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Gaur R, Sharma SK, Kumar S, Mudgal SK, Patidar V, Juhi A. Knowledge, attitude and perceived barriers related to directly observed treatment, short-course among patients and caregivers attending tuberculosis clinics: a cross-sectional survey. Monaldi Arch Chest Dis 2024. [PMID: 39356184 DOI: 10.4081/monaldi.2024.3154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 08/30/2024] [Indexed: 10/03/2024] Open
Abstract
Tuberculosis (TB) is a major worldwide health problem, particularly in India, where it accounts for a quarter of infections. Adherence to the directly observed treatment, short-course (DOTS), which is necessary for TB treatment, is difficult in resource-limited circumstances. This study addressed the knowledge, attitude, and perceived barriers related to TB and DOTS adherence among patients and caregivers. A cross-sectional survey was undertaken at the selected TB clinics between November 2023 and March 2024. Purposive sample yielded 180 patients and 217 caregivers. Data were obtained using validated, self-structured questionnaires that assessed knowledge, attitude, and perceived barriers to TB and DOTS adherence. Statistical analysis was carried out with IBM SPSS version 23.0. The study found that caregivers had considerably greater TB knowledge than patients (p<0.05). Many patients misunderstood the cause of TB (50.6%) and embraced various misconceptions about the disease, such as TB spreading by shaking hands or sharing food, swimming in a holy river to cure diseases, and TB being the result of sin or karmic retribution. Distance to treatment facilities (95.6%), the necessity to take time off from work (91.7%), and social stigma (65.0%) were identified as the top three barriers to DOTS adherence. The study highlighted considerable gaps in knowledge, distant healthcare facilities, busy work schedules, and social stigma as barriers to TB treatment adherence in Deoghar, Jharkhand. Addressing these challenges via focused education and support activities is essential for enhancing DOTS adherence and TB treatment outcomes.
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Affiliation(s)
- Rakhi Gaur
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand.
| | - Suresh Kumar Sharma
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
| | - Suman Kumar
- Department of Microbiology, All India Institute of Medical Sciences, Deoghar, Jharkhand.
| | - Shiv Kumar Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand.
| | - Vipin Patidar
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand.
| | - Ayesha Juhi
- Department of Physiology, All India Institute of Medical Sciences, Deoghar, Jharkhand.
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Perez RL, Chase J, Tanner R. Shared challenges to the control of complex intracellular neglected pathogens. Front Public Health 2024; 12:1423420. [PMID: 39324165 PMCID: PMC11422159 DOI: 10.3389/fpubh.2024.1423420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/13/2024] [Indexed: 09/27/2024] Open
Abstract
The complex intracellular pathogens Mycobacterium tuberculosis, Mycobacterium leprae, Leishmania spp., and Burkholderia pseudomallei, which cause tuberculosis, leprosy, leishmaniasis, and melioidosis respectively, represent major health threats with a significant global burden concentrated in low- and middle-income countries. While these diseases vary in their aetiology, pathology and epidemiology, they share key similarities in the biological and sociodemographic factors influencing their incidence and impact worldwide. In particular, their occurrence in resource-limited settings has important implications for research and development, disease prevalence and associated risk factors, as well as access to diagnostics and therapeutics. In accordance with the vision of the VALIDATE (VAccine deveLopment for complex Intracellular neglecteD pAThogeEns) Network, we consider shared challenges to the effective prevention, diagnosis and treatment of these diseases as shaped by both biological and social factors, illustrating the importance of taking an interdisciplinary approach. We further highlight how a cross-pathogen perspective may provide valuable insights for understanding and addressing challenges to the control of all four pathogens.
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Affiliation(s)
- Rebecca Lynn Perez
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Wadham College, University of Oxford, Oxford, United Kingdom
| | - Jemima Chase
- Wadham College, University of Oxford, Oxford, United Kingdom
| | - Rachel Tanner
- Wadham College, University of Oxford, Oxford, United Kingdom
- Department of Biology, University of Oxford, Oxford, United Kingdom
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3
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Vibulchai N, Dana K, Sanchan M, Churari C, Jadboonnak B, Sawangsri W, Pothiporn WT, Sutthicharoen U. The effect of the peer support intervention on internalized stigma among Thai patients with tuberculosis: A repeated measures design. BELITUNG NURSING JOURNAL 2024; 10:408-415. [PMID: 39211457 PMCID: PMC11350345 DOI: 10.33546/bnj.3327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/14/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Internalized stigma among patients with tuberculosis (TB) significantly affects delayed diagnosis, increased disease transmission, and poor treatment outcomes. However, conclusive empirical evidence on psychosocial interventions to reduce internalized stigma among patients with TB in Thailand remains scarce. Objective This study aimed to examine the impact of a peer support intervention on reducing internalized stigma among patients with TB in Thailand. Methods A one-group within-subjects repeated-measure design was conducted in the Muang Maha Sarakham district, Thailand, from February 2023 to July 2023. The study included 26 participants who met specified criteria. Measurements were taken at baseline, three months, and six months following TB diagnosis and medication treatment. The peer support intervention comprised TB health education, psycho-educational sessions, self-management support, and home visits. The Internalized Stigma of Tuberculosis Scale Thai Version was used to measure internalized stigma. Statistical analyses included descriptive statistics and repeated measures ANOVA. Results Mean scores of total internalized stigma and its sub-dimensions (alienation, stereotype endorsement, discrimination experience, social withdrawal, and stigma resistance) differed significantly across the three-time points (p <0.001, p <0.001, p <0.001, p <0.001, p <0.001, p = 0.002, respectively). Furthermore, stigma resistance scores significantly increased from pre-intervention to three months (p = 0.005) and from pre-intervention to six months (p = 0.007). However, no significant increase was observed from three to six months (p = 0.079). Conclusions The study underlines the positive impact of peer support intervention in reducing internalized stigma among patients with TB in Thailand over time. The findings suggest that interventions focusing on peer support can potentially address internalized stigma, highlighting the importance of integrating these strategies into healthcare practices to enhance patient care and improve TB management outcomes.
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Affiliation(s)
- Nisakorn Vibulchai
- Boromarajonani College of Nursing, Nakhon Ratchasima, Faculty of Nursing, Praboromarajchanok Institute, Ministry of Public Health, Thailand
| | - Kamthorn Dana
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Ministry of Public Health, Thailand
| | - Monruedee Sanchan
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Ministry of Public Health, Thailand
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Jumagdao KMA, Refuerzo DRL, Caing AMC, Carillo SSW, Dumas VSM, Avila KHR, Siayngco KJM, Pacaol NF. Tuberculosis and the brain drain problem. J Public Health (Oxf) 2024; 46:e540-e541. [PMID: 38850563 DOI: 10.1093/pubmed/fdae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024] Open
Affiliation(s)
- Ken Michael A Jumagdao
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | - Dwyane Roz L Refuerzo
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | - Altea Mae C Caing
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | | | - Vincent Simon M Dumas
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | - Katrina Heart R Avila
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | - Kyle Jomarc M Siayngco
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
| | - Niñoval F Pacaol
- Secondary Laboratory School, Eastern Visayas State University, Tacloban City 6500, Philippines
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Hayward SE, Vanqa N, Makanda G, Tisile P, Ngwatyu L, Foster I, Mcinziba AA, Biewer A, Mbuyamba R, Galloway M, Bunyula S, van der Westhuizen HM, Friedland JS, Medina-Marino A, Viljoen L, Schoeman I, Hoddinott G, Nathavitharana RR. "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. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:55. [PMID: 39157720 PMCID: PMC11324783 DOI: 10.1186/s44263-024-00084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024]
Abstract
Background Anticipated, 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. Methods Using 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. Results Intervention 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. Conclusions Decreasing 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. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00084-z.
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Affiliation(s)
- Sally E. Hayward
- Institute for Infection and Immunity, St George’s, University of London, London, UK
- TB Proof, Cape Town, South Africa
| | - Nosivuyile Vanqa
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Abenathi A. Mcinziba
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | | | | | | | - Jon S. Friedland
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Lario Viljoen
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Stanikzai MH, Rahimy N, Baray AH, Anwary Z, Ahmad M, Sayam H. High stigma prevalence and associated factors among TB patients in Southern Afghanistan: A multi-center cross-sectional study. Indian J Tuberc 2024; 71 Suppl 2:S203-S207. [PMID: 39370184 DOI: 10.1016/j.ijtb.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/06/2024] [Accepted: 08/12/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND TB stigma represents a growing threat to TB care. Understanding TB stigma distribution and associating factors is crucial for effective TB control in Afghanistan. OBJECTIVES To profile the prevalence of TB-related stigma and its associating factors among TB patients in Southern Afghanistan. METHODS In this multi-center cross-sectional study, we randomly recruited 603 adult TB patients from 2 major TB treatment sites in Southern Afghanistan. A score of >8 on the Stigma Scale for Chronic Illness-8 items (SSCI-8 items) was considered as positive for TB-related stigma. We fitted a binary logistic regression model. RESULTS Out of the 603 TB patients included in this study, 88.3% (95%CI: 85.8-90.9%) had TB-related stigma using the SSCI-8 cutoff (>8). Being in the age group 18-40 years, rural residence, no formal education, severe perception of illness, lack of TB knowledge, and symptoms of depression had positive associations with TB stigma. CONCLUSION A considerable percentage (88.3%) of patients had TB stigma. We identified potential risk factors that could serve as a benchmark for guiding policy efforts and interventions that aim to reduce stigma among TB patients in Afghanistan.
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Affiliation(s)
| | - Najeebullah Rahimy
- Para-Clinic Department, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Ahmad Haroon Baray
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Zabihullah Anwary
- Clinic Department, Faculty of Medicine, Bost University, Helmand, Afghanistan
| | - Mujeeb Ahmad
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Hadia Sayam
- Department of Public Health, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
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Matos VC, Torres TS, Luz PM. Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions. PLoS One 2024; 19:e0308443. [PMID: 39116156 PMCID: PMC11309385 DOI: 10.1371/journal.pone.0308443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In Brazil, ~35% of people living with HIV (PLHIV) have poor adherence to antiretroviral therapy (ART). HIV-related stigma is associated with worst continuum of care outcomes, however evidence from Brazil is scarce. We explored pathways between HIV-related stigma dimensions and ART adherence among Brazilian cisgender gay, bisexual and other men who have sex with men (MSM) living with HIV. METHODS A sample of MSM ≥18 years was recruited online between February/March 2020 through advertisements on Hornet, a location-based dating app. Validated scales were used to assess ART adherence and HIV-related stigma. Indirect and direct pathways between HIV-related stigma dimensions and ART adherence were estimated using structural equation models while considering socio-demographic and substance use related variables. Models were estimated using mean- and variance-adjusted weighted least squares, and goodness of fit indices were calculated. FINDINGS Among 1,719 MSM living with HIV who reported starting ART, 70% were adherent. There was evidence of indirect effects of concerns about public attitudes (standardized coefficient (SC) = -0.095, 95% confidence interval (95%CI) = -0.172 - -0.017) and personalized HIV-stigma (SC = -0.022, 95%CI = -0.043 - -0.001) on ART adherence mediated through negative self-image. Personalized HIV stigma and concerns about public attitudes were both positively associated with negative self-image (SC = 0.129, 95%CI = 0.066-0.193; SC = 0.549, 95%CI = 0.494-0.603), and concerns about public attitudes was associated with HIV disclosure concerns (SC = 0.522, 95%CI = 0.463-0.581). However, the direct paths from personalized HIV stigma and concerns about public attitudes to ART adherence were not significant. INTERPRETATION Our research underscores the critical need for multifaceted interventions to eliminate HIV-related stigma at both individual and societal levels. At the individual level, psychotherapeutic interventions to improve self-image might helpful. Additionally, public policy should aim to dismantle structural stigma with awareness campaigns on various media channels, integration of anti-stigma curriculum into schools, and training for professionals.
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Affiliation(s)
- Victor C. Matos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Nasir A, Hassan II, Ma’ruf A, Suharno NE, Goenharto S, Purwanto CR, Tyas APM. Coping efforts made: Psychological burden of people living with tuberculosis due to social stigma in society. A qualitative phenomenology study. PLoS One 2024; 19:e0303331. [PMID: 39078843 PMCID: PMC11288456 DOI: 10.1371/journal.pone.0303331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/23/2024] [Indexed: 08/02/2024] Open
Abstract
The psychological burden is greatly felt by people living with tuberculosis because the characteristics of the disease are very visible and very contagious, and the obligation to take the right dose of medication with long treatment. This is what makes tuberculosis a very stigmatic disease. The aim of this research is to explore the psychological burden felt by people living with tuberculosis due to social stigma by society and how coping efforts are made. This research uses a qualitative phenomenological design through in-depth face-to-face interviews which take place in a semi-structured manner with the hope of obtaining complete data. The purposive sampling method was used in this research with Participatory Interpretative Phenomenology analysis involving 25 participants consisting of 16 men and 9 women. This research produced several themes, including 1) "The Perception of stigma limiting space and time", 2) "The Opportunities for interpersonal interaction become narrow", 3) "The mental stress as a challenging emotion", and 4) " Expanding coping efforts". The psychological burden is felt by people living with tuberculosis because society's treatment is felt to be very discriminatory due to the social stigma that has developed in society so they lose the opportunity to interact with society. For that reason, they tried to explore some of the personal and environmental resources used to modify adaptive coping in resolving perceived psychological burdens. Given the possibility of ongoing stigma and discrimination during tuberculosis treatment programs, it is important to consider the psychological burden in this context, both on the general population and on groups affected by stigma.
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Affiliation(s)
- Abd Nasir
- Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | | | - Anwar Ma’ruf
- Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
- Department of Basic Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga Surabaya, Surabaya, Indonesia
| | | | | | - Cucuk Rahmadi Purwanto
- Doctoral Candidate of Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- Faculty of Vocational Studies, Airlangga University, Surabaya, Indonesia
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Bucaktepe PGE, Akgül F, Çelİk SB. Evaluation of the effects of pandemic-related fears on anxiety and depression: the mediating roles of traumatic stress and loneliness. BMC Psychol 2024; 12:388. [PMID: 38997784 PMCID: PMC11241983 DOI: 10.1186/s40359-024-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic. METHODS A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software. RESULTS Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively). CONCLUSIONS The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.
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Affiliation(s)
| | - Fethiye Akgül
- Department of Infectious Diseases and Clinical Microbiology, Batman Training and Research Hospital, Batman, Turkey
| | - Sercan Bulut Çelİk
- Batman GAP Family Health Center, Provincial Health Directorate, Batman, Turkey
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Foster I, Biewer A, Vanqa N, Makanda G, Tisile P, Hayward SE, Wademan DT, Anthony MG, Mbuyamba R, Galloway M, Human W, van der Westhuizen HM, Friedland JS, Medina-Marino A, Schoeman I, Hoddinott G, Nathavitharana RR. "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. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:41. [PMID: 38919729 PMCID: PMC11194205 DOI: 10.1186/s44263-024-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
Background Though 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. Methods We 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. Results Surveys 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. Conclusions Stigma 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. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00070-5.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- International Development Research Center, Global Health Program, Ottawa, Canada
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Sally E. Hayward
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Jon S. Friedland
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
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Kılıç A, Clarke AL, Moon Z, Hamada Y, Chan AHY, Rahman A, Layton C, Griffiths CJ, Zenner D, Powell E, Kunst H, Lipman M, Mandelbaum M, Papineni P, Tattersall T, Duong T, Abubakar I, Rangaka MX, Horne R. Health and illness beliefs in adults with tuberculosis infection during the COVID-19 pandemic in the UK. DIALOGUES IN HEALTH 2024; 4:100162. [PMID: 38516222 PMCID: PMC10953974 DOI: 10.1016/j.dialog.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 03/23/2024]
Abstract
Background COVID-19 disrupted the TB prevention programme in the UK, especially for TB infection (TBI) care. We explore whether experience of the COVID-19 pandemic impacted on patients' perceptions of TBI and its treatment. Methods Semi-structured interviews were conducted as part of the Research to Improve Detection and Treatment of TBI (RID-TB) programme, exploring perceptual and practical barriers to TBI treatment. Nineteen people diagnosed with TBI were interviewed between August 2020 and April 2021. Recordings were transcribed and analysed using a constant comparative approach, allowing for a dynamic and iterative exploration of themes. Themes are organised using the Perceptions and Practicalities Approach. Findings Some participants perceived TBI as a risk factor for increased susceptibility to COVID-19, while some thought that treatment for TBI might protect against COVID-19 or mitigate its effects. Adaptations to TB services (e.g., remote follow-up) and integrated practices during the COVID-19 restrictions (e.g., medication being posted) addressed some practical barriers to TBI treatment. However, we identified beliefs about TBI and COVID-19 that are likely to act as barriers to engagement with TBI treatment, including: interpreting service delays as an indication of TBI not being serious enough for treatment and concerns about contracting COVID-19 in TB clinics. Interpretation COVID-19 and TBI service delays influence people's perceptions and practical barriers to TBI treatment adherence. Failure to address these beliefs may lead to people's concerns about their treatment not being fully addressed. Utilised service adaptations like remote consultations to address practical barriers may be relevant beyond COVID-19. Funding NIHR RID-TB Program (RP-PG-0217-20009).
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Affiliation(s)
- Ayşenur Kılıç
- School of Pharmacy, University College London, London, UK
| | - Amy L. Clarke
- School of Pharmacy, University College London, London, UK
| | - Zoe Moon
- School of Pharmacy, University College London, London, UK
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Amy Hai Yan Chan
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Ananna Rahman
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
| | | | - Chris J. Griffiths
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominik Zenner
- Centre for Primary Care, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ellen Powell
- MRC Clinical Trials Unit, University College London, UK
| | - Heinke Kunst
- Respiratory Medicine, Queen Mary University of London, London, UK
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, UK
- UCL-TB and UCL Respiratory, University College London, London, UK
| | | | | | | | - Trinh Duong
- MRC Clinical Trials Unit, University College London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Molebogeng X. Rangaka
- Institute for Global Health, University College London, London, UK
- Division of Epidemiology and Biostatistics & CIDRI-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
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12
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Shah M, Dansky Z, Nathavitharana R, Behm H, Brown S, Dov L, Fortune D, Gadon NL, Gardner Toren K, Graves S, Haley CA, Kates O, Sabuwala N, Wegener D, Yoo K, Burzynski J. NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings. Clin Infect Dis 2024:ciae199. [PMID: 38632829 DOI: 10.1093/cid/ciae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Maunank Shah
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Zoe Dansky
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Ruvandhi Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Heidi Behm
- TB Program, Oregon Health Authority, Portland, OR, USA
| | | | - Lana Dov
- Washington State Department of Health, WA, USA
| | - Diana Fortune
- National Tuberculosis Controllers Association, Smyrna, GA, USA
| | | | | | - Susannah Graves
- Department of Public Health, City and County of San Francisco, CA, USA
| | - Connie A Haley
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, TN, USA
| | - Olivia Kates
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Kathryn Yoo
- Society of Epidemiologists in Tuberculosis Control (SETC); Texas Department of State Health Services, Tuberculosis and Hansen's Disease Unit (TXDSHS), TX, USA
| | - Joseph Burzynski
- New York City Department of Health and Mental Hygiene, New York, NY, USA
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13
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Yi Y, Sun M, Lu J, Dou X, Yu Y, Zhou L. Psychometric Characteristics of the Chinese Version of the Tuberculosis Related-Stigma Scale in a Population of Medical Students and Its Correlation with Selected Demographic Characteristics. Risk Manag Healthc Policy 2024; 17:815-826. [PMID: 38595754 PMCID: PMC11003432 DOI: 10.2147/rmhp.s446068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background As future health workers, medical students' attitudes towards tuberculosis (TB) patients can impact TB control. However, in China, there is a lack of well-quantified assessment regarding the stigma among medical students towards TB patients. Therefore, this study aimed to validate the Chinese version of the Tuberculosis related-Stigma Scale (TSS) in medical students and to apply the scale to measure stigma and its determinants. Methods A total of 1035 eligible medical students participated in the cross-sectional questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were first conducted to test Chinese version of the TSS construct validity, and then internal consistency was assessed using Cronbach's α. Finally, multiple linear regression analyses were conducted to identify predictors of stigma. Results EFA extracted two factors ("Social distance" and "Exclusionary sentiments"). The CFA further confirmed the two-factor construct. The internal consistency, convergent and divergent validity of the adapted Chinese version of the TSS was acceptable. Furthermore, Whether one has received TB health education and whether know a person with TB are associated with all dimensions of TB stigma, while differences in sex and place of residence play different roles in influencing the different dimensions of stigma. Conclusion The adapted Chinese version of the TSS can be used to assess the level of stigma among medical students in China towards tuberculosis patients. When implementing future interventions to reduce stigma associated with TB, special attention should be given to medical students from urban areas, of male gender, who have not received TB health education, and no know a person with TB. However, these two dimensions ("Social distance" and "Exclusionary sentiments") are impacted by different determinants and should therefore be addressed separately when designing, implementing, and evaluating measures to reduce stigma.
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Affiliation(s)
- Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Meng Sun
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Yingying Yu
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian City, Liaoning Province, People’s Republic of China
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14
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Abdullahi LH, Oketch S, Komen H, Mbithi I, Millington K, Mulupi S, Chakaya J, Zulu EM. Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study. BMJ Open 2024; 14:e077989. [PMID: 38569714 PMCID: PMC11146361 DOI: 10.1136/bmjopen-2023-077989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/14/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health concern in Kenya despite the massive global efforts towards ending TB. The impediments to TB prevention and care efforts include poor health systems, resource limitations and other sociopolitical contexts that inform policy and implementation. Notably, TB cases are much higher in men than women. Therefore, the political economy analysis (PEA) study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. DESIGN PEA adopts a qualitative, in-depth approach through key informant interviews (KII) and documentary analysis. SETTING AND PARTICIPANTS The KIIs were distributed among government entities, academia, non-state actors and community TB groups from Kenya. RESULTS The themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritisation for TB programmes, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programmes were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviours. The themes around the economic situation were poverty and unemployment, food insecurity and malnutrition. The political context centred around the systemic and governance gaps in the health system from the national and devolved health functions. CONCLUSION Broad contextual factors identified from the PEA widen the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is essential to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care.
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Affiliation(s)
- Leila H Abdullahi
- Research Department, African Institute for Development Policy, Nairobi, Kenya
| | - Sandra Oketch
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Henry Komen
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | | | | | | | | | - Eliya M Zulu
- African Institute for Development Policy, Nairobi, Kenya
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15
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Nguyen HB, Vo LNQ, Forse RJ, Wiemers AMC, Huynh HB, Dong TTT, Phan YTH, Creswell J, Dang TMH, Nguyen LH, Shedrawy J, Lönnroth K, Nguyen TD, Dinh LV, Annerstedt KS, Codlin AJ. Is convenience really king? Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam: a longitudinal patient cost study. Infect Dis Poverty 2024; 13:27. [PMID: 38528604 DOI: 10.1186/s40249-024-01196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In Viet Nam, tuberculosis (TB) represents a devastating life-event with an exorbitant price tag, partly due to lost income from daily directly observed therapy in public sector care. Thus, persons with TB may seek care in the private sector for its flexibility, convenience, and privacy. Our study aimed to measure income changes, costs and catastrophic cost incurrence among TB-affected households in the public and private sector. METHODS Between October 2020 and March 2022, we conducted 110 longitudinal patient cost interviews, among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program (NTP) in Ha Noi, Hai Phong and Ho Chi Minh City, Viet Nam. Using a local adaptation of the WHO TB patient cost survey tool, participants were interviewed during the intensive phase, continuation phase and post-treatment. We compared income levels, direct and indirect treatment costs, catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression. RESULTS The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort (USD 868 vs USD 578; P = 0.010). However, private sector treatment was also significantly costlier (USD 2075 vs USD 1313; P = 0.005), driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants (USD 754 vs USD 164; P < 0.001). This resulted in no significant difference in catastrophic costs between the two cohorts (Private: 55% vs NTP: 52%; P = 0.675). Factors associated with catastrophic cost included being a single-person household [adjusted odds ratio (aOR = 13.71; 95% confidence interval (CI): 1.36-138.14; P = 0.026], unemployment during treatment (aOR = 10.86; 95% CI: 2.64-44.60; P < 0.001) and experiencing TB-related stigma (aOR = 37.90; 95% CI: 1.72-831.73; P = 0.021). CONCLUSIONS Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector. Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector, use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.
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Affiliation(s)
| | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi, Viet Nam.
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Rachel Jeanette Forse
- Friends for International TB Relief, Ha Noi, Viet Nam
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Huy Ba Huynh
- Friends for International TB Relief, Ha Noi, Viet Nam
| | | | | | | | | | | | - Jad Shedrawy
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Knut Lönnroth
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | - Kristi Sidney Annerstedt
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Andrew James Codlin
- Friends for International TB Relief, Ha Noi, Viet Nam
- Department of Global Public Health, WHO Collaboration Centre On Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
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16
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Laji P, Asghar M. Perceived causes and stigmatization of tuberculosis among Apatani tribe of Arunachal Pradesh. Indian J Tuberc 2024; 71 Suppl 2:S245-S249. [PMID: 39370191 DOI: 10.1016/j.ijtb.2024.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/20/2024] [Accepted: 03/07/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Tuberculosis (TB) is a pressing public health issue in many developing countries, with India having the highest number of cases. Lack of awareness and stigmatization of TB remains a significant barrier to addressing this challenge. This paper examines the perceived causes and stigma associated with TB among Apatani tribe of Arunachal Pradesh. METHODS The study employed a mixed research approach, involving 106 TB patients (both pulmonary and extrapulmonary), both current and retrospective cases, from the Apatani tribe in Ziro valley, Arunachal Pradesh. Participants were selected from all the seven traditionally divided villages using purposive sampling. Semi-structured pre-tested schedules were used to conduct interviews with the patients. RESULTS Among participants, 29.24% attributed TB to transmission, 34.91% had alternative explanations, and 35.85% remained uncertain about the causes. Notably, more Pulmonary TB patients reported transmission as the cause. A 10.75% higher likelihood of having misconceptions was observed among males. Literate individuals had 13.27% greater chance of being aware, although, higher education levels did not consistently follow this trend. Perceived stigmatization was evident mainly due to the contagious nature of the disease. CONCLUSION A significant knowledge gap was evident among TB patients, with very few having a clear understanding of the causes of this disease. Gender differences in this regard were minimal. Literate individuals were more likely to understand the causes. Additionally, perceived stigmatization was a notable concern in the study.
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Affiliation(s)
- Pura Laji
- Department of Anthropology, Rajiv Gandhi University, Arunachal Pradesh, India
| | - Md Asghar
- Department of Anthropology, Rajiv Gandhi University, Arunachal Pradesh, India.
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17
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Siddaiah A, Srinivasan K, Heylen E, Ekstrand ML. Stigma and discrimination by healthcare providers towards patients diagnosed with HIV and tuberculosis: A study from India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2024; 37:82-85. [PMID: 39222528 PMCID: PMC11477220 DOI: 10.25259/nmji_1000_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background High levels of human HIV and tuberculosis (TB) stigma have been reported among healthcare workers (HCWs). Methods We compared HIV and TB stigma scores reported by nursing students and ward staff from hospitals across India. Transmission worry (TW) and intent to discriminate (ID) for HIV and TB were captured using a validated stigma scale. Results A total of 3733 individuals were interviewed. Nursing students and ward staff expressed higher TW while carrying out high- and low-risk tasks on patients with HIV compared to TB. Mean scores were 2.1 and 1.86 among nursing students; 1.82 and 1.79 among ward staff (all p<0.001). Both groups expressed a significantly higher ID against patients with HIV compared to TB (mean percentage: 75.6 and 70.3 among nursing students; and 81.8 and 78.8 among ward staff; all p<0.001). Conclusion TB stigma has implications for providing quality TB care. Training of HCWs regarding transmission dynamics, the importance of standard precautions during patient care, regardless of diagnosis is essential.
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Affiliation(s)
- Archana Siddaiah
- Department of Community Medicine, St John's National Academy of Health Sciences, Koramangala, Bengaluru 560034, Karnataka, India
| | - Krishnamachari Srinivasan
- Department of Community Medicine, St John's National Academy of Health Sciences, Koramangala, Bengaluru 560034, Karnataka, India
| | - Elsa Heylen
- Center for AIDS Prevention Studies, University of California, UCSF DPS, Box 0886 550 16th St, 3rd floor, San Francisco 94143, California, USA
| | - Maria L Ekstrand
- Center for AIDS Prevention Studies, University of California, UCSF DPS, Box 0886 550 16th St, 3rd floor, San Francisco 94143, California, USA
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18
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Tadesse AW, Mganga A, Dube TN, Alacapa J, van Kalmthout K, Letta T, Mleoh L, Garfin AMC, Maraba N, Charalambous S, Foster N, Jerene D, Fielding KL. Feasibility and acceptability of the smart pillbox and medication label with differentiated care to support person-centered tuberculosis care among ASCENT trial participants - A multicountry study. Front Public Health 2024; 12:1327971. [PMID: 38444445 PMCID: PMC10913790 DOI: 10.3389/fpubh.2024.1327971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Digital adherence technologies (DATs) can offer alternative approaches to support tuberculosis treatment medication adherence. Evidence on their feasibility and acceptability in high TB burden settings is limited. We conducted a cross-sectional survey among adults with drug-sensitive tuberculosis (DS-TB), participating in pragmatic cluster-randomized trials for the Adherence Support Coalition to End TB project in Ethiopia (PACTR202008776694999), the Philippines, South Africa and Tanzania (ISRCTN 17706019). Methods From each country we selected 10 health facilities implementing the DAT intervention (smart pillbox or medication labels, with differentiated care support), ensuring inclusion of urban/rural and public/private facilities. Adults on DS-TB regimen using a DAT were randomly selected from each facility. Feasibility of the DATs was assessed using a standardized tool. Acceptability was measured using a 5-point Likert-scale, using the Capability, Opportunity, Motivation, Behavior (COM-B) model. Mean scores of Likert-scale responses within each COM-B category were estimated, adjusted for facility-level clustering. Data were summarized by country and DAT type. Results Participants using either the pillbox (n = 210) or labels (n = 169) were surveyed. Among pillbox users, phone ownership (79%), use of pillbox reminders (87%) and taking treatment without the pillbox (22%) varied by country. Among label users, phone ownership (81%), paying extra to use the labels (8%) and taking treatment without using labels (41%) varied by country. Poor network, problems with phone charging and access, not having the pillbox and forgetting to send text were reasons for not using DATs. Overall, people with TB had a favorable impression of both DATs, with mean composite scores between 4·21 to 4·42 across COM-B categories. Some disclosure concerns were reported. Conclusion From client-perspective, pillboxes and medication labels with differentiated care support were feasible to implement and acceptable in variety of settings. However, implementation challenges related to network, phone access, stigma, additional costs to people with TB to use DATs need to be addressed.
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Affiliation(s)
- Amare W. Tadesse
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | | | - Tanyaradzwa N. Dube
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | | | | | - Taye Letta
- National Tuberculosis Control Program, Ethiopian Ministry of Health, Addis Ababa, Ethiopia
| | - Liberate Mleoh
- National Tuberculosis Control Program, Ministry of Health, Dodoma, Tanzania
| | - Anna M. C. Garfin
- National Tuberculosis Control Program, Department of Health, Manila, Philippines
| | - Noriah Maraba
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Nicola Foster
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Degu Jerene
- Evidence and Impact, KNCV Tuberculosis Plus, The Hague, Netherlands
| | - Katherine L. Fielding
- TB Centre, Department of Infectious Disease Epidemiology and International Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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19
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Hayward SE, Vanqa N, Makanda G, Tisile P, Ngwatyu L, Foster I, Mcinziba A, Biewer A, Mbuyamba R, Galloway M, Bunyula S, Westhuizen HM, Friedland JS, Marino-Medina A, Viljoen L, Schoeman I, Hoddinott G, Nathavitharana RR. "As a patient I do not belong to the clinic, I belong to the community." Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South Africa. RESEARCH SQUARE 2024:rs.3.rs-3921970. [PMID: 38405783 PMCID: PMC10889064 DOI: 10.21203/rs.3.rs-3921970/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Anticipated, internal, and enacted stigma are major barriers to 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. Methods Using 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. Results Intervention components across socio-ecological levels shared common behaviour change strategies, namely education, empowerment, engagement, and innovation. 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 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. Consideration of how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested to decrease anticipated and enacted stigma. 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. Conclusions Decreasing 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-informed intervention components should be prioritised by TB programs, including integrated TB/HIV care services.
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Affiliation(s)
| | | | | | | | | | | | | | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Harvard Medical School
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Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002489. [PMID: 38190416 PMCID: PMC10773931 DOI: 10.1371/journal.pgph.0002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6-64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0-50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0-50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94-4.03), those LTFU (aB 2.86; 0.85-4.87), males (aB 1.73; 0.59-2.87), those losing or changing job due to TB (aB 2.09; 0.31-3.88) and those living in a rural area (aB 1.41; 0.19-2.63). Depression was identified in 41.5% (95% CI 37.7-45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15-1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia
| | - Saidah Rauf
- Department of Nursing, Politeknik Kesehatan Kemenkes Ambon, Maluku, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia
| | - Helmi Suryani Nasution
- Department of Public Health, Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia
| | - I. Wayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Kota Denpasar, Bali, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Liverpool, United Kingdom
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21
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Sekandi JN, Quach T, Olum R, Nakkonde D, Farist L, Obiekwe R, Zalwango S, Buregyeya E. Stigma and Associated Sex Disparities Among Patients with Tuberculosis in Uganda: A Cross-Sectional Study. RESEARCH SQUARE 2024:rs.3.rs-3794900. [PMID: 38260614 PMCID: PMC10802719 DOI: 10.21203/rs.3.rs-3794900/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Tuberculosis (TB) is one of the leading causes of death from a single infectious agent globally. Stigma associated with TB encompassing self-, anticipated-, and public-stigma has significant negative effects on treatment adherence. In Uganda, limited data exist on the prevalence of stigma and its relationship with sex among patients with TB. We evaluate prevalence of three types of stigma and their relationship with the sex of patients undergoing TB treatment. Methods This cross-sectional study was conducted between July 2020 to March 2021 at selected TB clinics in Kampala, Uganda. Eligible participants were aged 18-65 with confirmed TB and starting their prescribed treatment. We collected data on socio-demographics and used 13 items to capture the self-, anticipated-, and public-stigma from which we composed the dependent variables. The primary independent variable was sex. We employed multivariable logistic regression analysis to evaluate the association between sex and the three stigma types. Additionally, we considered potential confounders such as age, HIV, and employment status. Statistical significance was defined as p<0.05. Results In this study we enrolled 144 participants with a mean age of 35.8 years (standard deviation = 12). Half of the participants (50%, n=72) were female, 44% had a secondary education, 37.5% were unemployed, and 32.6% were co-infected with HIV. The prevalence of self-stigma was 71.1%, anticipated stigma was 75.7%, and public stigma was 41.7%. Significant factors were associated with self-stigma were female sex (adjusted odds ratio (AOR): 2.35 95% CI: 1.02-5.74) and unemployment (AOR: 2.95 95% CI: 1.16-8.58). HIV-positive status was significantly associated with anticipated stigma (AOR: 3.58 95% CI: 1.38-11.23). However, none of the variables we evaluated showed a significant association with public stigma. Conclusions Our study showed a high prevalence of self, anticipated and public stigma among TB patients. Notably, females and unemployed individuals were at a higher risk of self-stigma, while those with HIV/AIDS and TB were more likely to report anticipated stigma. To combat stigma effectively, interventions should be tailored to cater to sex-specific needs and persons living with HIV. Future research should delve further in determinants of TB-related stigma in high-burden settings.
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Affiliation(s)
- Juliet N Sekandi
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Trang Quach
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Leila Farist
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Rochelle Obiekwe
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Sarah Zalwango
- Kampala Capital City Authority, Department of Public Health Service and Environment, Kampala, Uganda
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Kumar V, Shankar G, Akhter Y. Deciphering drug discovery and microbial pathogenesis research in tuberculosis during the two decades of postgenomic era using entity mining approach. Arch Microbiol 2023; 206:46. [PMID: 38153595 DOI: 10.1007/s00203-023-03776-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023]
Abstract
We examined literature on Mycobacterium tuberculosis (Mtb) subsequent to its genome release, spanning years 1999-2020. We employed scientometric mapping, entity mining, visualization techniques, and PubMed and PubTator databases. Most popular keywords, most active research groups, and growth in quantity of publications were determined. By gathering annotations from the PubTator, we determined direction of research in the areas of drug hypersensitivity, drug resistance (AMR), and drug-related side effects. Additionally, we examined the patterns in research on Mtb metabolism and various forms of tuberculosis, including skin, brain, pulmonary, extrapulmonary, and latent tuberculosis. We discovered that 2011 had the highest annual growth rate of publications, at 19.94%. The USA leads the world in publications with 18,038, followed by China with 14,441, and India with 12,158 publications. Studies on isoniazid and rifampicin resistance showed an enormous increase. Non-tuberculous mycobacteria also been the subject of more research in effort to better understand Mtb physiology and as model organisms. Researchers also looked at co-infections like leprosy, hepatitis, plasmodium, HIV, and other opportunistic infections. Host perspectives like immune response, hypoxia, and reactive oxygen species, as well as comorbidities like arthritis, cancer, diabetes, and kidney disease etc. were also looked at. Symptomatic aspects like fever, coughing, and weight loss were also investigated. Vitamin D has gained popularity as a supplement during illness recovery, however, the interest of researchers declined off late. We delineated dominant researchers, journals, institutions, and leading nations globally, which is crucial for aligning ongoing and evolving landscape of TB research efforts. Recognising the dominant patterns offers important information about the areas of focus for current research, allowing biomedical scientists, clinicians, and organizations to strategically coordinate their efforts with the changing priorities in the field of tuberculosis research.
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Affiliation(s)
- Vinit Kumar
- Department of Library and Information Science, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India.
| | - Gauri Shankar
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India
| | - Yusuf Akhter
- Department of Biotechnology, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Raebareli Road, Lucknow, 226025, Uttar Pradesh, India.
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23
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Saleem UA, Karimi AS, Ehsan H. A Systematic Review on Pulmonary TB Burden and Associated Factors Among Immigrants in the UK. Infect Drug Resist 2023; 16:7835-7853. [PMID: 38162319 PMCID: PMC10757787 DOI: 10.2147/idr.s441536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Background The rapid growth of international human migration has positioned the UK in the top five countries in the world with 9.4 million immigrants in 2022. These immigrants originate from low- and middle-income countries and remain particularly at risk of developing TB. In the UK, the number of TB cases has been increasing, and the influx of immigrants could be a contributing factor. Objective This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK. Design The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies. Results Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3-6 months for TB patients. Conclusion The UK's control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality.
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Affiliation(s)
- Uzair Ahmad Saleem
- Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, the Netherlands
| | - Ali Sina Karimi
- Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
| | - Hedayatullah Ehsan
- Medical Sciences Research Center, Ghalib University, Kabul, Afghanistan
- Kabul University of Medical Sciences, Kabul, Afghanistan
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24
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Gabalape Arnold S, Ozayr Haroon M. A comparative analysis of the profile and treatment outcomes of tuberculosis patients managed at the community and primary health care facilities in Botswana. J Clin Tuberc Other Mycobact Dis 2023; 33:100400. [PMID: 37808203 PMCID: PMC10550795 DOI: 10.1016/j.jctube.2023.100400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background Successful treatment of Tuberculosis (TB) is necessary for mitigating and averting millions of deaths annually. This study compared the profiles and measured the association between patients, health system-related factors, and TB treatment outcomes of patients managed through the community tuberculosis care model with those managed in primary health care settings. Methods A retrospective multicenter cross-sectional study was conducted in six districts in Botswana. Patient's records were reviewed using a data extraction sheet, and data not captured on registers were obtained using a structured questionnaire. Results Three hundred and twenty-four TB patients were sampled. Most participants (84 %; n = 273) were receiving community-based DOT. Patients with moderate TB knowledge (OR 5.3,955 CI 1.01-27.7), good perception of TB care (OR 11, 95 % CI 1.29-94.0), were more likely to enroll for community DOT and achieve treatment cure. Those in businesses (OR 3.85 95 %CI 1.10-22.6), always had treatment available (OR 3.66, 95 % CI 1.12-11.4), never drank alcohol (OR 2.11, 95 %CI 1.06-4.19), used their vehicle (OR 2.11.95 %CI 0.99-4.48) were likely to enroll for community DOT. Conclusion A patient-specific education program and continuous improvement practices to increase patient TB knowledge and satisfaction should be implemented at all levels to improve treatment outcomes.
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Affiliation(s)
- Sejie Gabalape Arnold
- Discipline of Public Health Medicine, University of KwaZulu, Natal, Durban, South Africa
- Department of Health Promotion and Education, Boitekanelo College, Botswana
| | - Mahomed Ozayr Haroon
- Discipline of Public Health Medicine, University of KwaZulu, Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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25
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Barbosa P, Vieira M, Ramos JP, Duarte R. Unveiling the power of neutral and inclusive language in tuberculosis prevention and care. Breathe (Sheff) 2023; 19:230157. [PMID: 38351945 PMCID: PMC10862121 DOI: 10.1183/20734735.0157-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
Language plays a crucial role in shaping discourses and responses related to disease, particularly tuberculosis (TB). Stigmatising language and attitudes surrounding TB can lead to discrimination and marginalisation of affected individuals, creating barriers to seeking proper diagnosis and treatment. The terminology used to describe TB-affected individuals can be disempowering and criminalising, reinforcing an "othering" of those affected. To combat this, engaging with TB-affected communities is essential to co-construct a neutral and inclusive vocabulary that respects the dignity of individuals and fosters empathy and support. Thus, an inclusive language approach empowers affected individuals as active participants in their health management, encouraging open communication and the development of support networks. By adopting a neutral and inclusive language system, healthcare providers and communities can work together to remove unnoticed hurdles and align with the World Health Organization's TB care and prevention goals.
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Affiliation(s)
- Pedro Barbosa
- Unidade de Investigação em Epidemiologia (EPI Unit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Estudos de Populações, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Mariana Vieira
- Unidade de Investigação em Epidemiologia (EPI Unit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - João Pedro Ramos
- Unidade de Investigação em Epidemiologia (EPI Unit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Estudos de Populações, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- Unidade de Investigação em Epidemiologia (EPI Unit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Estudos de Populações, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Serviço de Pneumologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
- Unidade de Investigação Clínica, Administração Regional de Saúde do Norte, Porto, Portugal
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26
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Lissouba P, Rücker SCM, Otieno LA, Akatukwasa C, Xulu S, Monjane C, Akinyi M, Okal B, Lubega AV, Stewart R, Bossard C, Ohler L, Antabak NT, Musoke M, Muyindike W, Huerga H. Experiences and perceptions of urine sampling for tuberculosis testing among HIV patients: a multisite qualitative descriptive study. BMJ Open 2023; 13:e058805. [PMID: 38035738 PMCID: PMC10689410 DOI: 10.1136/bmjopen-2021-058805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES Evidence on the acceptability of urine-based assays for tuberculosis (TB) diagnosis among patients remains limited. We sought to describe patients' experiences and perceptions of urine sampling for TB testing at point of care. SETTING Study sites in Kenya, Uganda, Mozambique and South Africa. PARTICIPANTS Adult ambulatory HIV patients enrolled in a TB diagnostic study were selected purposively. INTERVENTION For this qualitative descriptive study, audiorecorded individual interviews conducted with consenting participants were translated, transcribed and analysed using content analysis. Ethical agreement was obtained from relevant ethical review committees. RESULTS Fifty-eight participants were interviewed. Three domains were identified. Overall, participants described urine sampling as easy, rapid and painless, with the main challenge being lacking the urge. Urine was preferred to sputum sampling in terms of simplicity, comfort, stigma reduction, convenience and practicality. While perceptions regarding its trustworthiness for TB diagnosis differed, urine sampling was viewed as an additional mean to detect TB and beneficial for early diagnosis. Participants were willing to wait for several hours for same-day results to allay the emotional, physical and financial burden of having to return to collect results, and would rather not pay for the test. Facilitators of urine sampling included cleanliness and perceived privacy of sampling environments, comprehensive sampling instructions and test information, as well as supplies such as toilet paper and envelopes ensuring confort and privacy when producing and returning samples. Participants motivation for accepting urine-based TB testing stemmed from their perceived susceptibility to TB, the value they attributed to their health, especially when experiencing symptoms, and their positive interactions with the medical team. CONCLUSIONS This study suggests that urine sampling is well accepted as a TB diagnostic method and provides insights on how to promote patients' uptake of urine-based testing and improve their sampling experiences. These results encourage the future broad use of urine-based assays at point of care.
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Affiliation(s)
- Pascale Lissouba
- Field Epidemiology and Training Department, Epicentre, Paris, France
| | | | - Lucy Atieno Otieno
- Médecins Sans Frontières, Homa Bay, Kenya
- Center for Global Health Research, KEMRI, Kisumu, Kenya
| | | | - Sibongiseni Xulu
- Médecins Sans Frontières, Eshowe, South Africa
- Africa Health Research Institute (AHRI), Somkhele, South Africa
- School of Psychology, University of Kwa-Zulu Natal (UKZN), Durban, South Africa
| | | | | | - Beryl Okal
- Médecins Sans Frontières, Homa Bay, Kenya
| | | | | | - Claire Bossard
- Field Epidemiology and Training Department, Epicentre, Paris, France
| | | | | | | | - Winnie Muyindike
- Epicentre, Mbarara, Uganda
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda
| | - Helena Huerga
- Field Epidemiology and Training Department, Epicentre, Paris, France
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27
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Chiang SS, Zeng C, Roman-Sinche B, Altamirano E, Beckhorn CB, Leon-Ostos K, Espinoza-Meza R, Lecca L, Franke MF. Adaptation and validation of a TB stigma scale for adolescents in Lima, Peru. Int J Tuberc Lung Dis 2023; 27:754-760. [PMID: 37749835 PMCID: PMC10519385 DOI: 10.5588/ijtld.23.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND: TB-related stigma contributes to poor clinical outcomes and reduced wellbeing for affected individuals. Adolescents may be particularly susceptible to TB-related stigma due to their heightened sensitivity to peer acceptance, yet few studies have evaluated TB-related stigma in this group. Without a validated scale, it remains challenging to measure TB-related stigma in adolescents.METHODS: We adapted and validated the Van Rie TB Stigma Scale (VTSS) for adolescents on treatment for rifampicin-susceptible TB in Lima, Peru. The modified stigma scale was administered within a larger survey, which measured other psychosocial factors, including depression, adverse childhood experiences (ACEs), and social support. Data analysis included factor analysis, internal consistency, and convergent validity.RESULTS: From October 2020 to September 2021, 249 adolescents (individuals aged 10-19 years) completed the survey. Preliminary confirmatory factor analysis led to removal of two items. The final 10-item scale demonstrated good internal consistency (Cronbach's α = 0.82) and adequate model fit (χ²/df = 2.0; root mean square error of approximation: 0.06; comparative fit index: 0.94; Tucker-Lewis Index: 0.92: standardized root mean square residual: 0.05). Stigma was positively correlated with ACEs (γ = 0.13), depression (γ = 0.39), and suicidal ideation (γ = 0.27), and negatively correlated with social support (γ = -0.19).CONCLUSION: This adolescent TB stigma scale may serve as a practical tool to measure TB-related stigma and evaluate the impact of stigma-reduction interventions in adolescents.
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Affiliation(s)
- S S Chiang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI
| | - C Zeng
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA, Socios En Salud - Sucursal Perú, Lima, Perú
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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28
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Machavariani E, Nonyane BAS, Lebina L, Mmolawa L, West NS, Dowdy DW, Martinson N, Ahmad B, Hanrahan CF. Perceived stigma among people with TB and household contacts. Int J Tuberc Lung Dis 2023; 27:675-681. [PMID: 37608483 PMCID: PMC10443789 DOI: 10.5588/ijtld.22.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: TB-related stigma hampers access to diagnosis and treatment, making it important to understand the demographic and clinical characteristics associated with perceived TB stigma. TB stigma has not been studied in household contacts before, yet they comprise an important population for epidemic control, with high risk of infection.METHOD: A cross-sectional study was conducted among people with TB and household contacts in South Africa using a 12-item perceived TB stigma scale (score range: 0-36). Demographic and clinical characteristic data were collected using a close-ended questionnaire. A linear mixed-effects regression model was used to explore perceived TB stigma levels and its associated characteristics.RESULTS: The sample included 143 people with TB and 135 household contacts. The mean perceived TB stigma score among people with TB was 22.1 (95% CI 21.1-23.1) and 22.2 (95% CI 21.1-23.3) among household contacts. Being in the same household explained 24.3% variability in stigma perception. Residence in the urban study site (Soshanguve) and a positive HIV diagnosis were associated with higher perceived TB stigma score.CONCLUSIONS: People with TB and household contacts have similarly high prevalence of perceived TB stigma. Positive HIV status and urban location were associated with higher prevalence of perceived TB stigma.
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Affiliation(s)
| | - B A S Nonyane
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Lebina
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - L Mmolawa
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - N S West
- University of California, San Francisco, CA, USA
| | - D W Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - N Martinson
- Perinatal HIV Research Unit, Johannesburg, South Africa
| | - B Ahmad
- Yale School of Medicine, New Haven, CT
| | - C F Hanrahan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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29
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Klever AM, Alexander KA, Almeida D, Anderson MZ, Ball RL, Beamer G, Boggiatto P, Buikstra JE, Chandler B, Claeys TA, Concha AE, Converse PJ, Derbyshire KM, Dobos KM, Dupnik KM, Endsley JJ, Endsley MA, Fennelly K, Franco-Paredes C, Hagge DA, Hall-Stoodley L, Hayes D, Hirschfeld K, Hofman CA, Honda JR, Hull NM, Kramnik I, Lacourciere K, Lahiri R, Lamont EA, Larsen MH, Lemaire T, Lesellier S, Lee NR, Lowry CA, Mahfooz NS, McMichael TM, Merling MR, Miller MA, Nagajyothi JF, Nelson E, Nuermberger EL, Pena MT, Perea C, Podell BK, Pyle CJ, Quinn FD, Rajaram MVS, Mejia OR, Rothoff M, Sago SA, Salvador LCM, Simonson AW, Spencer JS, Sreevatsan S, Subbian S, Sunstrum J, Tobin DM, Vijayan KKV, Wright CTO, Robinson RT. The Many Hosts of Mycobacteria 9 (MHM9): A conference report. Tuberculosis (Edinb) 2023; 142:102377. [PMID: 37531864 PMCID: PMC10529179 DOI: 10.1016/j.tube.2023.102377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
The Many Hosts of Mycobacteria (MHM) meeting series brings together basic scientists, clinicians and veterinarians to promote robust discussion and dissemination of recent advances in our knowledge of numerous mycobacterial diseases, including human and bovine tuberculosis (TB), nontuberculous mycobacteria (NTM) infection, Hansen's disease (leprosy), Buruli ulcer and Johne's disease. The 9th MHM conference (MHM9) was held in July 2022 at The Ohio State University (OSU) and centered around the theme of "Confounders of Mycobacterial Disease." Confounders can and often do drive the transmission of mycobacterial diseases, as well as impact surveillance and treatment outcomes. Various confounders were presented and discussed at MHM9 including those that originate from the host (comorbidities and coinfections) as well as those arising from the environment (e.g., zoonotic exposures), economic inequality (e.g. healthcare disparities), stigma (a confounder of leprosy and TB for millennia), and historical neglect (a confounder in Native American Nations). This conference report summarizes select talks given at MHM9 highlighting recent research advances, as well as talks regarding the historic and ongoing impact of TB and other infectious diseases on Native American Nations, including those in Southwestern Alaska where the regional TB incidence rate is among the highest in the Western hemisphere.
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Affiliation(s)
- Abigail Marie Klever
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Kathleen A Alexander
- Department of Fish and Wildlife Conservation, Virginia Tech, Blacksburg, VA, USA; CARACAL/Chobe Research Institute Kasane, Botswana
| | - Deepak Almeida
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Z Anderson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA; Department of Microbiology, The Ohio State University, Columbus, OH, USA
| | | | - Gillian Beamer
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Paola Boggiatto
- Agricultural Research Service, United States Department of Agriculture, Ames, IA, USA
| | - Jane E Buikstra
- Center for Bioarchaeological Research, Arizona State University, Tempe, AZ, USA
| | - Bruce Chandler
- Division of Public Health, Alaska Department of Health, AK, USA
| | - Tiffany A Claeys
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Aislinn E Concha
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Paul J Converse
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Keith M Derbyshire
- Division of Genetics, The Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Sciences, University at Albany, Albany, NY, USA
| | - Karen M Dobos
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Kathryn M Dupnik
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Janice J Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Mark A Endsley
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin Fennelly
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Rockville, MD, USA
| | - Carlos Franco-Paredes
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA; Hospital Infantil de México Federico Gómez, México, USA
| | | | - Luanne Hall-Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Don Hayes
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Courtney A Hofman
- Department of Anthropology, University of Oklahoma, Norman, OK, USA; Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, OK, USA
| | - Jennifer R Honda
- Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Natalie M Hull
- Department of Civil, Environmental, and Geodetic Engineering, The Ohio State University, Columbus, OH, USA
| | - Igor Kramnik
- Pulmonary Center, The Department of Medicine, Boston University Chobanian & Aveedisian School of Medicine, National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Karen Lacourciere
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Ramanuj Lahiri
- United States Department of Health and Human Services, Health Resources and Services Administration, Health Systems Bureau, National Hansen's Disease Program, Baton Rouge, LA, USA
| | - Elise A Lamont
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Michelle H Larsen
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Sandrine Lesellier
- French Agency for Food, Environmental & Occupational Health & Safety (ANSES), Laboratory for Rabies and Wildlife,Nancy, France
| | - Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Najmus S Mahfooz
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Temet M McMichael
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Marlena R Merling
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Michele A Miller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jyothi F Nagajyothi
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
| | - Elizabeth Nelson
- Microbial Paleogenomics Unit, Dept of Genomes and Genetics, Institut Pasteur, Paris, France
| | - Eric L Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA
| | - Maria T Pena
- United States Department of Health and Human Services, Health Resources and Services Administration, Health Systems Bureau, National Hansen's Disease Program, Baton Rouge, LA, USA
| | - Claudia Perea
- Animal & Plant Health Inspection Service, United States Department of Agriculture, Ames, IA, USA
| | - Brendan K Podell
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Charlie J Pyle
- Department of Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, NC, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Fred D Quinn
- Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Murugesan V S Rajaram
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | - Oscar Rosas Mejia
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA
| | | | - Saydie A Sago
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Liliana C M Salvador
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Andrew W Simonson
- Department of Microbiology and Molecular Genetics and the Center for Vaccine Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John S Spencer
- Department of Microbiology, Immunology, and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, USA
| | - Srinand Sreevatsan
- Pathobiology & Diagnostic Investigation Department, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Selvakumar Subbian
- Public Health Research Institute (PHRI), New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | | | - David M Tobin
- Department of Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, NC, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - K K Vidya Vijayan
- Department of Microbiology and Immunology, Center for AIDS Research, and Children's Research Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caelan T O Wright
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
| | - Richard T Robinson
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, OH, USA.
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Galea JT, Chu AL, Sweetland AC, Jimenez J, Yataco R, Calderón R, Zhang Z, Huang CC, Lecca L, Murray M. Latent TB and depressive symptoms in household contacts of persons with active TB. Int J Tuberc Lung Dis 2023; 27:682-687. [PMID: 37608477 PMCID: PMC10443790 DOI: 10.5588/ijtld.22.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: Depression is common among persons with TB and is associated with poor clinical outcomes. However, little is known about the relationship between latent TB infection (LTBI) and depression. We assessed the association between LTBI and depressive symptoms among household contacts (HHCs) of patients receiving TB treatment.METHODS: We enrolled 1,009 HHCs of 307 patients receiving TB treatment in Lima, Peru, during 2016-2018. At enrollment, HHC LTBI status was assessed using the interferon-gamma release assay (IGRA). Depressive symptoms were assessed at baseline and 12 months later using the Patient Health Questionnaire-9 (PHQ-9) with a cut-off of ≥5. We used logistic regression to estimate the odds ratio (OR) for PHQ-9 ≥5, comparing HHCs with and without baseline LTBI.RESULTS: Among 921 HHCs, 374 (41.0%) had LTBI at baseline, and 69 (12.4%) of 567 HHCs had PHQ-9 ≥5. Compared to HHCs without LTBI at enrollment, those with LTBI had almost two times the odds of PHQ-9 ≥5 at follow-up after controlling for potential confounders (adjusted OR 1.93, 95% CI 1.09-3.39); this association was driven by greater severities of depressive symptoms.CONCLUSION: HHCs with LTBI had increased odds of depressive symptoms 1 year later. This population may benefit from mental health screening and interventions integrated into TB programs.
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Affiliation(s)
- J T Galea
- School of Social Work, University of South Florida, Tampa, FL, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - A L Chu
- Department of Medical Education, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - A C Sweetland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, NY, USA
| | | | | | - R Calderón
- Socios En Salud, Lima, Grupo de Investigación en Bioquímica y Biología Sintética, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Z Zhang
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - C-C Huang
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - L Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Socios En Salud, Lima
| | - M Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Guzman K, Crowder R, Leddy A, Maraba N, Jennings L, Ahmed S, Sultana S, Onjare B, Shilugu L, Alacapa J, Levy J, Katamba A, Kityamuwesi A, Bogdanov A, Gamazina K, Cattamanchi A, Khan A. Acceptability and feasibility of digital adherence technologies for drug-susceptible tuberculosis treatment supervision: A meta-analysis of implementation feedback. PLOS DIGITAL HEALTH 2023; 2:e0000322. [PMID: 37582066 PMCID: PMC10426983 DOI: 10.1371/journal.pdig.0000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023]
Abstract
Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis of implementation feedback obtained from people with TB and health care workers (HCWs) involved in TB REACH Wave 6-funded DAT evaluation projects. Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model to people with TB and their health care workers. The surveys included questions on demographics and technology use, Likert scale questions to assess capability, opportunity, and motivation to use DAT and open-ended feedback. We summarized demographic and technology use data descriptively, generated pooled estimates of responses to Likert scale questions within each COM-B category for people with TB and health care workers using random effects models, and performed qualitative analysis of open-ended feedback using a modified framework analysis approach. The analysis included surveys administered to 1290 people with TB and 90 HCWs across 6 TB REACH-funded projects. People with TB and HCWs had an overall positive impression of DATs with pooled estimates between 4·0 to 4·8 out of 5 across COM-B categories. However, 44% of people with TB reported taking TB medications without reporting dosing via DATs and 23% reported missing a dose of medication. Common reasons included problems with electricity, network coverage, and technical issues with the DAT platform. DATs were overall perceived to reduce visits to clinics, decrease cost, increase social support, and decrease workload of HCWs. DATs were acceptable in a wide variety of settings. However, there were challenges related to the feasibility of using current DAT platforms. Implementation efforts should concentrate on ensuring access, anticipating, and addressing technical challenges, and minimizing additional cost to people with TB.
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Affiliation(s)
- Kevin Guzman
- University of California, San Francisco, United States of America
| | - Rebecca Crowder
- University of California, San Francisco, United States of America
| | - Anna Leddy
- University of California, San Francisco, United States of America
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amera Khan
- Stop TB Partnership/TB REACH, Geneva, Switzerland
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Alsoukhni MA, Khader Y, Abaza H, Wilson N, Satyanarayana S. Tuberculosis-related knowledge, behaviors, stigmatizing attitude, and discrimination among refugees, migrants, and the general population in Jordan. SAGE Open Med 2023; 11:20503121231187743. [PMID: 37492648 PMCID: PMC10363878 DOI: 10.1177/20503121231187743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective A better understanding of tuberculosis-related knowledge, attitude, practices in the community, and other issues can help in implementing evidence-driven activities to control tuberculosis in Jordan. This study aimed to assess tuberculosis-related knowledge, attitude, and behaviors among refugees, migrants, and general population, and assess their stigmatizing and discrimination attitudes toward tuberculosis patients, social behavior toward tuberculosis, and healthcare-seeking behaviors. Methods A cross-sectional study was conducted among Jordanians, Syrian refugees, and migrants living in four governorates including Amman, Zarqa, Mafraq, and Irbid during the study period of June to September 2021. A structured questionnaire was developed to collect data via face-to-face interviews. Descriptive statistics, chi-square test, and general linear model procedure were used to analyze data. Results A total of 2302 (27.7% Jordanians, 25.7% urban refugees, 22.1% camp refugees, and 24.5% migrants) participated in this study. Of the total, 90.1% of participants reported that they have heard of tuberculosis. However, 88.9% of Jordanians, 92.8% of urban refugees, 92% of camp refugees, and 90.5% of migrants had low level of tuberculosis-related knowledge. About 62.0% of urban refugees, 54.8% of Jordanians, 43.0% of camp refugees, and 55.4% of migrants had moderate to high stigmatizing attitude toward tuberculosis patients. About 15.1% of Jordanians, 10.6% of urban refugees, 23.7% of camp refugees, and 16.1% of migrants had moderate to high level of discriminating attitude toward tuberculosis patients. Camp refugees had a significantly higher level of discriminating attitude toward tuberculosis patients than the other groups. Conclusion This study identified significant gaps in tuberculosis-related knowledge among the targeted groups. Moderate to high level of stigmatizing attitude was reported by a considerable proportion of the study participants. This suggests a need for public health education programs to educate people on tuberculosis causes, signs, symptoms, mode of transmission, and address related stigma, especially among the most disadvantaged and affected communities in Jordan.
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Affiliation(s)
- Majd A Alsoukhni
- Center of Excellence for Applied Epidemiology, Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Yousef Khader
- Department of Community Medicine, Public Health, and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Hiba Abaza
- Migration Health Division, International Organization for Migration, Amman, Jordan
| | - Nevin Wilson
- Migration Health Division, International Organization for Migration, Amman, Jordan
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Stephen A, Nair S, Joshi A, Aggarwal S, Adhikari T, Diwan V, Devi KR, Mishra BK, Yadav GK, Sahu D, Gulati BK, Sharma S, Yadav J, Ovung S, Duggal C, Sharma M, Bangar SD, Rebecca PB, Rani S, Selvaraj P, Xavier GG, Peter V, Watson B, Kannan T, Asmathulla KSMD, Bhattacharya D, Turuk J, Palo SK, Kanungo S, Behera AK, Pandey AK, Zaman K, Misra B, Kumar N, Behera S, Singh R, Narain K, Kant R, Sahay S, Tiwari R, Thomas BE, Karikalan N, Panda S, Vardhana Rao MV, Ujagare D, Chinchore S. Gender differences in COVID-19 knowledge, risk perception, and public stigma among the general community: Findings from a nationwide cross-sectional study in India. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 93:103776. [PMID: 37303828 PMCID: PMC10229202 DOI: 10.1016/j.ijdrr.2023.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/10/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
Introduction Individual and community characteristics predictive of knowledge, perception, and attitude on COVID-19, specifically on gender, have not been adequately explored. Objective To examine the gender differences in COVID-19 knowledge, self-risk perception and public stigma among the general community and to understand other socio-demographic factors which were predictive of them. Method A nationally representative cross-sectional multi-centric survey was conducted among adult individuals(≥18 yrs) from the community member (N = 1978) from six states and one union territory of India between August 2020 to February 2021. The participants were selected using systematic random sampling. The data were collected telephonically using pilot-tested structured questionnaires and were analyzed using STATA. Gender-segregated multivariable analysis was conducted to identify statistically significant predictors (p < 0.05) of COVID-19-related knowledge, risk perception, and public stigma in the community. Results Study identified significant differences between males and females in their self-risk perception (22.0% & 18.2% respectively) and stigmatizing attitude (55.3% & 47.1% respectively). Highly educated males and females had higher odds of having COVID-19 knowledge (aOR: 16.83: p < 0.05) than illiterates. Highly educated women had higher odds of having self-risk perception (aOR: 2.6; p < 0.05) but lower public stigma [aOR: 0.57; p < 0.05]. Male rural residents had lower odds of having self-risk perception and knowledge [aOR: 0.55; p < 0.05 & aOR: 0.72; p < 0.05] and female rural residents had higher odds of having public stigma [aOR: 1.36; p < 0.05]. Conclusion Our study findings suggest the importance of considering thegender differentials and their background, education status and residential status in designing effective interventions to improve knowledge and reduce risk perception and stigma in the community about COVID-19.
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Affiliation(s)
- A Stephen
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Saritha Nair
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Aparna Joshi
- School of Human Ecology, Tata Institute of Social Sciences, Mumbai, India
| | - Sumit Aggarwal
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Tulsi Adhikari
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Vishal Diwan
- Division of Environmental Monitoring & Exposure Assessment (Water & Soil), ICMR- National Institute for Research in Environmental Health, Bhopal, India
| | - Kangjam Rekha Devi
- Divison of Enteric Disease, ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Bijaya Kumar Mishra
- Department of Medical, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Damodar Sahu
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Bal Kishan Gulati
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Saurabh Sharma
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Jeetendra Yadav
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Senthanro Ovung
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Chetna Duggal
- School of Human Ecology, Tata Institute of Social Sciences, Mumbai, India
| | - Moina Sharma
- Department of Environmental Health & Epidemiology, ICMR- National Institute for Research in Environmental Health, Bhopal, India
| | - Sampada Dipak Bangar
- Divisions of Epidemiology and Statistics, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Pricilla B Rebecca
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - S Rani
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Pradeep Selvaraj
- Office of District Non-Communicable Disease, Directorate of Public Health and Preventive Medicine, Chennai, India
| | | | - Vanessa Peter
- Informational & Resource Centre for the Deprived Urban Communities, Chennai, India
| | - Basilea Watson
- Electronic Data Processing Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - T Kannan
- Electronic Data Processing Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, India
- Epidemiology and Statistics Unit, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - K S M D Asmathulla
- Integrated People Development Project Trust, Krishnagiri, Tamil Nadu, India
| | - Debdutta Bhattacharya
- Department of Microbiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Jyotirmayee Turuk
- Department of Microbiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Subrata Kumar Palo
- Department of Microbiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
- Department of Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Srikanta Kanungo
- Department of Microbiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
- Department of Epidemiology, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Ajit Kumar Behera
- Department of Clinical, ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Kamran Zaman
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - BrijRanjan Misra
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Niraj Kumar
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | | | - Rajeev Singh
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
| | - Kanwar Narain
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Rajni Kant
- ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India
- Research Management, Policy, Planning and Coordination Cell, Indian Council of Medical Research, New Delhi, India
| | - Seema Sahay
- Social &Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | | | - Beena Elizabeth Thomas
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - N Karikalan
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Samiran Panda
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - M Vishnu Vardhana Rao
- ICMR-National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India
| | - Dhammsagar Ujagare
- Social &Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
| | - Sneha Chinchore
- Social &Behavioral Research, ICMR-National AIDS Research Institute, Pune, Maharashtra, India
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Njuguna I, Moraa H, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O’Malley G. 'They should show them love even if their status of being HIV positive is known': Youth and caregiver stigma experience and strategies to end HIV stigma in schools. Trop Med Int Health 2023; 28:466-475. [PMID: 37177902 PMCID: PMC10278085 DOI: 10.1111/tmi.13878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE HIV stigma and discrimination is widespread in sub-Saharan Africa and is associated with poor clinical outcomes. Schools play a critical role in the life of youth and have been identified as a potentially stigmatising environment. We sought to explore school HIV stigma drivers, facilitators, manifestations and outcomes among youth living with HIV (YLH) as well as potential stigma reduction interventions in Kenya. METHODS Semi-structured in-depth qualitative interviews with 28 school-attending YLH aged 14-19 years and 24 caregivers of YLH were analysed using directed content analysis. Results were summarised using the Health and Stigma Framework. RESULTS Drivers and facilitators of HIV stigma in the school environment included misconceptions about HIV transmission, HIV treatment outcomes and long-term overall health of people living with HIV. HIV stigma manifested largely as gossip, isolation and loss of friendships. Fear of HIV stigma or experienced stigma resulted in poor adherence to antiretroviral treatment-particularly among YLH in boarding schools-and poor mental health. Stigma also impacted school choice (boarding vs. day school) and prevented HIV disclosure to schools which was necessary for optimal support for care. Proposed interventions to address HIV stigma in schools included HIV education, psychosocial support for YLH, support for HIV disclosure to schools while ensuring confidentiality and building YLH resilience. CONCLUSION There is an urgent need to develop interventions to address HIV stigma in schools to ensure optimised health and social outcomes for YLH. Future studies to understand the most effective and efficient interventions are needed.
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Affiliation(s)
- Irene Njuguna
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Hellen Moraa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Anjuli D. Wagner
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Epidemiology, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Medicine, University of Washington, Box 359931, Seattle, WA 98104, USA
- Departments of Pediatrics, University of Washington, Box 359931, Seattle, WA 98104, USA
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, P.O. Box 20723-00202, Nairobi, Kenya
| | - Gabrielle O’Malley
- Departments of Global Health, University of Washington, Box 359931, Seattle, WA 98104, USA
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Hammouda EA, Gobran WF, Tawfeek RM, Esmail OF, Ashmawy R, Youssef N, Ghazy RM. Survey to measure the quality of life of patients with tuberculosis in Alexandria, Egypt: a cross-sectional study. BMC Health Serv Res 2023; 23:534. [PMID: 37226176 DOI: 10.1186/s12913-023-09381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/09/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Assessment of quality of life (QoL) in patients with tuberculosis (TB) may improve healthcare providers' understanding of the disease burden. This study aimed to investigate the QoL of patients with TB in Alexandria, Egypt. METHODS This cross-sectional study was conducted in chest clinics and main chest hospitals in Alexandria, Egypt. A structured interview questionnaire was used to collect data from participants through face-to-face interviews from November 20, 2021, until the June 30, 2022. We included all adult patients aged 18 years or above during the intensive or continuation phase of treatment. The World Health Organization (WHO) WHOQOL-BREF instrument was used to measure QoL, which includes the physical, psychological, social relationships, and environmental health domains. Using propensity score matching, a group of TB free population was recruited from the same setting and completed the questionnaire. RESULTS A total of 180 patients participated in the study: 74.4% were males, 54.4% were married, 60.0% were 18-40 years old, 83.3% lived in urban areas, 31.7% were illiterate, 69.5% reported insufficient income, and 10.0% had multidrug-resistant TB. The TB-free population group had higher QoL scores than the TB patients' group: (65.0 ± 17.5 vs. 42.4 ± 17.8) for the physical domain, (59.2 ± 13.6 vs. 41.9 ± 15.1) for the psychological domain, (61.8 ± 19.9 vs. 50.3 ± 20.6) for the social domain, (56.3 ± 19.3 vs. 44.5 ± 12.8) for the environment domain, (4.0(3.0-4.0) vs. 3.0(2.0-4.0)) for general health, and (4.0(3.0-4.0) vs. 2.0(2.0-3.0)) for the general QoL, P < 0.0001. Patients with TB aged 18-30 years had the highest environmental score compared with the other age groups (P = 0.021). CONCLUSIONS TB had a significant negative impact on QoL, with the physical and psychological domains being the most affected. This finding necessitates strategies to improve QoL of patients with to enhance their compliance to treatment.
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Affiliation(s)
- Esraa Abdellatif Hammouda
- Department of Clinical Research, El-Raml pediatric hospital, Ministry of Health and Population, Alexandria, Egypt.
| | - Wahib Fayez Gobran
- Director of Chest Diseases, Ministry of Health and Population, Alexandria, Egypt
| | | | | | - Rasha Ashmawy
- Department of Clinical Research, Maamoura Chest Hospital, Ministry of Health and Population, Alexandria, Egypt
| | - Naglaa Youssef
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
- Department of Medical-surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Rahmati S, Nasehi M, Bahrampour A, Mirzazadeh A, Shahesmaeili A. Barriers and gaps in tuberculosis care and treatment in Iran: A multi-center qualitative study. J Clin Tuberc Other Mycobact Dis 2023; 31:100353. [PMID: 36874622 PMCID: PMC9982675 DOI: 10.1016/j.jctube.2023.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Introduction Patients with Tuberculosis (TB) still have barriers in accessing high quality care and treatment services. In this qualitative study, we investigated barriers in accessing TB health services including confirmatory diagnosis, treatment adherence and recurrence of pulmonary TB using patients, physicians, and policy makers point of view. Materials and methods In this qualitative research from November to March 2021, 3 policy makers from the Ministry of Health, 12 provincial TB experts and physicians from the TB control program and 33 patients diagnosed with TB from 4 provinces were enrolled for a semi-structured in-depth interview. All interviews were audio recorded and then transcribed. Framework analysis was done by MAXQDA 2018 software to identify key themes. Results Several barriers reported for TB care and treatment: Poor knowledge of patents about TB symptoms, failure to screen for TB among at-risk patients by physicians, similar symptoms between TB and other lung diseases, low sensitivity of TB diagnostic tests, incomplete case finding and contact-tracing, stigma related to TB, and patients poor adherence due to long TB treatment. In addition, COVID-19 pandemic disrupted TB services and decreased detection, care and treatment services for TB patients. Conclusion Our findings highlight the need for interventions to increase public and healthcare providers awareness about TB symptoms, using more sensitive diagnostic tests, and interventions to reduce stigma, and improve case finding and contact tracing effort. Improving patients' adherence required better monitoring and shorter effective treatment regimes.
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Affiliation(s)
- Shoboo Rahmati
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Iran
| | - Abbas Bahrampour
- Modeling in Health Research Center, Institute for Futures Studies in Health, Department of Biostatistics and Epidemiology, Faculty of Health Kerman University of Medical Sciences, Kerman, IRAN. Adjunct Professor of Griffith University, Brisbane, QLD, Australia
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California San Francisco, California, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma towards people with tuberculosis: a cross-cultural adaptation and validation of a scale in Indonesia. BMC Psychol 2023; 11:112. [PMID: 37055814 PMCID: PMC10100612 DOI: 10.1186/s40359-023-01161-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a highly stigmatised disease that can cause or exacerbate mental health disorders. Despite increased awareness of the importance of reducing TB stigma, validated tools to measure TB stigma remain scarce. This study aimed to culturally adapt and validate the Van Rie TB Stigma Scale in Indonesia, a country with the second largest TB incidence worldwide. METHODS We validated the scale in three phases: translation, cultural adaptation, and psychometric evaluation. We invited diverse experts to an interdisciplinary panel for the cross-cultural adaptation, then performed a psychometric evaluation of the scale: exploratory and confirmatory factor analyses, reliability analysis, and correlation analysis with Patient Health Questionnaire 9 [PHQ-9]. RESULTS We culturally adapted the original scale's language and content during the translation and cultural adaptation phases. After psychometric evaluation with 401 participants in seven provinces of Indonesia, we removed two items. The new scale had two forms: (A) patient and (B) community perspective forms. Both forms had good internal consistency, with respective Cronbach's alpha values of 0.738 and 0.807. We identified three loading factors in Form A (disclosure, isolation, and guilty) and two loading factors in Form B (isolation and distancing). The scale showed correlation with PHQ-9 (Form A, rs = 0.347, p < 0.001; Form B, rs = 0). CONCLUSIONS The culturally adapted Indonesian version of Van Rie's TB Stigma Scale is comprehensive, reliable, internally consistent, and valid. The scale is now ready for applied scale-up in research and practice to measure TB-stigma and evaluate the impact of TB-stigma reduction interventions in Indonesia.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430 Indonesia
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, 3015CN Rotterdam, The Netherlands
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan 90245 Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Ant. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Health Behaviour, Environment, and Social Medicine, and Centre of Health Behaviour and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, 16451 Indonesia
| | - Saidah Rauf
- Politeknik Kesehatan Kemenkes Maluku, Maluku, 97711 Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, 78124 Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, 25129 Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, 25128 West Sumatera Indonesia
| | | | - IWayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Bali, 80232 Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Pegangsaan Timur No 16, Jakarta, 10310 Indonesia
- South East Asian Ministers of Education Organization Regional Center for Food and Nutrition, Jakarta, 13120 Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, 171 76 Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP UK
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Bamidele J, Abiodun O, Sodeinde K, Daniel O. Quality of life among tuberculosis patients on treatment in Southwest Nigeria. Indian J Tuberc 2023; 71 Suppl 2:S184-S190. [PMID: 39370181 DOI: 10.1016/j.ijtb.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/05/2022] [Accepted: 04/05/2023] [Indexed: 10/08/2024]
Abstract
BACKGROUND Tuberculosis is still a major public health concern that affects millions of people worldwide. Despite the fact that tuberculosis has a well-established treatment, little attention is paid to the quality of life of TB patients on treatment. Poor quality of life has been linked to lower treatment adherence in patients having TB. As a result, the purpose of this study was to evaluate the quality of life of tuberculosis patients and its associated factors. METHODS The study was a cross-sectional study conducted in Southwest Nigeria among drug-susceptible tuberculosis patients between February and September 2020. The World Health Organization Quality of Life Brief version questionnaire was used to collect data on quality of life (WHOQOL-BREF). A total of 330 people were approached. SPSS version 20 was used to analyze the data. The descriptive data was analyzed using means, standard deviations, and proportions, while the Chi-Square test and binary logistic regression were used to assess the association between variables. P < 0.05 was used to determine statistical significance. RESULTS The respondents' average age was 35.50 ± 11.59 years and most of the respondents (67.9%) were males. The overall mean quality of life was good (4.01 ± 0.529) with the highest score (66.47 ± 10.50) in the environmental domain and the least score (62.88 ± 15.36) in the social domain. There was an association between good quality of life and the patient's length of illness prior to diagnosis (AOR = 0.468, 95% CI = 0.225-0.973). CONCLUSION In line with this study, the overall quality of life of drug-susceptible tuberculosis patients is good and is related to the duration of illness before the diagnosis of tuberculosis was made. Therefore, more efforts should be made to increase awareness of tuberculosis and intensify active case finding to enhance early case detection and a better quality of life.
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Affiliation(s)
- Janet Bamidele
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.
| | - Olumide Abiodun
- Department of Community Medicine, Babcock University, Ilishan, Ogun State, Nigeria
| | - Kolawole Sodeinde
- Department of Community Medicine, Babcock University, Ilishan, Ogun State, Nigeria
| | - Olusoji Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
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Nightingale R, Carlin F, Meghji J, McMullen K, Evans D, van der Zalm MM, Anthony MG, Bittencourt M, Byrne A, du Preez K, Coetzee M, Feris C, Goussard P, Hirasen K, Bouwer J, Hoddinott G, Huaman MA, Inglis-Jassiem G, Ivanova O, Karmadwala F, Schaaf HS, Schoeman I, Seddon JA, Sineke T, Solomons R, Thiart M, van Toorn R, Fujiwara PI, Romanowski K, Marais S, Hesseling AC, Johnston J, Allwood B, Muhwa JC, Mortimer K. Post-TB health and wellbeing. Int J Tuberc Lung Dis 2023; 27:248-283. [PMID: 37035971 PMCID: PMC10094053 DOI: 10.5588/ijtld.22.0514] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 04/11/2023] Open
Abstract
TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.
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Affiliation(s)
- R Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - F Carlin
- Department of Infectious Diseases, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK
| | - J Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Respiratory Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - K McMullen
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Bittencourt
- University Hospital, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - A Byrne
- Department of Thoracic Medicine, St Vincent´s Hospital Clinical School University of New South Wales, Sydney, NSW, Australia
| | - K du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Coetzee
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - C Feris
- Occupational Therapy Department, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Namibia, Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - P Goussard
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - K Hirasen
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Paediatric Pulmonology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Bouwer
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M A Huaman
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - O Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - F Karmadwala
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, Department of Infectious Diseases, Imperial College London, London, UK
| | - T Sineke
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - M Thiart
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R van Toorn
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Tygerberg, South Africa
| | - P I Fujiwara
- Task Force, Global Plan to End TB, 2023-2030, Stop TB Partnership, Geneva, Switzerland
| | - K Romanowski
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - S Marais
- Division of Neurology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa, Neurology Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - B Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine, Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J C Muhwa
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya
| | - K Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals NHS foundation Trust, Liverpool, UK, Department of Medicine, University of Cambridge, Cambridge, UK, Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Morgan CE, Thahir S, Ngimbi P, Mwandagalirwa MK, Ntambua S, Matondo J, Tabala M, Mbendi C, Kaba D, Yotebieng M, Parr JB, Banek K, Thompson P. Participant perspectives to improve tenofovir adherence in the prevention of mother-to-child transmission of hepatitis B virus in Kinshasa, DRC. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.30.23287808. [PMID: 37034729 PMCID: PMC10081418 DOI: 10.1101/2023.03.30.23287808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Prevention of mother-to-child transmission (PMTCT) programs for hepatitis B virus (HBV) are critical to reach the World Health Organization's 2030 HBV elimination goals. Despite demonstrated feasibility utilizing HIV infrastructure, HBV PMTCT programs are not implemented in many African settings, including in the Democratic Republic of Congo (DRC). In a previous pilot of HBV PMTCT implementation in DRC's capital, Kinshasa, we observed low TDF metabolite levels at delivery among women with high-risk HBV who were given tenofovir disoproxil fumarate (TDF) antiviral therapy. As such, we conducted qualitative interviews with women who received TDF to understand facilitators and barriers of medication adherence. We used a modified Information-Motivation-Behavioral Skills model (IMB+) as a framework for thematic content analysis. We found that trust in healthcare workers, familial support, and improved awareness of the disease and treatment options were important facilitators of TDF adherence; pill size, social stigma, and low HBV knowledge were barriers to adherence. While overall acceptance of TDF was high in this pilot, improved TDF adherence is needed in order to reach efficacious levels for preventing transmission from mothers to newborns. We suggest ongoing HBV sensitization within existing maternity and HIV care infrastructure would address gaps in knowledge and stigma identified here. Additionally, given the trust women have towards maternity center staff and volunteers, scaled HBV PMTCT interventions should include specific sensitization and education for healthcare affiliates, who currently receive no HBV prevention or information in DRC. This study is timely as TDF, particularly future long-acting formulations, could be considered as an alternate rather than adjuvant to birth-dose vaccination for HBV PMTCT in sub-Saharan Africa.
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Affiliation(s)
| | - Sahal Thahir
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Patrick Ngimbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Sarah Ntambua
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jolie Matondo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Martine Tabala
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Charles Mbendi
- University Hospital, Kinshasa, Democratic Republic of Congo
| | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Jonathan B Parr
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kristin Banek
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Peyton Thompson
- University of North Carolina at Chapel Hill, Chapel Hill, USA
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DeSanto D, Velen K, Lessells R, Makgopa S, Gumede D, Fielding K, Grant AD, Charalambous S, Chetty-Makkan CM. A qualitative exploration into the presence of TB stigmatization across three districts in South Africa. BMC Public Health 2023; 23:504. [PMID: 36922792 PMCID: PMC10017062 DOI: 10.1186/s12889-023-15407-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) stigma is a barrier to active case finding and delivery of care in fighting the TB epidemic. As part of a project exploring different models for delivery of TB contact tracing, we conducted a qualitative analysis to explore the presence of TB stigma within communities across South Africa. METHODS We conducted 43 in-depth interviews with 31 people with TB and 12 household contacts as well as five focus group discussions with 40 ward-based team members and 11 community stakeholders across three South African districts. RESULTS TB stigma is driven and facilitated by fear of disease coupled with an understanding of TB/HIV duality and manifests as anticipated and internalized stigma. Individuals are marked with TB stigma verbally through gossip and visually through symptomatic identification or when accessing care in either TB-specific areas in health clinics or though ward-based outreach teams. Individuals' unique understanding of stigma influences how they seek care. CONCLUSION TB stigma contributes to suboptimal case finding and care at the community level in South Africa. Interventions to combat stigma, such as community and individual education campaigns on TB treatment and transmission as well as the training of health care workers on stigma and stigmatization are needed to prevent discrimination and protect patient confidentiality.
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Affiliation(s)
- Daniel DeSanto
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Richard Lessells
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
- KwaZulu-Natal Research Innovation & Sequencing Platform, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Dumile Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Centre for General Education, Durban University of Technology, Durban, South Africa
| | - Katherine Fielding
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
| | - Alison D Grant
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- London School of Hygiene & Tropical Medicine, TB Centre, London, UK
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M Chetty-Makkan
- The Aurum Institute, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Egere U, Shayo EH, Chinouya M, Taegtmeyer M, Ardrey J, Mpagama S, Ntinginya NE, Ahmed R, Hussein EH, Sony AE, Wingfield T, Obasi A, Tolhurst R. "Honestly, this problem has affected me a lot": a qualitative exploration of the lived experiences of people with chronic respiratory disease in Sudan and Tanzania. BMC Public Health 2023; 23:485. [PMID: 36915117 PMCID: PMC10010645 DOI: 10.1186/s12889-023-15368-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Over 500 million people live with chronic respiratory diseases globally and approximately 4 million of these, mostly from the low- and middle-income countries including sub-Saharan Africa, die prematurely every year. Despite high CRD morbidity and mortality, only very few studies describe CRDs and little is known about the economic, social and psychological dimensions of living with CRDs in sub-Saharan Africa. We aimed to gain an in-depth understanding of the social, livelihood and psychological dimensions of living with CRD to inform management of CRDs in Sudan and Tanzania. METHOD We conducted 12 in-depth interviews in 2019 with people with known or suspected CRD and 14 focus group discussions with community members in Gezira state, Sudan and Dodoma region, Tanzania, to share their understanding and experience with CRD. The data was analysed using thematic framework analysis. RESULTS People with CRD in both contexts reported experiences under two broad themes: impact on economic wellbeing and impact on social and psychological wellbeing. Capacity to do hard physical work was significantly diminished, resulting in direct and indirect economic impacts for them and their families. Direct costs were incurred while seeking healthcare, including expenditures on transportation to health facility and procurement of diagnostic tests and treatments, whilst loss of working hours and jobs resulted in substantial indirect costs. Enacted and internalised stigma leading to withdrawal and social exclusion was described by participants and resulted partly from association of chronic cough with tuberculosis and HIV/AIDS. In Sudan, asthma was described as having negative impact on marital prospects for young women and non-disclosure related to stigma was a particular issue for young people. Impaired community participation and restrictions on social activity led to psychological stress for both people with CRD and their families. CONCLUSION Chronic respiratory diseases have substantial social and economic impacts among people with CRD and their families in Sudan and Tanzania. Stigma is particularly strong and appears to be driven partly by association of chronic cough with infectiousness. Context-appropriate measures to address economic impacts and chronic cough stigma are urgently needed as part of interventions for chronic respiratory diseases in these sub-Saharan African contexts.
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Affiliation(s)
- Uzochukwu Egere
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK.
| | - Elizabeth H Shayo
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Martha Chinouya
- Faculty of Education, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
- Tropical Infectious Diseases Unit, Royal Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, UK
| | - Jane Ardrey
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
| | - Stellah Mpagama
- Kibong'oto Infectious Diseases Hospital, Mae Street, Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | | | - Rana Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
| | | | | | - Tom Wingfield
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
- Tropical Infectious Diseases Unit, Royal Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
- Honorary Consultant in HIV and Genitourinary Medicine, AXESS Clinic, The Royal Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, L3 5QA, Liverpool, UK
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Keter AK, Lynen L, Van Heerden A, Wong E, Reither K, Goetghebeur E, Jacobs BKM. Evaluation of tuberculosis diagnostic test accuracy using Bayesian latent class analysis in the presence of conditional dependence between the diagnostic tests used in a community-based tuberculosis screening study. PLoS One 2023; 18:e0282417. [PMID: 36862729 PMCID: PMC9980779 DOI: 10.1371/journal.pone.0282417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 03/03/2023] Open
Abstract
Diagnostic accuracy studies in pulmonary tuberculosis (PTB) are complicated by the lack of a perfect reference standard. This limitation can be handled using latent class analysis (LCA), assuming independence between diagnostic test results conditional on the true unobserved PTB status. Test results could remain dependent, however, e.g. with diagnostic tests based on a similar biological basis. If ignored, this gives misleading inferences. Our secondary analysis of data collected during the first year (May 2018 -May 2019) of a community-based multi-morbidity screening program conducted in the rural uMkhanyakude district of KwaZulu Natal, South Africa, used Bayesian LCA. Residents of the catchment area, aged ≥15 years and eligible for microbiological testing, were analyzed. Probit regression methods for dependent binary data sequentially regressed each binary test outcome on other observed test results, measured covariates and the true unobserved PTB status. Unknown model parameters were assigned Gaussian priors to evaluate overall PTB prevalence and diagnostic accuracy of 6 tests used to screen for PTB: any TB symptom, radiologist conclusion, Computer Aided Detection for TB version 5 (CAD4TBv5≥53), CAD4TBv6≥53, Xpert Ultra (excluding trace) and culture. Before the application of our proposed model, we evaluated its performance using a previously published childhood pulmonary TB (CPTB) dataset. Standard LCA assuming conditional independence yielded an unrealistic prevalence estimate of 18.6% which was not resolved by accounting for conditional dependence among the true PTB cases only. Allowing, also, for conditional dependence among the true non-PTB cases produced a 1.1% plausible prevalence. After incorporating age, sex, and HIV status in the analysis, we obtained 0.9% (95% CrI: 0.6, 1.3) overall prevalence. Males had higher PTB prevalence compared to females (1.2% vs. 0.8%). Similarly, HIV+ had a higher PTB prevalence compared to HIV- (1.3% vs. 0.8%). The overall sensitivity for Xpert Ultra (excluding trace) and culture were 62.2% (95% CrI: 48.7, 74.4) and 75.9% (95% CrI: 61.9, 89.2), respectively. Any chest X-ray abnormality, CAD4TBv5≥53 and CAD4TBv6≥53 had similar overall sensitivity. Up to 73.3% (95% CrI: 61.4, 83.4) of all true PTB cases did not report TB symptoms. Our flexible modelling approach yields plausible, easy-to-interpret estimates of sensitivity, specificity and PTB prevalence under more realistic assumptions. Failure to fully account for diagnostic test dependence can yield misleading inferences.
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Affiliation(s)
- Alfred Kipyegon Keter
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Alastair Van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily Wong
- Africa Health Research Institute, Durban, South Africa
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Bart K. M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
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Chaychoowong K, Watson R, Barrett DI. Perceptions of stigma among pulmonary tuberculosis patients in Thailand, and the links to delays in accessing healthcare. J Infect Prev 2023; 24:77-82. [PMID: 36815061 PMCID: PMC9940242 DOI: 10.1177/17571774231152720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Background Delay in seeking care increases the morbidity and mortality in tuberculosis (TB) patients and leads to increased likelihood of transmission within the community. Stigmatisation is one of the influencing factors causing delay in accessing healthcare when experiencing symptoms of TB. Objective This study aimed to explore the relationship between TB stigmatisation and patient delay among pulmonary tuberculosis (PTB) patients. Methods A mixed methods study was undertaken among 300 randomly sampled participants who completed questionnaire surveys, supplemented by 25 in-depth interviews with purposively-sampled participants identified as delaying access to healthcare. Results Participants reporting higher perceived levels of TB stigmatisation demonstrated a longer duration of patient delay (p < 0.001). Qualitative data reinforced the view that perceptions of TB as being a disease carrying with it a stigma contributed to a delay in seeking healthcare. This was also exacerbated in patients with HIV-positive. Given that HIV-positive status is still subject to stigma in some parts of society, patients demonstrated additional reluctance to seek out healthcare if they were known to be HIV-positive whilst also experiencing symptoms of TB. Discussion The study highlights that accurate and objective information about TB is required to reduce societal stigmatisation related to the disease, thereby reducing the reluctance of patients to access healthcare.
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Affiliation(s)
| | - Roger Watson
- Faculty of Health Sciences, University of Hull, Hull, UK
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Teo AKJ, Rahevar K, Morishita F, Ang A, Yoshiyama T, Ohkado A, Kawatsu L, Yamada N, Uchimura K, Choi Y, Chen Z, Yi S, Yanagawa M, Oh KH, Viney K, Marais B, Kim H, Kato S, Liu Y, Ong CW, Islam T. Tuberculosis in older adults: case studies from four countries with rapidly ageing populations in the western pacific region. BMC Public Health 2023; 23:370. [PMID: 36810018 PMCID: PMC9942033 DOI: 10.1186/s12889-023-15197-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The Western Pacific Region has one of the fastest-growing populations of older adults (≥ 65 years) globally, among whom tuberculosis (TB) poses a particular concern. This study reports country case studies from China, Japan, the Republic of Korea, and Singapore reflecting on their experiences in managing TB among older adults. FINDINGS Across all four countries, TB case notification and incidence rates were highest among older adults, but clinical and public health guidance focused on this population was limited. Individual country reports illustrated a range of practices and challenges. Passive case finding remains the norm, with limited active case finding (ACF) programs implemented in China, Japan, and the Republic of Korea. Different approaches have been trialled to assist older adults in securing an early diagnosis, as well as adhering to their TB treatment. All countries emphasised the need for person-centred approaches that include the creative application of new technology and tailored incentive programs, as well as reconceptualisation of how we provide treatment support. The use of traditional medicines was found to be culturally entrenched among older adults, with a need for careful consideration of their complementary use. TB infection testing and the provision of TB preventive treatment (TPT) were underutilised with highly variable practice. CONCLUSION Older adults require specific consideration in TB response policies, given the burgeoning aging population and their high TB risk. Policymakers, TB programs and funders must invest in and develop locally contextualised practice guidelines to inform evidence-based TB prevention and care practices for older adults.
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Affiliation(s)
- Alvin Kuo Jing Teo
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Kalpeshsinh Rahevar
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines.
| | - Fukushi Morishita
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Alicia Ang
- grid.508010.cDivision of Infectious Diseases, Department of Medicine, Woodlands Health, Singapore, Singapore
| | - Takashi Yoshiyama
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Akihiro Ohkado
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Lisa Kawatsu
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Norio Yamada
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Kazuhiro Uchimura
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Youngeun Choi
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Zi Chen
- Office of International Cooperation, Innovation Alliance on Tuberculosis Diagnosis and Treatment, Beijing, China
| | - Siyan Yi
- grid.4280.e0000 0001 2180 6431Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore ,grid.513124.00000 0005 0265 4996KHANA Center for Population Health Research, Phnom Penh, Cambodia ,grid.265117.60000 0004 0623 6962Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA USA
| | - Manami Yanagawa
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kyung Hyun Oh
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kerri Viney
- grid.3575.40000000121633745Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Ben Marais
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney Institute for Infectious Diseases (Sydney ID) and the Centre of Research Excellence in Tuberculosis (TB-CRE), Sydney, NSW Australia
| | - Heejin Kim
- Korean National Tuberculosis Association, Seoul, Republic of Korea
| | - Seiya Kato
- grid.419151.90000 0001 1545 6914Research Institute of Tuberculosis, Anti-Tuberculosis Association, Tokyo, Japan
| | - Yuhong Liu
- grid.24696.3f0000 0004 0369 153XBeijing Chest Hospital, Capital Medical University, Beijing, China
| | - Catherine W.M. Ong
- grid.412106.00000 0004 0621 9599Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Tauhid Islam
- grid.483407.c0000 0001 1088 4864World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
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Mavragani A, Alam K, Gyawali P, Mahumud RA. Examining Drug-Resistant Tuberculosis Stigma Among Health Care Workers Toward the Development of a Stigma-Reduction Intervention: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e43084. [PMID: 36637899 PMCID: PMC9883742 DOI: 10.2196/43084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DRTB) is an increasing threat to human health and economic security worldwide. Exacerbating the severity of DRTB is the low rate of service delivery, leading to increased community transmission of the disease, further amplified by stigma. Health workers are on the front line of service delivery; their efforts in all areas of disease control are suspected of having resulted in stigmatization, impacting patient-centered care. As a growing concern, attention to addressing the DRTB stigma confronting health workers is required. However, little is known about stigma among health workers delivering services to patients with DRTB. This scoping review will provide an overview that could help inform appropriate responses toward stigma-reduction interventions for these health workers. OBJECTIVE This scoping review protocol articulates a methodology that will examine the facets of DRTB-related stigma confronting health workers in high TB- and DRTB-burdened countries. This scoping review will (1) summarize stigma barriers and facilitators contributing to stigmatization among health workers delivering services to patients with DRTB, (2) identify the most common stigma barrier and facilitator, and (3) summarize the stigma-reduction intervention recommendations in the studies. METHODS Guided by Arksey and O'Malley's framework and the recommendations of Munn et al, we will conduct a scoping review of relevant literature providing evidence of DRTB-related stigma among health workers from countries with a high burden of tuberculosis (TB) and DRTB. We will search published articles written in English from 2010 onward in electronic databases using Medical Subject Headings and keywords. Our search will apply a 3-step search strategy and use software tools to manage references and facilitate the entire scoping review process. The findings of our review will be presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist. Our study is registered with Open Science Framework Registries. RESULTS This scoping review is part of a bigger project that will critically investigate stigma among health workers delivering services to patients resistant to TB medications. This study began in November 2021 and is expected to finish in 2023. The study has retrieved 593 abstracts out of 12,138 articles searched since February 2022 from the identified databases. The findings of this study will be published in a peer-reviewed journal. CONCLUSIONS This review will provide an outline of the aspects of DRTB-related stigma confronting health workers. The findings of this review could help inform appropriate responses toward stigma-reduction interventions for these health workers. This is significant because interventions addressing related TB (and DRTB) stigma in the workplace are lacking. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43084.
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Affiliation(s)
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Prajwal Gyawali
- School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Rashidul Alam Mahumud
- National Health and Medical Research Council Clinical Trial Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ma J, Vongpradith A, Ledesma JR, Novotney A, Yi S, Lim K, Hay SI, Murray CJL, Kyu HH. Progress towards the 2020 milestones of the end TB strategy in Cambodia: estimates of age and sex specific TB incidence and mortality from the Global Burden of Disease Study 2019. BMC Infect Dis 2022; 22:904. [PMID: 36463098 PMCID: PMC9719136 DOI: 10.1186/s12879-022-07891-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Cambodia was recently removed from the World Health Organization's (WHO's) top 30 high tuberculosis (TB) burden countries. However, Cambodia's TB burden remains substantial, and the country is on the WHO's new global TB watchlist. We aimed to examine the levels and trends in the fatal and non-fatal TB burden in Cambodia from 1990 to 2019, assessing progress towards the WHO End TB interim milestones, which aim to reduce TB incidence rate by 20% and TB deaths by 35% from 2015 to 2020. METHODS We leveraged the Global Burden of Disease 2019 (GBD 2019) analytical framework to compute age- and sex-specific TB mortality and incidence by HIV status in Cambodia. We enumerated TB mortality utilizing a Bayesian hierarchical Cause of Death Ensemble modeling platform. We analyzed all available data sources, including prevalence surveys, population-based tuberculin surveys, and TB cause-specific mortality, to produce internally consistent estimates of incidence and mortality using a compartmental meta-regression tool (DisMod-MR 2.1). We further estimated the fraction of tuberculosis mortality among individuals without HIV coinfection attributable to the independent effects of alcohol use, smoking, and diabetes. RESULTS In 2019, there were 6500 (95% uncertainty interval 4830-8680) deaths due to all-form TB and 50.0 (43.8-57.8) thousand all-form TB incident cases in Cambodia. The corresponding age-standardized rates were 53.3 (39.9-69.4) per 100,000 population for mortality and 330.5 (289.0-378.6) per 100,000 population for incidence. From 2015 to 2019, the number of all-form TB deaths decreased by 11.8% (2.3-21.1), while the age-standardized all-form TB incidence rate decreased by 11.1% (6.3-15.6). Among individuals without HIV coinfection in 2019, alcohol use accounted for 28.1% (18.2-37.9) of TB deaths, smoking accounted for 27.0% (20.2-33.3), and diabetes accounted for 12.5% (7.1-19.0). Removing the combined effects of these risk factors would reduce all-form TB deaths by 54.2% (44.2-62.2). DISCUSSION Despite significant progress in reducing TB morbidity and mortality since 1990, Cambodia is not on track to achieve the 2020 WHO End TB interim milestones. Existing programs in Cambodia can benefit from liaising with risk factor control initiatives to accelerate progress toward eliminating TB in Cambodia.
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Affiliation(s)
- Jianing Ma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
| | - Jorge R Ledesma
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
| | - Amanda Novotney
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA
| | - Kruy Lim
- Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15Th Ave. NE, Seattle, WA, 98195, USA.
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
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Kraaijeveld SR, Jamrozik E. Moralization and Mismoralization in Public Health. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:655-669. [PMID: 36045179 PMCID: PMC9432796 DOI: 10.1007/s11019-022-10103-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/09/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022]
Abstract
Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of 'mismoralization', which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example (tuberculosis) and two contemporary cases related to COVID-19 (infection and vaccination status) that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize-as individuals and as social groups-whenever and wherever moralization is unjustified.
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Affiliation(s)
| | - Euzebiusz Jamrozik
- Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative, Johns Hopkins University, Baltimore, United States
- Ethox and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
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Atkins S, Heimo L, Carter DJ, Ribas Closa M, Vanleeuw L, Chenciner L, Wambi P, Sidney-Annerstedt K, Egere U, Verkuijl S, Brands A, Masini T, Viney K, Wingfield T, Lönnroth K, Boccia D. The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework. BMC Public Health 2022; 22:2153. [PMID: 36419146 PMCID: PMC9686126 DOI: 10.1186/s12889-022-14579-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents. OBJECTIVES To increase knowledge of the socioeconomic impact of TB on children and adolescents. METHODS We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically. RESULTS Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group. CONCLUSION The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.
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Affiliation(s)
- S Atkins
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - L Heimo
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - D J Carter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M Ribas Closa
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - L Vanleeuw
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - L Chenciner
- Royal Free London NHS Foundation Trust, London, UK
| | - P Wambi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K Sidney-Annerstedt
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - U Egere
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Verkuijl
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A Brands
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Masini
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - K Viney
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Wingfield
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - K Lönnroth
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - D Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Huq KATME, Moriyama M, Krause D, Shirin H, Awoonor-Willaims JK, Rahman M, Rahman MM. Perceptions, Attitudes, Experiences and Opinions of Tuberculosis Associated Stigma: A Qualitative Study of the Perspectives among the Bolgatanga Municipality People of Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14998. [PMID: 36429715 PMCID: PMC9690500 DOI: 10.3390/ijerph192214998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) is the tenth leading cause of death worldwide. About 1.3 million people die from TB each year, and most of them are in developing countries. The stigma associated with TB is a barrier to seeking treatment and adequate care. It causes a delay in treatment-seeking and diagnosis and thus decreases the likelihood of being cured and ultimately leads to death. The objective of this study was to explore the perceptions, attitudes, experiences, and opinions about stigma related to TB among adults infected with TB and adults who were not infected with TB. Our study was qualitative in nature. The study was conducted in the community of Bolgatanga municipality of the upper-east region of Ghana. Three focus group discussions (FGDs) were conducted; one with six TB-infected females, one with seven TB-infected males, and one with six non-TB-infected participants. Data were analyzed using qualitative content analysis and presented in pre-defined and/or emerging themes: perception about signs and symptoms observed by TB infected person, attitudes towards TB patients before and after diagnosis, reasons for stigmatization, perception about diagnostic testing, and taking the drugs. Transcripts of the discussions were read, and a list of meanings for units, codes, and themes was generated on the research question. We identified the existence of stigma associated with TB. TB-infected male patients had more autonomy in decision-making about receiving treatment and other family matters compared to female TB patients. TB-infected women suffered more economic vulnerability due to the loss of their work, and the stigma was worsened due to delayed diagnosis and treatment, and they were regarded as liabilities rather than assets. TB-infected patients became stigmatized because non-TB-infected community participants did not want to come into close contact with them. Our findings suggest heightening of advocacy, communication, social mobilization, and health education on TB in the community of Bolgatanga municipality is needed to allay TB-related stigma, especially for women.
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Affiliation(s)
- K. A. T. M. Ehsanul Huq
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - David Krause
- Clinical Research Center, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Habiba Shirin
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | | | - Mahfuzur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
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