We evaluated and compared stigma, depression, and quality of life (QoL) among people with TB diagnosed through active (ACF) and passive (PCF) case-finding in Nepal.MethodsWe prospectively recruited adults with TB diagnosed through ACF and PCF in four districts of Nepal between August 2018 and April 2019. Participants were interviewed at 8–12 weeks (baseline) and 22–26 weeks (follow-up) following treatment initiation. TB stigma was measured using an adapted Van Rie Stigma Scale (0 = no stigma to 30 = highest stigma). Depression was measured using a locally-validated Patient Health Questionnaire (PHQ-9). Mild and major depression were indicated by PHQ-9 scores 5–9 and ≥ 10, respectively. QoL was measured using the EuroQoL 5-Dimension 5-level (EQ-5D-5L) from 0 to 1 (optimal QoL); and self-rated health from 0 to 100 (optimal self-rated health).ResultsWe recruited 221 participants (111 ACF; 110 PCF) with a mean age of 48 years (standard deviation [SD] = ± 16), of whom 147/221 (67%) were men. The mean TB stigma score was 12 (SD = 7.3) at baseline and 12 (SD = 6.7) at follow-up. The most commonly perceived elements of TB stigma at baseline were that people with TB experienced guilt (110/221, 50%) and feared disclosure outside their household (114/221, 52%). Self-rated health and EQ-5D-5L scores increased from baseline to follow-up (69.3 to 80.3, p < 0.001; 0.92 to 0.9, p = 0.009). Nearly one-third of participants (68/221, 31%) had mild or major depression at baseline. The proportion of participants with major depression decreased from baseline to follow-up (11.5% vs. 5%, p = 0.012). There was a moderate, significant positive correlation between depression and stigma scores (r = 0.41, p < 0.001). There were no differences found in TB stigma, self-rated health, QoL, or prevalence of mild/major depression between ACF and PCF participants.ConclusionsWe found a substantial, persistent, and clustered psychosocial impact among adults with TB diagnosed through both ACF and PCF strategies in Nepal. These findings suggest an urgent need to develop effective, evidence-based psychosocial support interventions with the potential to be integrated with existing ACF strategies and routine TB service activities.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis.

Defining tuberculosis stigma: a protocol for a systematic review, analysis, and thematic synthesis

Background Throughout recorded history, tuberculosis is believed to have killed more people than any other infectious disease. Despite the World Health Organization’s determination that preventing and controlling tuberculosis will require understanding and reducing tuberculosis stigma, we noted strikingly diverse definitions and lack of consensus in describing tuberculosis stigma. Furthermore, we found no systematic reviews in the existing tuberculosis stigma literature characterizing, comparing, or assessing tuberculosis stigma definitions or their consistency. To address this knowledge gap, we intend to conduct a systematic review of existing tuberculosis stigma definitions used in the academic research literature, and through quantitative synthesis of the words and phrases contained within those definitions, identify themes that characterize tuberculosis stigma. Methods Studies containing definitions of tuberculosis stigma will be identified by searching two electronic databases -- PubMed and PsycINFO – using the Medical Subject Heading (MeSH) terms “stigma[MeSH Major Topic] AND tuberculosis[MeSH Major Topic]”. Study inclusion criteria will consist of: a) original research published in English, (due to logistical constraints); b) qualitative studies using semi-structured interviews and focus group discussions; c) quantitative studies including descriptive studies and trials, questionnaires, and cross-sectional surveys; and d) mixed method studies. Included studies will be searched for definitions of tuberculosis stigma using the search term “defin”. Descriptive words and phrases will be extracted from definitions and categorized into themes, based on noun, verb, adjective, and adverb derivatives; and synonym definitions. Predominant themes will then be identified and further categorized as emotion, thought, or behaviour themes. Relative frequencies of definitions, and definition words and phrases, will be compared quantitively. Conclusions This systematic review and thematic analysis is intended to characterize academic definitions of tuberculosis stigma and identify predominant tuberculosis stigma themes contained within those definitions. Registration PROSPERO (CRD42023440978; 23 July 2023).

Ubuntu Is a Critical Component in the Fight against Human Immunodeficiency Virus and Tuberculosis Stigma: Nursing Students' Perceptions.

Stigma is one of the documented barriers to achieving universal access to human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment, care, and support programs. The lack of African social theories to emphasize these issues may be the cause of the continent's failure to reduce stigma. We can use Ubuntu, an African philosophy that emphasizes sociability and ethics, to deepen our understanding of how to reduce HIV- and TB-related stigma in South Africa. In many African regions, Ubuntu values and principles were found to assist in reducing problems related to HIV. Ubuntu is a comprehensive phrase used by Africans to signify the characteristics that incorporate the core human virtues of compassion and humanity. We explored the perceptions of nursing students regarding the use of Ubuntu in the fight against HIV and TB stigma. Qualitative participatory research was used to engage all first- and second-level nursing students enrolled for the 2023 academic year at the selected university in South Africa. Purposive sampling was used to recruit the participants. An interactive workshop was used to gather data. The data from the recordings and flip charts were analysed together. Throughout the study, trustworthiness and ethical principles were upheld. Two primary themes emerged as expressions of Ubuntu in relation to a reduction in HIV and TB stigma and recognition of Ubuntu as a tool to combat stigma associated with HIV and TB. This confirms that within Ubuntu, there are elements that might be applied to reduce stigma attached to HIV and TB.

Pediatric Tuberculosis Infection Care Facilitators and Barriers: A Qualitative Study.

A total of 700 000 US children and adolescents are estimated to have latent tuberculosis (TB) infection. Identifying facilitators and barriers to engaging in TB infection care is critical to preventing pediatric TB disease. We explored families' and clinicians' perspectives on pediatric TB infection diagnosis and care. We conducted individual interviews and small group discussions with primary care and subspecialty clinicians, and individual interviews with caregivers of children diagnosed with TB infection. We sought to elicit facilitators and barriers to TB infection care engagement. We used applied thematic analysis to elucidate themes relating to care engagement, and organized themes using a cascade-grounded pediatric TB infection care engagement framework. We enrolled 19 caregivers and 24 clinicians. Key themes pertaining to facilitators and barriers to care emerged that variably affected engagement at different steps of care. Clinic and health system themes included the application of risk identification strategies and communication of risk; care ecosystem accessibility; programs to reduce cost-related barriers; and medication adherence support. Patient- and family-level themes included TB knowledge and beliefs; trust in clinicians, tests, and medical institutions; behavioral skills; child development and parenting; and family resources. Risk identification, education techniques, trust, family resources, TB stigma, and care ecosystem accessibility enabled or impeded care cascade engagement. Our results delineate an integrated pediatric TB infection care engagement framework that can inform multilevel interventions to improve retention in the pediatric TB infection care cascade.

A Systematic Review and Psychometric Appraisal of Instruments Measuring Tuberculosis Stigma in Sub-Saharan Africa.

Tuberculosis (TB) stigma is one barrier to TB testing, treatment uptake and treatment completion. Therefore, stigma measurement must be approached through rigorous scientific methodology in order to accurately and reliably estimate the impact of TB stigma on treatment outcomes. The aim of this systematic review is to evaluate the methods and instruments used to measure TB stigma and interrogate strategies used to culturally validate measures of TB stigma in global research. Two reviewers used the PRISMA method to extract and analyze the existing body of literature on TB stigma in Sub-Saharan Africa. A thorough search was performed using three data bases generating 2,302 independent studies. After systematic screening, this review includes 28 studies. Of those studies, 13 used a psychometrically validated instrument while 15 used informal questionnaires or proxy variables to measure stigma. Psychometric appraisal was limited due to the number of studies that measured stigma using unvalidated questionnaires or proxy variables. The Patient and Community Perceptions of TB scales validated by Van Rie et al. were the most commonly used instruments to measure TB stigma; additionally, many instruments were not culturally or linguistically validated in Sub-Saharan Africa. Our appraisal emphasizes the need for reliable and valid instruments to measure TB stigma in low- and middle-income countries most affected by TB.

Health Education To Reduce Negative Stigma And Increase Willingness To Screen For Tuberculosis

Tuberculosis (TB) is still a health problem in the world because Tuberculosis (TB) is one of the 10 highest causes of death worldwide and the main cause of death from infectious agents. The stigma circulating in society influences the desire of patients not to undergo treatment or comply with TB treatment and people who have symptoms become afraid to check themselves and undergo screening because they are reluctant to be viewed negatively by society. This case study aims to determine the effect of health education as an effort to reduce negative stigma and increase willingness to screen. This research uses a case study method consisting of a needs assessment and intervention provided by a health education and TB screening program. Management data showed that 37 residents of Ciwalen Village who were studied had been diagnosed with pulmonary tuberculosis. Of the 37 people who had been diagnosed with pulmonary TB, only 34 people regularly took medication. The results of health education were 13 residents from taking part in screening activities before the health education activity and after the health education activity was held the number increased by 28 people. It can be concluded that the stigma of TB in society has an impact on the TB control process. Health education activities carried out as an effort to reduce the stigma of TB can increase the willingness of residents to undergo TB screening, especially for residents who are at high risk or residents who have symptoms.