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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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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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Storvig E, Harstad I, Ehrnström B, Iversen VC. Beyond the diagnosis of drug-resistant Tuberculosis in Norway: patients' experiences before, during and after treatment. BMC Public Health 2024; 24:1801. [PMID: 38971760 PMCID: PMC11227233 DOI: 10.1186/s12889-024-19342-8] [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: 03/07/2024] [Accepted: 07/02/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND This study aims to explore the varied experiences of patients with drug-resistant tuberculosis in Norway. The study emphasizes challenges and implications of being diagnosed with drug-resistant tuberculosis, including the impact on psychosocial health during the diagnosis, disease, treatment, isolation and recovery phases. Norway is a low endemic country of tuberculosis. Most patients are immigrants, and some of them have recently arrived in the country. Patients undergoing treatment for drug-resistant tuberculosis endure prolonged and demanding treatment that could affect their psychosocial health. METHODS This qualitative study conducted 16 in-depth interviews with individuals aged 18 years and above who were diagnosed with drug-resistant tuberculosis. All participants completed the treatment between 2008 and 2020. Fourteen participants were immigrants, and eight of them had resided in Norway for less than four years before diagnosis. Data analysis followed the six-phase reflexive thematic analysis framework, focusing on identifying patterns in participants' experiences, thoughts, expectations and attitudes. RESULTS The narratives of the participants highlighted the complexities of navigating the diagnosis of drug-resistant tuberculosis, treatment, side effects and life after treatment. Immigrants encountered additional challenges, including language barriers and adapting to new social environments. All participants reported experiencing physical health issues that additionally affected their mental health and social activity. Several participants had a delayed or prolonged diagnosis that complicated their disease trajectory. Participants with suspected or confirmed contagious pulmonary tuberculosis underwent hospital isolation for periods ranging from weeks to six months. The participants reported mental health issues, social isolation and stigma, however few were offered follow-up by a psychologist. Many participants had persistent problems at the time of the interviews. Three main themes emerged from the analysis: Delayed and prolonged diagnosis; Psychosocial impact of isolation during treatment; The life after tuberculosis. CONCLUSION This study highlights the enduring impact of drug-resistant tuberculosis on patients and the significance of timely diagnosis, psychosocial support and post-treatment follow-up. The participants universally faced serious implications of the disease, including stigma and isolation. Participants who experienced delayed diagnosis, reflected on missed early intervention opportunities. We recommend further research in low endemic countries to evaluate the international and local recommendations on psychosocial support.
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Affiliation(s)
- Eline Storvig
- Department of Infectious Diseases, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Ingunn Harstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU),, Trondheim, Norway
- Department of Pulmonary Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Birgitta Ehrnström
- Department of Infectious Diseases, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Mid-Norway Group for Sepsis Research, Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Valentina C Iversen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Nidelv Mental Health Center, St. Olavs University Hospital, Trondheim, Norway
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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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5
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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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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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7
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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, Westhuizen HM, Friedland JS, Marino-Medina 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 TB stigma intervention design. RESEARCH SQUARE 2023:rs.3.rs-3716733. [PMID: 38168425 PMCID: PMC10760241 DOI: 10.21203/rs.3.rs-3716733/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: 01/05/2024]
Abstract
Background Though 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 further conducted 25 in-depth interviews with PWTB (n=22) and caregivers TB (n=3). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organised using the CARD (Constraints, Actions, Risks and Desires) framework. Results Surveys revealed at least one-third of PWTB and one-quarter of caregivers report experiences of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in rural locations (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, and 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and in concert as key constraints to impede care, and underpins failure to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through 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 wellbeing. Participants desired counselling, identifying a specific role for TB survivors as peer counsellors, 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 indicator rather than intermediary contributor to poor cascade outcomes. Multicomponent stigma interventions are needed, including counselling 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.
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Affiliation(s)
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | - Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Michaile G Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | | | | | | | | | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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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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9
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Ramos JP, Vieira M, Pimentel C, Argel M, Barbosa P, Duarte R. Building bridges: multidisciplinary teams in tuberculosis prevention and care. Breathe (Sheff) 2023; 19:230092. [PMID: 37719241 PMCID: PMC10501709 DOI: 10.1183/20734735.0092-2023] [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: 04/20/2023] [Accepted: 06/07/2023] [Indexed: 09/19/2023] Open
Abstract
People with or affected by tuberculosis (TB) experience complex social and cultural constraints that may affect treatment outcomes by impeding access to proper care or by hindering treatment adherence. Low levels of health literacy which leads to inadequate disease information; stigma, discrimination and other forms of prejudice that may result in marginalisation and ostracisation; and socioeconomic vulnerabilities that hamper one's capacity to access essential goods or increase the risk of exposure to the disease are some of the barriers highlighted. These complex hurdles are also disproportionately felt by people with or affected by TB due to gender-related inequalities that need to be properly addressed. Additionally, TB prevention and care should encompass interventions aimed at improving and promoting mental health, given that mental unhealth may further thwart treatment adherence and success. A multifaceted and multidisciplinary approach to TB is required to answer these complex barriers.
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Affiliation(s)
- João Pedro Ramos
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Mariana Vieira
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | | | - Pedro Barbosa
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- Departamento de Estudos das Populações, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
- EPI Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Unidade de Investigaçao Clínica da Administraçao Regional de Saúde do Norte, Porto, Portugal
- Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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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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Fekih-Romdhane F, Obeid S, Chidiac G, Dabbous M, Malaeb D, Hallit R, Hallit S. Measuring public attitudes towards people living with chronic diseases in Arabic-speaking populations: adaptation and development of the Social Stigma Scale of Chronic Diseases (SSS-CD). BMC Public Health 2023; 23:1375. [PMID: 37464332 DOI: 10.1186/s12889-023-16315-1] [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: 01/09/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND A large proportion of the population in Arab countries suffer from chronic diseases. According to the statistics by the Global Health Estimates, chronic illnesses contribute by 71% to total deaths in the Arab region. While chronic illnesses have been demonstrated to carry high levels of social stigma, it is only recently that little research attention has been given to this topic in the Arab world. It is well-established that the social stigma construct is culturally-dependent. Therefore, the lack of an Arabic measure highlighted the urgent need for developing a culturally adapted and valid instrument to assess social stigma toward people living with chronic diseases. In this study, we aimed to examine the psychometric properties of the Arabic translation, adaptation and development of "the Social Stigma Scale of Chronic Diseases" (SSS-CD). METHOD Fifteen items derived from the literature and assessing social stigma towards chronic diseases have been administered to 570 Arabic-speaking adults from the Lebanese general population (aged 24.59 ± 6.75years; 68.6% women). Items were translated into Arabic using a forward-backward translation method. Exploratory factor analysis (EFA) using a principal-axis EFA on the first split-half subsample, followed by a confirmatory factor analysis (CFA) tested on the model extracted from the EFA on the second split-half subsample, were conducted to examine the construct validity of the SSS-CD. Fit indices were deemed adequate if the normed model chi-square (χ²/df) ≤ 3, the Steiger-Lind root mean square error of approximation (RMSEA) ≤ 0.08, the Tucker-Lewis Index (TLI) and the comparative fit index (CFI) ≥ 0.90. RESULTS Findings revealed that the 10-item SSS-CD has a unidimensional factor structure, with the following fit indices: χ2/df = 92.95/34 = 2.73, RMSEA = 0.077 (90% CI 0.059, 0.096), SRMR = 0.062, CFI = 0.939, TLI = 0.919. A good internal consistency was demonstrated by a McDonald's omega value of 0.73 for the total score. Findings also supported invariance across gender, with men exhibiting higher levels of social stigma attached to chronic diseases than women. All three dimensions of stigmatization (social, psychological and evolutionary stigmatization) were positively correlated with SSS-CD scores (Social self-interest [r = .40; p < .001], Evolutionary self-interest [r = .37; p < .001], Psychological self-interest [r = .42; p < .001]), demonstrating relatively strong convergent validity. CONCLUSION Our findings suggest that the SSS-CD has robust psychometric qualities. We thus preliminarily suggest that the scale is valid, reliable and suitable for use among Arabic-speaking people from the general population to measure public attitudes towards people living with chronic diseases. Providing this psychometrically sound measure will hopefully enable to foster research in this area in order to draw a clear overview of the prevalence and characteristics of social stigma attached to chronic diseases in Arabic-speaking communities. However, given that this was the first study to examine the psychometric properties of the SSS-CD, the present findings and conclusions should be considered tentative pending future cross-national validation studies.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Georgio Chidiac
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Dermatology, University Claude Bernard Lyon 1, Lyon, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Rabih Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Infectious Disease, Bellevue Medical Center, Mansourieh, Lebanon
- Department of Infectious Disease, Notre Dame des Secours University Hospital Center, Street 93, Byblos, Postal Code 3, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Washington R, Ramanaik S, Kumarasamy K, Sreenivasa PB, Adepu R, Reddy RC, Shah A, Swamickan R, Maryala BK, Mukherjee A, Pujar A, Panibatla V, Lakkappa MH, Potty RS. A mixed methods evaluation of a differentiated care model piloted for TB care in south India. J Public Health Res 2023; 12:22799036231197176. [PMID: 37746516 PMCID: PMC10515523 DOI: 10.1177/22799036231197176] [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: 10/03/2022] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background India's National TB Elimination Program emphasizes patient-centered care to improve TB treatment outcomes. We describe the lessons learned from the implementation of a differentiated care model for TB care among individuals diagnosed with active TB. Design and methods Used mixed methods to pilot the Differentiated Care Model. Community health workers (CHWs) conducted a risk and needs assessment among individuals who were recently began TB treatment. Individuals identified with specific factors that are associated with poor treatment adherence were provided education, counseling, and linked to treatment and support services. Examined changes in TB treatment outcomes between the two cohorts of individuals on TB treatment before and after the intervention. We used qualitative research methods to explore the experiences of patients, family members, and front-line TB workers with the implementation of the DCM pilot. Results The CHWs were adept at the identification of individuals with risks to non-adherence. However, only a few provided differentiated care, as envisioned. There was no significant change in the TB treatment outcomes between the two cohorts of patients examined. CHWs' ability to provide differentiated care on a scale was limited by the short duration of implementation, their inadequate skills to manage co-morbidities, and the suboptimal support at the field level. Conclusions It is feasible for a cadre of well-trained front-line workers, mentored and supported by counselors and doctors, to provide differentiated care to those at risk for unfavorable TB treatment outcomes. However, differentiated care must be implemented on a scale for a duration that allows a change from the conventional practice of front-line workers, in order to influence the outcomes of population-level TB treatment.
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Affiliation(s)
- Reynold Washington
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- St John’s Research Institute, Bengaluru, Karnataka, India
| | | | | | | | - Rajesham Adepu
- Office of the Joint Director (TB), Commissionerate of Health and Family Welfare, Hyderabad, Telangana, India
| | - Ramesh Chandra Reddy
- Office of the Joint Director (TB), Lady Willingdon State TB Centre, Bengaluru, Karnataka, India
| | - Amar Shah
- Tuberculosisi and Infectious Diseases Division, USAID/India, New Delhi, India
| | - Reuben Swamickan
- Tuberculosisi and Infectious Diseases Division, USAID/India, New Delhi, India
| | | | | | - Ashwini Pujar
- Karnataka Health Promotion Trust, Bengaluru, Karnataka, India
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Shamputa IC, Law MA, Kelly C, Nguyen DTK, Burdo T, Umar J, Barker K, Webster D. Tuberculosis related barriers and facilitators among immigrants in Atlantic Canada: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001997. [PMID: 37276222 DOI: 10.1371/journal.pgph.0001997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
Tuberculosis (TB) is a disease caused by the bacterium Mycobacterium tuberculosis and affects approximately one-quarter of the world's population. Immigrant populations in Canada are disproportionately affected by TB. Canada's immigration medical examinations include screening for active TB but not latent TB infection (LTBI). In LTBI, the bacterium remains dormant within the host but can reactivate and cause disease. Once active, TB can be transmitted to close contacts sharing confined spaces leading to the possibility of outbreaks in the broader community. This study aimed to 1) assess the current TB knowledge, perceived risk, and risk behaviors of immigrants in Atlantic Canada as well as 2) identify barriers and facilitators to testing and treatment of TB among this population. Three focus group discussions were conducted with a total of 14 non-Canadian born residents of New Brunswick aged 19 years and older. Data were analyzed using inductive thematic analysis. Four themes were identified from the data relating to barriers to testing and treatment of LTBI: 1) Need for education, 2) stigma, 3) fear of testing, treatment, and healthcare system, and 4) complacency. Results included reasons individuals would not receive TB testing, treatment, or seek help, as well as facilitators to testing and treatment. These findings may inform the implemention of an LTBI screening program in Atlantic Canada and more broadly across the country.
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Affiliation(s)
- Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira A Law
- Department of Psychology, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Clara Kelly
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Duyen Thi Kim Nguyen
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
- Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Tatum Burdo
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Jabran Umar
- Dalhousie University New Brunswick, MD Program, Saint John, New Brunswick, Canada
| | - Kimberley Barker
- Government of New Brunswick, Department of Health, Saint John, New Brunswick, Canada
| | - Duncan Webster
- Division of Microbiology, Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Dalhousie Medicine New Brunswick, Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- Division of Infectious Diseases, Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
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Sattler S, Maskileyson D, Racine E, Davidov E, Escande A. Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis. BMC Public Health 2023; 23:521. [PMID: 36934221 PMCID: PMC10024019 DOI: 10.1186/s12889-023-15234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/07/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization. METHODS We conducted a multifactorial vignette survey experiment (28-design, i.e., NVignettes = 256) in Germany (NRespondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19. RESULTS Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less. CONCLUSION Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.
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Affiliation(s)
- Sebastian Sattler
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany.
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany.
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Quebec, QC, Canada.
| | - Dina Maskileyson
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Quebec, QC, Canada
- Department of Medicine, Université de Montréal, Quebec, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Quebec, Canada
| | - Eldad Davidov
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
- University of Zurich and University Research Priority Program "Social Networks", Zurich, Switzerland
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15
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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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Andrade A, D’Oliveira A, De Souza LC, Bastos ACRDF, Dominski FH, Stabile L, Buonanno G. Effects of Air Pollution on the Health of Older Adults during Physical Activities: Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3506. [PMID: 36834200 PMCID: PMC9960154 DOI: 10.3390/ijerph20043506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Atmospheric pollutants present environmental threats to health and have been investigated in different environments, such as highways, squares, parks, and gyms. These environments are frequented by older adults, who are considered fragile to the harmful impacts of pollution present in the air. The aim was to analyze the state of the art on the effects of air pollution on the health of older adults during physical activities (PAs) through a mapping review. The search was performed in PubMed, Web of Science, Scopus, and Cinahl databases until June 2022. Of the 10,109 studies initially identified, 58 met the inclusion criteria. The most investigated health outcome was cardiovascular disease, followed by respiratory outcomes. Particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and ozone (O3) were the most investigated pollutants. Of the 75 health outcomes investigated, in 29, air pollution had harmful effects on the health of the older adults during the practice of PA, more frequently in cardiovascular diseases. In 25 outcomes, the beneficial effects of PA to the health of the older adults remained, despite exposure to high and low concentrations of pollutants, most often in terms of mental disorders. We conclude that poor air quality is a harmful factor for the health of older adults during the practice of PAs, more frequently in cardiovascular and respiratory diseases. On the other hand, for mental-health-related outcomes (depression and cognition), in most studies, the beneficial effects of PA in older adults were maintained, even after exposure to pollutants.
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Affiliation(s)
- Alexandro Andrade
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianópolis 88035-901, Brazil
| | - Anderson D’Oliveira
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianópolis 88035-901, Brazil
| | - Loiane Cristina De Souza
- Health and Sports Science Center, Department of Physical Education, CEFID, Santa Catarina State University, Florianópolis 88035-901, Brazil
| | | | - Fábio Hech Dominski
- Department of Physical Education, Univille University, Joinville 89219-710, Brazil
| | - Luca Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, Italy
| | - Giorgio Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, Italy
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane 4001, Australia
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Ryckman T, Robsky K, Cilloni L, Zawedde-Muyanja S, Ananthakrishnan R, Kendall EA, Shrestha S, Turyahabwe S, Katamba A, Dowdy DW. Ending tuberculosis in a post-COVID-19 world: a person-centred, equity-oriented approach. THE LANCET. INFECTIOUS DISEASES 2023; 23:e59-e66. [PMID: 35963272 PMCID: PMC9365311 DOI: 10.1016/s1473-3099(22)00500-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic has disrupted systems of care for infectious diseases-including tuberculosis-and has exposed pervasive inequities that have long marred efforts to combat these diseases. The resulting health disparities often intersect at the individual and community levels in ways that heighten vulnerability to tuberculosis. Effective responses to tuberculosis (and other infectious diseases) must respond to these realities. Unfortunately, current tuberculosis programmes are generally not designed from the perspectives of affected individuals and fail to address structural determinants of health disparities. We describe a person-centred, equity-oriented response that would identify and focus on communities affected by disparities, tailor interventions to the mechanisms by which disparities worsen tuberculosis, and address upstream determinants of those disparities. We detail four key elements of the approach (data collection, programme design, implementation, and sustainability). We then illustrate how organisations at multiple levels might partner and adapt current practices to incorporate these elements. Such an approach could generate more substantial, sustainable, and equitable reductions in tuberculosis burden at the community level, highlighting the urgency of restructuring post-COVID-19 health systems in a more person-centred, equity-oriented way.
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Affiliation(s)
- Theresa Ryckman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Katherine Robsky
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Lucia Cilloni
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emily A Kendall
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sourya Shrestha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda; Center for Tuberculosis Research, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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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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19
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Bedingfield N, Lashewicz B, Fisher D, King-Shier K. Canadian tuberculosis health care workers' perspectives on education and counselling for patients and family members who are born outside of Canada. Glob Public Health 2023; 18:2174265. [PMID: 36789497 DOI: 10.1080/17441692.2023.2174265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Tuberculosis health care workers (TB HCWs) in low incidence settings have important perspectives on providing TB education and counselling to patients and family members born in other countries. The purpose of this qualitative study was to explore HCWs' perspectives on barriers and facilitators for capacity-building education and counselling with patients and family members born outside of Canada experiencing advanced infectious TB in Calgary, a city in western Canada. Data were collected through semi-structured interviews and field notes and thematically analysed. Twenty-four HCWs representing clerical staff, nurses, physicians, and allied health professionals employed in TB care were interviewed. HCWs described how multi-level barriers such as patients' fear of death, complex intra-family communication, information-laden appointments, and patients' precarious employment collided resulting in overwhelmed patients and reduced connection to family. Some HCWs were unsure how to discuss TB stigma with patients and family members. HCWs perceived that increased continuity of care and providing patients and family members with digestible amounts of information earlier were important steps towards better practice. HCWs identified that patients and families could benefit from preparation for initial appointments, increased continuity, and improved patient education materials. HCWs should also receive skills-training to facilitate individual and family counselling.
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Affiliation(s)
- Nancy Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Dina Fisher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathryn King-Shier
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Nursing, University of Calgary, Calgary, Canada
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20
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Foster I, Galloway M, Human W, Anthony M, Myburgh H, Vanqa N, Wademan DT, Makanda G, Tisile P, Schoeman I, Hoddinott G, Nathavitharana RR. Analysing interventions designed to reduce tuberculosis-related stigma: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000989. [PMID: 36962638 PMCID: PMC10022226 DOI: 10.1371/journal.pgph.0000989] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/08/2022] [Indexed: 03/17/2023]
Abstract
Stigma is a critical barrier for TB care delivery; yet data on stigma reduction interventions is limited. This review maps the available literature on TB stigma reduction interventions, using the Health Stigma and Discrimination framework and an implementation analysis to identify research gaps and inform intervention design. Using search terms for TB and stigma, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data, conducted a quality assessment, and assessed implementation. Results were categorized by socio-ecological level, then sub-categorized by the stigma driver or manifestation targeted. After screening 1865 articles, we extracted data from nine. Three studies were implemented at the individual and interpersonal level using a combination of TB clubs and interpersonal support to target internal and anticipated stigma among persons with TB. Two studies were implemented at the interpersonal level using counselling or a video based informational tool delivered to households to reduce stigma drivers and manifestations. Three studies were implemented at the organizational level, targeting drivers of stigma among healthcare workers (HW) and enacted stigma among HWs. One study was implemented at the community level using an educational campaign for community members. Stakeholder consultation emphasized the importance of policy level interventions and education on the universality of risk to destigmatize TB. Review findings suggest that internal and anticipated TB stigma may be addressed effectively with interventions targeted towards individuals using counselling or support groups. In contrast, enacted TB stigma may be better addressed with information-based interventions implemented at the organizational or community level. Policy level interventions were absent but identified as critical by stakeholders. Implementation barriers included the lack of high-quality training and integration with mental health services. Three key gaps must be addressed in future research: consistent stigma definitions, standardized stigma measurement, and measurement of implementation outcomes.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- Global Health, International Development Research Centre, Ottawa, Canada
| | | | | | - Michaile Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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21
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Yang YM, Priyanti RP, Lee BO. Experiences with Tuberculosis Management among Community-Based Care Providers in Indonesia: A Qualitative Study. J Community Health Nurs 2022; 39:227-237. [PMID: 36189942 DOI: 10.1080/07370016.2022.2083915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
To explore experiences with TB management among community-based care providers. Descriptive qualitative study. A total of 25 care providers were selected using purposive sampling. Data were collected by semi-structured interviews and analyzed using content analysis. Six themes emerged from this study: "various dissemination channels," "compassionate religious volunteerism," "shortage of resources," "keeping TB cases hidden," "patient impediments to care," and "perceived economic burdens of patients." The findings can provide an understanding that the management of tuberculosis in the community requires collaboration between various institutions as well as patients. Building a sustainable TB system would be beneficial. A TB care model can be established between government and other institutions.
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Affiliation(s)
- Yung-Mei Yang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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22
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Harrison RE, Shyleika V, Falkenstein C, Garsevanidze E, Vishnevskaya O, Lonnroth K, Sayakci Ö, Sinha A, Sitali N, Skrahina A, Stringer B, Tan C, Mar HT, Venis S, Vetushko D, Viney K, Vishneuski R, Carrion Martin AI. Patient and health-care provider experience of a person-centred, multidisciplinary, psychosocial support and harm reduction programme for patients with harmful use of alcohol and drug-resistant tuberculosis in Minsk, Belarus. BMC Health Serv Res 2022; 22:1217. [PMID: 36180873 PMCID: PMC9523183 DOI: 10.1186/s12913-022-08525-x] [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: 11/04/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation. Methods We recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings. Results Key themes related to the patients’ and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients’ illnesses, personal or interpersonal problems, administrative tasks, and job searches. Conclusions Patients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08525-x.
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Affiliation(s)
| | | | | | | | | | - Knut Lonnroth
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Alena Skrahina
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis (RSPCPT), Minsk, Republic of Belarus
| | | | | | | | | | - Dmitri Vetushko
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis (RSPCPT), Minsk, Republic of Belarus
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,School of Public Health, The University of Sydney, Sydney, Australia
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23
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Nuttall C, Fuady A, Nuttall H, Dixit K, Mansyur M, Wingfield T. Interventions pathways to reduce tuberculosis-related stigma: a literature review and conceptual framework. Infect Dis Poverty 2022; 11:101. [PMID: 36138434 PMCID: PMC9502609 DOI: 10.1186/s40249-022-01021-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prevention of tuberculosis (TB)-related stigma is vital to achieving the World Health Organisation's End TB Strategy target of eliminating TB. However, the process and impact evaluation of interventions to reduce TB-stigma are limited. This literature review aimed to examine the quality, design, implementation challenges, and successes of TB-stigma intervention studies and create a novel conceptual framework of pathways to TB-stigma reduction. METHOD We searched relevant articles recorded in four scientific databases from 1999 to 2022, using pre-defined inclusion and exclusion criteria, supplemented by the snowball method and complementary grey literature searches. We assessed the quality of studies using the Crowe Critical Appraisal Tool, then reviewed study characteristics, data on stigma measurement tools used, and interventions implemented, and designed a conceptual framework to illustrate the pathways to TB-stigma reduction in the interventions identified. RESULTS Of 14,259 articles identified, eleven met inclusion criteria, of which three were high quality. TB-stigma reduction interventions consisted mainly of education and psychosocial support targeted predominantly toward three key populations: people with TB, healthcare workers, and the public. No psychosocial interventions for people with TB set TB-stigma reduction as their primary or co-primary aim. Eight studies on healthcare workers and the public reported a decrease in TB-stigma attributed to the interventions. Despite the benefits, the interventions were limited by a dearth of validated stigma measurement tools. Three of eight studies with quantitative stigma measurement questionnaires had not been previously validated among people with TB. No qualitative studies used previously validated methods or tools to qualitatively evaluate stigma. On the basis of these findings, we generated a conceptual framework that mapped the population targeted, interventions delivered, and their potential effects on reducing TB-stigma towards and experienced by people with TB and healthcare workers involved in TB care. CONCLUSIONS Interpretation of the limited evidence on interventions to reduce TB-stigma is hampered by the heterogeneity of stigma measurement tools, intervention design, and outcome measures. Our novel conceptual framework will support mapping of the pathways to impacts of TB-stigma reduction interventions.
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Affiliation(s)
- Charlotte Nuttall
- grid.10025.360000 0004 1936 8470Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Ahmad Fuady
- grid.9581.50000000120191471Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10310 Jakarta, Indonesia
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC University Medical Center Rotterdam, 3015GD Rotterdam, The Netherlands
- grid.9581.50000000120191471Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, 10430 Jakarta, Indonesia
| | - Holly Nuttall
- grid.10025.360000 0004 1936 8470Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Kritika Dixit
- grid.4714.60000 0004 1937 0626Social Medicine, Infectious Diseases, and Migration (SIM) Group, Department of Public Health Sciences, Karolinska Institute, 10653 Stockholm, Sweden
- Birat Nepal Medical Trust, Lazimpat Road, Lazimpat, Kathmandu, 44600 Nepal
| | - Muchtaruddin Mansyur
- grid.9581.50000000120191471Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, 10310 Jakarta, Indonesia
| | - Tom Wingfield
- grid.10025.360000 0004 1936 8470Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- grid.4714.60000 0004 1937 0626Social Medicine, Infectious Diseases, and Migration (SIM) Group, Department of Public Health Sciences, Karolinska Institute, 10653 Stockholm, Sweden
- grid.48004.380000 0004 1936 9764Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA UK
- grid.513149.bTropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP UK
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Ahmed HA, Babiker HO. Intestinal tuberculosis—the challenging mimicker—in a young Sudanese patient: A case report. Clin Case Rep 2022; 10:e6210. [PMID: 35957772 PMCID: PMC9361794 DOI: 10.1002/ccr3.6210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hayat A. Ahmed
- Faculty of Medicine University of Khartoum Khartoum Sudan
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25
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Agbeko CK, Mallah MA, He B, Liu Q, Song H, Wang J. Mental Health Status and Its Impact on TB Treatment and Its Outcomes: A Scoping Literature Review. Front Public Health 2022; 10:855515. [PMID: 35712316 PMCID: PMC9194388 DOI: 10.3389/fpubh.2022.855515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) infection interferes with the health-related quality of life (HRQOL), including physical, social, mental, emotional and financial domains of individuals. The goal of this scoping review is to outline the most frequent mental issues encountered by TB patients and evaluate the effects of mental health on TB treatment outcomes. Our findings identify research gaps that could help bridge the overall treatment outcomes in the near future. Method A systematic stepwise approach was adopted to search online resource databases like PubMed, Web of science, and gray literature to retrieve published scientific articles for the review. Titles and abstracts of selected studies were examined for their possible eligibility. The studies matching our eligibility criteria were taken into account for this scoping review. Results One hundred and ninety three articles were retrieved out of which 26 met the final inclusion criteria. We found that studies adopting interventional approaches reported good mental wellbeing outcomes and better medical compliance as compared with studies that just investigated the subjects. The data represented 15 countries including three low-income countries (LICs), four low-middle-income-countries (LMICs), seven upper-middle-income countries (UMICs), and one high-income country (HIC). Conclusion Depression, anxiety, and poor social support, and stigma affect the wellbeing of individuals across the globe irrespective of age, race, demographic characteristics, geographical location, and social status.
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Affiliation(s)
- Charles Kwaku Agbeko
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | - Biyu He
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiao Liu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, China
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26
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Castañeda-Daniels NP, Campo-Arias A, Pedrozo-Pupo JC. Assessment of validity and reliability of the tuberculosis related stigma scale in Colombian patients. Curr Med Res Opin 2022; 38:1031-1036. [PMID: 35403523 DOI: 10.1080/03007995.2022.2065144] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To know the dimensionality and internal consistency of the Tuberculosis-Related Stigma Scale in patients living with tuberculosis in Santa Marta, Colombia. METHOD One hundred and twenty-two patients between the ages of 18 and 75 participated (M = 40.3, SD = 14.9), 63.9% were men, 44.3% were single, 69.7% had low income, 80.3% had pulmonary tuberculosis, and 13.1% had co-infection with HIV. The Tuberculosis-Related Stigma Scale was applied; it comprises perceived and internalised stigma subscales. The internal structure was explored by confirmatory factor analysis (EFA). Internal consistency was measured with Cronbach's alpha and McDonald's omega. Besides, the differential functioning of the scales according to gender was explored with Kendall's tau-b coefficient. RESULTS CFA did not show excellent goodness-of-fit indicators for the perceived stigma scale (Satorra-Bentler's chi-square of 184.48, degree of freedom of 44, p = .001, RMSEA of 0.16, 95%CI 0.14-0.19, CFI of 0.77, TLI of 0.72, and SRMR of 0.08) and internalised (Satorra-Bentler's chi-square of 189.14, degree of freedom of 54, p = .001; RMSEA of 0.14, 95%CI 0.12-0.17, CFI of 0.82, TLI of 0.78, and SRMR of 0.07). The alpha and omega coefficients were 0.89 and 0.91 for both scales. Non-gender differential functioning was observed; Kendall's tau-b was between 0.00 and 0.15. CONCLUSIONS The Tuberculosis-Related Stigma Scale has an excellent internal consistency but poor goodness-of-fit indicators of unidimensionality. Evaluating the scale's psychometric performance is recommenced in future research.
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Khan U, Lotia-Farrukh I, Akhtar A, Khowaja SN, Khan S, Madhani F, Parekh A, Adnan S, Ahmed S, Chaudhry M, Hussain H, Habib A, Butt S, Siddiqui MR, Ijaz R, Jamal S, Khan AB, Keshavjee S, Khan AJ, Salahuddin N, Khan PY. Re-Evaluating the Merits of Decentralisation as a Core Strategy for Effective Delivery of Drug-Resistant Tuberculosis Care in Pakistan. Health Policy Plan 2022; 37:979-989. [PMID: 35527232 PMCID: PMC9384034 DOI: 10.1093/heapol/czac038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/04/2022] [Accepted: 05/08/2022] [Indexed: 11/14/2022] Open
Abstract
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models—made increasingly urgent by the COVID-19 pandemic—are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005–1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
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Affiliation(s)
- Uzma Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Ahwaz Akhtar
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saira N Khowaja
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | | | - Asra Parekh
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Sana Adnan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saman Ahmed
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Mariam Chaudhry
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Hamidah Hussain
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | - Ali Habib
- Interactive Health Solutions, Karachi, Sindh, Pakistan
| | - Shahid Butt
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Muhammad R Siddiqui
- Provincial TB Program, Sindh, Pakistan
- Institute of Chest Diseases, Kotri, Sindh, Pakistan
| | - Raafia Ijaz
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Saba Jamal
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Abdul B Khan
- Indus Hospital and Health Network, Sindh, Pakistan
| | - Salmaan Keshavjee
- Harvard University, Cambridge, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Aamir J Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
| | | | - Palwasha Y Khan
- Interactive Research and Development, Karachi, Sindh, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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28
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Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR, Oliver S. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis of recipient and provider views. Cochrane Database Syst Rev 2022; 4:CD014877. [PMID: 35470432 PMCID: PMC9038447 DOI: 10.1002/14651858.cd014877.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Programmes that introduce rapid molecular tests for tuberculosis and tuberculosis drug resistance aim to bring tests closer to the community, and thereby cut delay in diagnosis, ensure early treatment, and improve health outcomes, as well as overcome problems with poor laboratory infrastructure and inadequately trained personnel. Yet, diagnostic technologies only have an impact if they are put to use in a correct and timely manner. Views of the intended beneficiaries are important in uptake of diagnostics, and their effective use also depends on those implementing testing programmes, including providers, laboratory professionals, and staff in health ministries. Otherwise, there is a risk these technologies will not fit their intended use and setting, cannot be made to work and scale up, and are not used by, or not accessible to, those in need. OBJECTIVES To synthesize end-user and professional user perspectives and experiences with low-complexity nucleic acid amplification tests (NAATs) for detection of tuberculosis and tuberculosis drug resistance; and to identify implications for effective implementation and health equity. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, PsycInfo and Science Citation Index Expanded databases for eligible studies from 1 January 2007 up to 20 October 2021. We limited all searches to 2007 onward because the development of Xpert MTB/RIF, the first rapid molecular test in this review, was completed in 2009. SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis, and were focused on perspectives and experiences of users and potential users of low-complexity NAATs to diagnose tuberculosis and drug-resistant tuberculosis. NAATs included Xpert MTB/RIF, Xpert MTB/RIF Ultra, Xpert MTB/XDR, and the Truenat assays. Users were people with presumptive or confirmed tuberculosis and drug-resistant tuberculosis (including multidrug-resistant (MDR-TB)) and their caregivers, healthcare providers, laboratory technicians and managers, and programme officers and staff; and were from any type of health facility and setting globally. MDR-TB is tuberculosis caused by resistance to at least rifampicin and isoniazid, the two most effective first-line drugs used to treat tuberculosis. DATA COLLECTION AND ANALYSIS We used a thematic analysis approach for data extraction and synthesis, and assessed confidence in the findings using GRADE CERQual approach. We developed a conceptual framework to illustrate how the findings relate. MAIN RESULTS We found 32 studies. All studies were conducted in low- and middle-income countries. Twenty-seven studies were conducted in high-tuberculosis burden countries and 21 studies in high-MDR-TB burden countries. Only one study was from an Eastern European country. While the studies covered a diverse use of low-complexity NAATs, in only a minority of studies was it used as the initial diagnostic test for all people with presumptive tuberculosis. We identified 18 review findings and grouped them into three overarching categories. Critical aspects users value People with tuberculosis valued reaching diagnostic closure with an accurate diagnosis, avoiding diagnostic delays, and keeping diagnostic-associated cost low. Similarly, healthcare providers valued aspects of accuracy and the resulting confidence in low-complexity NAAT results, rapid turnaround times, and keeping cost to people seeking a diagnosis low. In addition, providers valued diversity of sample types (for example, gastric aspirate specimens and stool in children) and drug resistance information. Laboratory professionals appreciated the improved ease of use, ergonomics, and biosafety of low-complexity NAATs compared to sputum microscopy, and increased staff satisfaction. Challenges reported to realizing those values People with tuberculosis and healthcare workers were reluctant to test for tuberculosis (including MDR-TB) due to fears, stigma, or cost concerns. Thus, low-complexity NAAT testing is not implemented with sufficient support or discretion to overcome barriers that are common to other approaches to testing for tuberculosis. Delays were reported at many steps of the diagnostic pathway owing to poor sample quality; difficulties with transporting specimens; lack of sufficient resources; maintenance of low-complexity NAATs; increased workload; inefficient work and patient flows; over-reliance on low-complexity NAAT results in lieu of clinical judgement; and lack of data-driven and inclusive implementation processes. These challenges were reported to lead to underutilization. Concerns for access and equity The reported concerns included sustainable funding and maintenance and equitable use of resources to access low-complexity NAATs, as well as conflicts of interest between donors and people implementing the tests. Also, lengthy diagnostic delays, underutilization of low-complexity NAATs, lack of tuberculosis diagnostic facilities in the community, and too many eligibility restrictions hampered access to prompt and accurate testing and treatment. This was particularly the case for vulnerable groups, such as children, people with MDR-TB, or people with limited ability to pay. We had high confidence in most of our findings. AUTHORS' CONCLUSIONS Low-complexity diagnostics have been presented as a solution to overcome deficiencies in laboratory infrastructure and lack of skilled professionals. This review indicates this is misleading. The lack of infrastructure and human resources undermine the added value new diagnostics of low complexity have for recipients and providers. We had high confidence in the evidence contributing to these review findings. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure equitable use of resources.
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Affiliation(s)
- Nora Engel
- Department of Health, Ethics & Society, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Eleanor A Ochodo
- Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Ricky Janssen
- Department of Health, Ethics & Society, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Karen R Steingart
- Honorary Research Fellow, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
- Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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de Groot LM, Straetemans M, Maraba N, Jennings L, Gler MT, Marcelo D, Mekoro M, Steenkamp P, Gavioli R, Spaulding A, Prophete E, Bury M, Banu S, Sultana S, Onjare B, Efo E, Alacapa J, Levy J, Morales MLL, Katamba A, Bogdanov A, Gamazina K, Kumarkul D, Ekaterina OL, Cattamanchi A, Khan A, Bakker MI. Time Trend Analysis of Tuberculosis Treatment While Using Digital Adherence Technologies-An Individual Patient Data Meta-Analysis of Eleven Projects across Ten High Tuberculosis-Burden Countries. Trop Med Infect Dis 2022; 7:tropicalmed7050065. [PMID: 35622692 PMCID: PMC9145978 DOI: 10.3390/tropicalmed7050065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 04/13/2022] [Indexed: 02/04/2023] Open
Abstract
Worldwide, non-adherence to tuberculosis (TB) treatment is problematic. Digital adherence technologies (DATs) offer a person-centered approach to support and monitor treatment. We explored adherence over time while using DATs. We conducted a meta-analysis on anonymized longitudinal adherence data for drug-susceptible (DS) TB (n = 4515) and drug-resistant (DR) TB (n = 473) populations from 11 DAT projects. Using Tobit regression, we assessed adherence for six months of treatment across sex, age, project enrolment phase, DAT-type, health care facility (HCF), and project. We found that DATs recorded high levels of adherence throughout treatment: 80% to 71% of DS-TB patients had ≥90% adherence in month 1 and 6, respectively, and 73% to 75% for DR-TB patients. Adherence increased between month 1 and 2 (DS-TB and DR-TB populations), then decreased (DS-TB). Males displayed lower adherence and steeper decreases than females (DS-TB). DS-TB patients aged 15−34 years compared to those >50 years displayed steeper decreases. Adherence was correlated within HCFs and differed between projects. TB treatment adherence decreased over time and differed between subgroups, suggesting that over time, some patients are at risk for non-adherence. The real-time monitoring of medication adherence using DATs provides opportunities for health care workers to identify patients who need greater levels of adherence support.
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Affiliation(s)
- Liza M. de Groot
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Masja Straetemans
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
| | - Noriah Maraba
- The Aurum Institute, Parktown, Johannesburg 2193, Gauteng, South Africa;
| | - Lauren Jennings
- Desmond Tutu Health Foundation, P.O. Box 13801, Mowbray, Cape Town 7705, Western Cape, South Africa;
| | - Maria Tarcela Gler
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Danaida Marcelo
- De La Salle Medical and Health Sciences Institute, City of Dasmariñas Cavite 4114, Philippines; (M.T.G.); (D.M.)
| | - Mirchaye Mekoro
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Pieter Steenkamp
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Riccardo Gavioli
- Health Poverty Action, London EC1V 2NX, UK; (M.M.); (P.S.); (R.G.)
| | - Anne Spaulding
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Edwin Prophete
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Margarette Bury
- Health Through Walls, Port-au-Prince HT 6110, Haiti; (A.S.); (E.P.); (M.B.)
| | - Sayera Banu
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Sonia Sultana
- Icddr,b, GPO Box 128, Dhaka 1000, Bangladesh; (S.B.); (S.S.)
| | - Baraka Onjare
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Egwuma Efo
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jason Alacapa
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Jens Levy
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Mona Lisa L. Morales
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands; (B.O.); (E.E.); (J.A.); (J.L.); (M.L.L.M.)
| | - Achilles Katamba
- Department of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | | | | | - Dzhumagulova Kumarkul
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Orechova-Li Ekaterina
- The Red Crescent National Society of the Kyrgyz Republic, Bishkek 720040, Kyrgyzstan; (D.K.); (O.-L.E.)
| | - Adithya Cattamanchi
- School of Medicine, University of California San Francisco, San Francisco, CA 94110, USA;
| | - Amera Khan
- Stop TB Partnership, 1218 Geneva, Switzerland
- Correspondence: (A.K.); (M.I.B.)
| | - Mirjam I. Bakker
- KIT Royal Tropical Institute, Global Health, 1092 AD Amsterdam, The Netherlands; (L.M.d.G.); (M.S.)
- Correspondence: (A.K.); (M.I.B.)
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Wouters E, van Rensburg AJ, Engelbrecht M, Buffel V, Campbell L, Sommerland N, Rau A, Kigozi G, van Olmen J, Masquillier C. How the 'HIV/TB co-epidemic-HIV stigma-TB stigma' syndemic impacts on the use of occupational health services for TB in South African hospitals: a structural equation modelling analysis of the baseline data from the HaTSaH Study (cluster RCT). BMJ Open 2022; 12:e045477. [PMID: 35383052 PMCID: PMC8984004 DOI: 10.1136/bmjopen-2020-045477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) has become an occupational health hazard in South African hospitals where healthcare workers (HCWs) are additionally confronted daily with HIV and its associated stigma, causing a syndemic. Early TB diagnosis and treatment are vital, but the uptake of these services through occupational healthcare units (OHUs) is low. The current study hypothesises that (1) the link between HIV and TB and (2) the perceived HIV stigmatisation by colleagues create (3) a double HIV-TB stigma which increases (4) internalised TB stigma and leads to (5) a lower willingness to use OHU services for TB screening and treatment. DESIGN A cross-sectional study using the baseline data from the HIV and TB Stigma among Healthcare workers Study (HaTSaH Study). SETTING Six hospitals in the Free State province of South Africa. PARTICIPANTS 820 HCWs of the six selected hospitals. RESULTS The study results demonstrate that the co-epidemic (β=0.399 (screening model) and β=0.345 (treatment model)) combined (interaction effect: β=0.133 (screening) and β=0.132 (treatment)) with the persistent stigmatisation of HIV is altering the attitudes towards TB (β=0.345 (screening) and β=0.400 (treatment)), where the stigmatising views of HIV are transferred to TB-illustrating the syndemic impact. Our model demonstrated that this syndemic not only leads to higher levels of internal TB stigma (β=0.421 (screening) and β=0.426 (treatment)), but also to a lower willingness to use the OHU for TB screening (probit coefficient=-0.216) and treatment (probit coefficient=-0.160). Confidentiality consistently emerged as a contextual correlate of OHU use. CONCLUSIONS Theoretically, our results confirm HIV as a 'syndemic generator' which changes the social meaning of TB in the hospital context. Practically, the study demonstrated that the syndemic of TB and HIV in a highly endemic context with stigma impacts the intended use of occupational TB services. TRIAL REGISTRATION NUMBER Pre-results of the trial registered at the South African National Clinical Trials Register, registration ID: DOH-27-1115-5204.
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Affiliation(s)
- Edwin Wouters
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa
| | | | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa
| | - Veerle Buffel
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
| | - Linda Campbell
- Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
| | | | - Asta Rau
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa
| | - G Kigozi
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa
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Bahar Z, Cal A, Beser A, Cavusoglu F, Deveci A, Badur S, Bahar IH. A study on the adaptation of the HIV/AIDS-related Stigma Scale into Turkish. Perspect Psychiatr Care 2022; 58:509-517. [PMID: 34878644 DOI: 10.1111/ppc.12984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aims to test the validity and reliability of the Turkish version of the HIV/AIDS-related Stigma Scale. DESIGN AND METHODS The study has a methodological design. The sample included a total of 428 participants. of the participants, 198 were HIV/AIDS patients, 230 were HIV-negative individuals. The data were analyzed using the Exploratory and Confirmatory Factor Analysis. FINDINGS The Turkish version of the HIV/AIDS-related Stigma Scale was found to be valid and reliable for the Turkish society. Cronbach's α was 0.93 for the community perspectives subscale and 0.89 for the patient perspectives subscale, and all the model fit indices were acceptable. PRACTICE IMPLICATIONS The level of stigmatization revealed by the scale helps gain an insight into the community and patient perspectives on HIV/AIDS.
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Affiliation(s)
- Zuhal Bahar
- Department of Nursing, Istanbul Aydin University, School of Health Sciences, Istanbul, Turkey
| | - Ayse Cal
- Department of Nursing, Ankara Medipol University School of Health Sciences, Ankara, Turkey
| | - Ayse Beser
- Department of Public Health Nursing, Koc University, Faculty of Nursing, Istanbul, Turkey
| | - Figen Cavusoglu
- Department of Public Health Nursing, Ondokuz Mayis University, Faculty of Health Sciences, Samsun, Turkey
| | - Aydin Deveci
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Selim Badur
- Vaccines Scientific Affairs and Public Health, GSK, Istanbul, Turkey
| | - Ismail Hakki Bahar
- Department of Nursing, Faculty of Health Sciences, Cyprus Science University, Kyrenia North, Cyprus
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Hodges J, Waldman AL, Koshkina O, Suzdalnitsky A, Schwendinger J, Vitko S, Plenskey A, Plotnikova Y, Moiseeva E, Koshcheyev M, Sebekin S, Zhdanova S, Ogarkov O, Heysell S, Dillingham R. Process evaluation for the adaptation, testing and dissemination of a mobile health platform to support people with HIV and tuberculosis in Irkutsk, Siberia. BMJ Open 2022; 12:e054867. [PMID: 35351714 PMCID: PMC8966533 DOI: 10.1136/bmjopen-2021-054867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We developed and tested a mobile health-based programme to enhance integration of HIV and tuberculosis (TB) care and to promote a patient-centred approach in a region of high coinfection burden. Phases of programme development included planning, stakeholder interviews and platform re-build, testing and iteration. SETTING In Irkutsk, Siberia, HIV/TB coinfection prevalence is high relative to the rest of the Russian Federation. PARTICIPANTS Pilot testing occurred for a cohort of 60 people with HIV and TB. RESULTS Key steps emerged to ensure the mobile health-based programme could be operational and adequately adapted for the context, including platform language adaptation, optimisation of server management, iteration of platform features, and organisational practice integration. Pilot testing of the platform rebuild yielded favourable patient perceptions of usability and acceptability at 6 months (n=47 surveyed), with 18 of 20 items showing scores above 4 (on a scale from 1 to 5) on average. Development of this mobile health-based programme for integrated care of infections highlighted the importance of several considerations for tailoring these interventions contextually, including language adaptation and technological capacity, but also, importantly, contextualised patient preferences related to privacy and communication with peers and/or providers, existing regional capacity for care coordination of different comorbidities, and infection severity and treatment requirements. CONCLUSIONS Our experience demonstrated that integration of care for TB and HIV can be well served by using multimodal mobile health-based programmes, which can enhance communication and streamline workflow between providers across multiple collaborating institutions and improve continuity between inpatient and outpatient care settings. Further study of programme impact on contextual disease-related stigma and social isolation as well as evaluation of implementation on a broader scale for HIV care is currently under way. TRIAL REGISTRATION NUMBER NCT03819374.
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Affiliation(s)
- Jacqueline Hodges
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ava Lena Waldman
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Olga Koshkina
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Alexey Suzdalnitsky
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Jason Schwendinger
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Serhiy Vitko
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | | | | | - Elena Moiseeva
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Mikhail Koshcheyev
- Irkutsk Regional Tuberculosis Referral Hospital, Irkutsk, Russian Federation
| | - Sergey Sebekin
- Irkutsk Regional AIDS Centre, Irkutsk, Russian Federation
| | - Svetlana Zhdanova
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Oleg Ogarkov
- Department of Epidemiology and Microbiology, Scientific Centre for Family Health and Human Reproduction Problems, Irkutsk, Russian Federation
| | - Scott Heysell
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases & International Health, University of Virginia Health System, Charlottesville, Virginia, USA
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Tuberculosis and Migrant Pathways in an Urban Setting: A Mixed-Method Case Study on a Treatment Centre in the Lisbon Metropolitan Area, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073834. [PMID: 35409517 PMCID: PMC8997607 DOI: 10.3390/ijerph19073834] [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: 02/01/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022]
Abstract
Tuberculosis (TB) is an infectious disease associated with poverty. In the European Union TB tends to concentrate in urban settings. In Lisbon, previous studies revealed, the presence of migrant populations from a high endemic country, is one of the risk factors contributing to TB. To better understand TB in foreign-born individuals in the Lisbon Metropolitan Area, a mixed-method case study was undertaken on a TB treatment centre in a high-risk part of urban Portugal. Quantitatively, annual TB cases were analysed from 2008 to 2018, dividing foreign-origin cases into recent migrants and long-term migrants. Qualitatively, we explored recent migrants’ reasons, experiences and perceptions associated with the disease. Our results showed that foreign-born individuals accounted for 45.7% of cases, mainly originated from Angola, Guinea-Bissau, and Cabo Verde. TB in recent migrants increased over the years for Angola and Guinea-Bissau, while for Cabo Verde TB cases were due to migrants residing in Portugal for more than 2 years. Recent migrants’ reasons to travel to Portugal were to study, to live and work, tourism, and seeking better healthcare. Visiting family and friends, historical links and common language were key drivers for the choice of country. Recent migrants and long-term migrants may present distinct background profiles associated with diagnosed TB.
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Impact of infectious disease epidemics on xenophobia: a systematic review. J Migr Health 2022; 5:100085. [PMID: 35252912 PMCID: PMC8891690 DOI: 10.1016/j.jmh.2022.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/22/2022] Open
Abstract
Xenophobia has a significant impact on the health of international migrants. During an infectious disease outbreak, stigma and prejudice are highly pronounced. Migrants, often seen as disease carriers, are socially rejected during epidemics. Ensure an equal treatment and healthcare assistance for migrants is imperative. Educational interventions are urgently needed to prevent xenophobic tendencies.
Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants.
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Alao MA, Ibrahim OR, Chan YH. Clinical and Psychosocial Determinants of Patients with Tuberculosis/Human Immunodeficiency Virus Co-Infection: A Structural Equation Model Approach. Niger J Clin Pract 2022; 25:105-109. [PMID: 35046203 DOI: 10.4103/njcp.njcp_466_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Tuberculosis (TB)/human immunodeficiency virus (HIV) co-infection is a complex mesh of physical and psychosocial disorders that require a multimodal and multifaceted approach for improved outcomes. Aims This study determined the treatment outcomes of patients with TB/HIV co-infection and the clinico-psychosocial predictors of the disease over a 10-year period in resource-limited settings. Patients and Methods This study reviewed the 10-year retrospective treatment outcomes of patients with TB/HIV co-infection in a tertiary centre. The data were retrieved from the TB treatment registers and analyzed with STATA 16.0. The effects of latent constructs of high clinical severity, stigmatization, and family stress/burden on treatment outcomes were evaluated using a structural equation model. Results Of the 1,321 who met the inclusion criteria, 1,193 had sufficient data. The mean age of the patients was 38.2 ± 16.7 years. The treatment adherence rate over the 10 years was 93.8% (±6.8%) but successful treatment outcome was 75.5% (±8.1%). Stigmatism of TB/HIV infections was experienced by adults and males (β = 0.972; P < 0.001 β = 0.674; P < 0.001, β = -0.770; P < 0.001, respectively), non-adherent to treatment (β = -0.460; P < 0.001) clinical severity of illness (β = 0.940; P < 0.001), and being HIV negative (β = -0.770; P < 0.001). Family Stress/Burden was strongly affected by both Death (β = 1.000; P < 0.001) and higher Stigmatism (β = 0.602; P < 0.001). Clinical severity of illness significantly influenced both Death and Unsatisfactory outcomes (β = 0.207; P < 0.001, β = 0.203; P < 0.05, respectively). Non-Adherence led to potentially unsatisfactory outcome. Conclusion TB/HIV co-infection is a complex psychosocial disorder that is significantly and negatively impacted by social determinants of the disease. A holistic approach to treatment intervention that addresses the latent factors of stigmatization, family stress/burden, and high clinical severity is key to achieving a successful treatment outcome.
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Affiliation(s)
- M A Alao
- Department of Paediatrics, Bowen University Teaching Hospital, Ogbomoso, Oyo State; Bowen University College of Medicine Iwo, Osun State; University College Hospital Ibadan, Oyo State, Nigeria
| | - O R Ibrahim
- Department of Paediatrics, Federal Medical Centre, Kastina, Katsina State, Nigeria
| | - Y H Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:710-716. [DOI: 10.1093/trstmh/trac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/16/2021] [Accepted: 03/20/2022] [Indexed: 11/14/2022] Open
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Oo MM, Liabsuetrakul T, Boonathapat N, Aung HKK, Pungrassami P. Association of Health Insurance and Documentation with Stigma and Social Support Among Myanmar Migrants with Tuberculosis Before and During Thailand's Policy on Border Closure Due to COVID-19: a Cross-Sectional Study. J Racial Ethn Health Disparities 2022; 9:2495-2507. [PMID: 34811647 PMCID: PMC8608234 DOI: 10.1007/s40615-021-01185-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand's policy on border closure. METHODS A cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand's policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure. RESULTS Of 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand's policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma. CONCLUSION The relationships between health insurance, documentation status and TB-related stigma were modified by Thailand's policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.
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Affiliation(s)
- Myo Minn Oo
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla Thailand
| | | | - Htet Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Das A, Lakhan T, Unisa S. Tuberculosis prevalence, knowledge of transmission and its association with vaccination of children. J Infect Prev 2021; 22:259-268. [PMID: 34880948 DOI: 10.1177/17571774211012777] [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: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background Understanding the perceptions of patients regarding tuberculosis (TB) will enable better design of a comprehensive, client-oriented program for the disease. Methods This study was conducted district-wise across India in 2015-2016 as part of the National Family Health Surveys (NFHS). Results We discovered that the prevalence of TB remains significantly high, with quite a high percentage of people being unaware of the exact cause of disease proliferation. The majority of people believed that touching or sharing utensils can be a source of TB. This perception affected the participants' responses about seeking diagnosis and treatment. However, it is a good sign that most people knew that TB is a curable disease that can be prevented to some extent if immunization with the Bacillus Calmette-Guérin (BCG) vaccine is done at the correct stage. So, a large section of the population had their children vaccinated. In addition, they would go for diagnosis if they had symptoms suggestive of the disease. Conclusion Findings from this study are indicative of the fact that a large population is aware that health facilities can make a significant contribution to the treatment of tuberculosis. There is a need to further investigate how this information could potentially be used to enhance early seeking of appropriate services among TB patients.
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Affiliation(s)
- Anisha Das
- Department of Statistics and Biostatistics, Florida State University, USA
| | - Tejal Lakhan
- Department of Bio-statistics and Demography, International Institute for Population Sciences, Mumbai, India
| | - Sayeed Unisa
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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Sousa ARD, Cerqueira SSB, Santana TDS, Suto CSS, Almeida ES, Brito LS, Casado E, Carvalho ESDS. Stigma experienced by men diagnosed with COVID-19. Rev Bras Enferm 2021; 75Suppl 1:e20210038. [PMID: 34816966 DOI: 10.1590/0034-7167-2021-0038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the stigma characteristics perceived in the experience of men who had COVID-19. METHOD this qualitative study involved men living in Brazil, diagnosed with COVID-19, who answered semi-structured questions in an online form. Data were subjected to thematic and lexical analysis, interpreted in the light of the stigma theory. RESULTS 92 men, adults, cisgender, heterosexual, of mixed race/color, belonging to middle class, living in the urban area, with higher education participated. The stigma characteristics evidenced were the occurrence of leave, perception of impolite treatment, use of labels and discrimination by co-workers, family members, neighbors and even healthcare professionals, with consequences for the psycho-emotional dimension. FINAL CONSIDERATIONS discrimination and exclusion derived from stigma surprised men marked by class and gender privileges, little used to being downgraded in interactions when compared to other groups.
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Affiliation(s)
| | | | | | | | | | | | - Elena Casado
- Universidad Complutense de Madrid. Madrid, España
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Dominski FH, Lorenzetti Branco JH, Buonanno G, Stabile L, Gameiro da Silva M, Andrade A. Effects of air pollution on health: A mapping review of systematic reviews and meta-analyses. ENVIRONMENTAL RESEARCH 2021; 201:111487. [PMID: 34116013 DOI: 10.1016/j.envres.2021.111487] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/15/2021] [Accepted: 06/03/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There has been a notable increase in knowledge production on air pollution and human health. OBJECTIVE To analyze the state of the art on the effects of air pollution on human health through a mapping review of existing systematic reviews and meta-analyses (SRs and MAs). METHODS The systematic mapping review was based on the recommendations for this type of scientific approach in environmental sciences. The search was performed using PubMed, Web of Science, Scopus, Cinahl, and Cochrane Library databases, from their inception through June 2020. RESULTS Among 3401 studies screened, 240 SRs and MAs satisfied the inclusion criteria. Five research questions were answered. There has been an overall progressive increase in publications since 2014. The majority of the SRs and MAs were carried out by researchers from institutions in China, the US, the UK, and Italy. Most studies performed a meta-analysis (161). In general, the reviews support the association of air pollution and health outcomes, and analyzed the effects of outdoor air pollution. The most commonly investigated health outcome type was the respiratory (mainly asthma and COPD), followed by cardiovascular outcomes (mainly stroke). Particulate matter (with a diameter of 2.5 μm (PM2.5) and 10 μm (PM10) or less) and nitrogen dioxide (NO2) were the most widely investigated pollutants in the reviews. The general population was the most common sample in the reviews, followed by children, and adults. The majority of the reviews investigated health outcomes of respiratory diseases in children, as well as cardiovascular diseases in all ages. Combining health outcomes and air pollutants, PM2.5 was included in a higher number of reviews in eight health outcomes, mainly cardiovascular diseases. DISCUSSION The majority of SRs and MAs showed that air pollution has harmful effects on health, with a focus on respiratory and cardiovascular outcomes. Future studies should extend the analysis to psychological and social aspects influenced by air pollution.
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Affiliation(s)
- Fábio Hech Dominski
- Laboratory of Sport and Exercise Psychology (Lape) - College of Health and Sport Science of the Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Joaquim Henrique Lorenzetti Branco
- Laboratory of Sport and Exercise Psychology (Lape) - College of Health and Sport Science of the Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Giorgio Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
| | - Luca Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
| | | | - Alexandro Andrade
- Laboratory of Sport and Exercise Psychology (Lape) - College of Health and Sport Science of the Santa Catarina State University (UDESC), Florianópolis, SC, Brazil.
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Junaid SA, Kanma-Okafor OJ, Olufunlayo TF, Odugbemi BA, Ozoh OB. Tuberculosis stigma: Assessing tuberculosis knowledge, attitude and preventive practices in surulere, Lagos, Nigeria. Ann Afr Med 2021; 20:184-192. [PMID: 34558447 PMCID: PMC8477276 DOI: 10.4103/aam.aam_40_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Tuberculosis (TB), though preventable and curable, remains a global health problem, ranked one of the top causes of death worldwide, despite the World Health Organization's strategies. This may be due to the stigma surrounding the disease. Aim This study assesses TB stigma in light of knowledge, attitudes, and preventive practices among individuals in an urban community. Settings and Design This was a descriptive, cross-sectional study among 317 residents of Surulere, Lagos, Nigeria, selected by multi-stage sampling. Subjects and Methods Data were collected using a pretested, semi-structured, interviewer-administered questionnaire and analyzed using Epi InfoTM version 7.2.2.6 2018 (Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA). Statistical Analysis Used Descriptive variables were summarized as frequencies, and the Chi-square test was used to test the associations. The level of significance was predetermined at P ≤0.05. Results Most participants were between the age group of 21 and 40 years. Approximately 9 out of every 10 respondents (91.8%) were aware of TB. Overall, only 2.4% of respondents had good knowledge of TB, more than half (59.1%) had positive attitudes toward TB, about one-third (37.1%) had good preventive practices and 22.7% of respondents expressed TB stigma, 63.6% would show no compassion or desire to help people with TB while 64.3% would rather people with TB were never employed. However, good knowledge translated into less stigma (P <0.001). Conclusions Most participants were aware of TB, although knowledge, attitude, and practice levels were poor. Knowledge was found to reduce TB stigma, reinforcing the need for improved community literacy regrading TB. This has the potential to influence health-seeking behavior and promote better TB prevention, detection, and treatment outcomes.
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Affiliation(s)
- Salamah Abimbola Junaid
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Oluchi Joan Kanma-Okafor
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Tolulope Florence Olufunlayo
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
| | - Babatunde A Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Obianuju Beatrice Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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Alene KA, Wangdi K, Colquhoun S, Chani K, Islam T, Rahevar K, Morishita F, Byrne A, Clark J, Viney K. Tuberculosis related disability: a systematic review and meta-analysis. BMC Med 2021; 19:203. [PMID: 34496845 PMCID: PMC8426113 DOI: 10.1186/s12916-021-02063-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The sustainable development goals aim to improve health for all by 2030. They incorporate ambitious goals regarding tuberculosis (TB), which may be a significant cause of disability, yet to be quantified. Therefore, we aimed to quantify the prevalence and types of TB-related disabilities. METHODS We performed a systematic review of TB-related disabilities. The pooled prevalence of disabilities was calculated using the inverse variance heterogeneity model. The maps of the proportions of common types of disabilities by country income level were created. RESULTS We included a total of 131 studies (217,475 patients) that were conducted in 49 countries. The most common type of disabilities were mental health disorders (23.1%), respiratory impairment (20.7%), musculoskeletal impairment (17.1%), hearing impairment (14.5%), visual impairment (9.8%), renal impairment (5.7%), and neurological impairment (1.6%). The prevalence of respiratory impairment (61.2%) and mental health disorders (42.0%) was highest in low-income countries while neurological impairment was highest in lower middle-income countries (25.6%). Drug-resistant TB was associated with respiratory (58.7%), neurological (37.2%), and hearing impairments (25.0%) and mental health disorders (26.0%), respectively. CONCLUSIONS TB-related disabilities were frequently reported. More uniform reporting tools for TB-related disability and further research to better quantify and mitigate it are urgently needed. PROSPERO REGISTRATION NUMBER CRD42019147488.
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Affiliation(s)
- Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Kent St, Bentley, Perth, 6102 Western Australia Australia
- Telethon Kids Institute, 15 Hospital Ave, Nedlands, Perth, Western Australia 6009 Australia
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Kinley Wangdi
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Samantha Colquhoun
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Kudakwashe Chani
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
| | - Tauhid Islam
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Kalpeshsinh Rahevar
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Fukushi Morishita
- World Health Organization (WHO) Regional Office for the Western Pacific, The Philippines, Manila, Philippines
| | - Anthony Byrne
- St Vincent’s Hospital, Sydney, 406 Victoria St, Darlinghurst, Sydney, 2010 New South Wales Australia
- The University of New South Wales, Randwick, Sydney, 2031 New South Wales Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, 4266 Queensland Australia
| | - Kerri Viney
- Research School of Population Health, The Australian National University, 62 Mills Road, Acton, Canberra, ACT 2601 Australia
- Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- The University of Sydney, University Road, Camperdown, Sydney, 2066 New South Wales Australia
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Nigam S, Sharma RK, Yadav R, Rao VG, Mishra P, Lingala MA, Bhat J. Experiences and needs of patients with MDR/XDR-TB: a qualitative study among Saharia tribe in Madhya Pradesh, Central India. BMJ Open 2021; 11:e044698. [PMID: 34385228 PMCID: PMC8362723 DOI: 10.1136/bmjopen-2020-044698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 07/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) continues to be a major public health threat posing a critical challenge to TB treatment and control worldwide. The present study was conducted among patients with DR-TB of the Saharia tribe residing in Madhya Pradesh state of Central India to document their experiences and needs, and to identify gaps for treatment adherence as this population is known to be poor because of migration and other factors. METHODS We conducted 16 in-depth interviews on purposively selected patients with DR-TB among the Saharia tribe using a predesigned open-ended in-depth interview guide, which included questions on domains like general physical health, diagnosis, treatment adherence, side-effects of drugs and experience related to the health facility. Out of these interviews, various subthemes were extracted. The obtained qualitative data were subjected to thematic analysis. RESULTS The study helped to understand the experiences and needs of the patients with DR-TB in various stages from diagnosis to treatment. Also, there was the impact of factors like lack of education and awareness, poor living conditions and lack of healthcare facilities on predominance of the disease in the community. Poor access to a healthcare facility, high pill burden and related side-effects, longer duration of treatment, financial burden, misbeliefs and misconceptions were prominent issues posing a challenge to treatment adherence. The narratives pointed out their struggle at every stage be it with diagnosis, treatment initiation or treatment adherence. CONCLUSION It is paramount to address the needs and experiences of patients with DR-TB to develop a patient-centric and context-specific approach conducive to the sociocultural set-up of tribal people. This will scale down the attrition rate of tribal patients while adhering to the complete treatment process and reducing the high burden of TB among the Saharia community. In addition, tribal patients should be counselled at regular intervals to increase their confidence in the treatment.
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Affiliation(s)
- Samridhi Nigam
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Ravendra K Sharma
- ICMR- National Institute of Medical Statistics, New Delhi, Delhi, India
| | - Rajiv Yadav
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Vikas Gangadhar Rao
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Prashant Mishra
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Mercy Aparna Lingala
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Jyothi Bhat
- Division of Communicable Diseases, ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
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Kim SH, Lee H, Kim Y. Health-related quality of life after pulmonary tuberculosis in South Korea: analysis from the Korea National Health and Nutrition Examination Survey between 2010 and 2018. Health Qual Life Outcomes 2021; 19:195. [PMID: 34372867 PMCID: PMC8350551 DOI: 10.1186/s12955-021-01833-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although several studies have reported an association between tuberculosis and health-related quality of life, the change in health-related quality of life after pulmonary tuberculosis has been rarely studied. The purpose of this study was to investigate the effect of past history of pulmonary tuberculosis on health-related quality of life using a nationwide, cross-sectional, observational study in Korea. METHODS Among 72,751 people selected using a stratified multi-stage sampling method, 7260 Korean participants were included using propensity score matching. Past history of pulmonary tuberculosis was defined as a previous diagnosis of pulmonary tuberculosis excluding patients with active pulmonary tuberculosis. The primary outcome, health-related quality of life, was assessed by EQ-5D disutility. RESULTS Before matching, the mean EQ-5D of individuals with pulmonary tuberculosis history was lower (0.066 vs. 0.056, p: 0.009). However, the difference was nullified after matching (0.066 vs. 0.062, p = 0.354). In multivariable Poisson regression analysis, EQ-5D disutility score was not associated with past pulmonary tuberculosis history. In subgroup analysis, past pulmonary tuberculosis history increased odds of low health-related quality of life in young (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.17-2.11, p = 0.003), unmarried (OR 1.98, 95% CI 1.05-3.73, p = 0.036), or separated patients (OR 1.30, 95% CI 1.02-1.66, p = 0.032). Age and marital status were modulating factors on the effect of past pulmonary tuberculosis history on health-related quality of life. CONCLUSIONS There was no difference in health-related quality of life between individuals with and without past pulmonary tuberculosis history. Young and unmarried groups had increased odds for low health-related quality of life after pulmonary tuberculosis due to modulating effects of age and marital status.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonology and Critical Care Medicine, Samsung Medical Center, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Youlim Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
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Biermann O, Mwoka M, Ettman CK, Abdalla SM, Shawky S, Ambuko J, Pearson M, Zeinali Z, Galea S, Mberu B, Valladares LM. Data, Social Determinants, and Better Decision-making for Health: the 3-D Commission. J Urban Health 2021; 98:4-14. [PMID: 34414512 PMCID: PMC8376119 DOI: 10.1007/s11524-021-00556-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/24/2022]
Abstract
More than a decade after the World Health Organization Commission on the Social Determinants of Health (SDoH), it is becoming widely accepted that social and economic factors, including but not limited to education, energy, income, race, ethnicity, and housing, are important drivers of health in populations. Despite this understanding, in most contexts, social determinants are not central to local, national, or global decision-making. Greater clarity in conceptualizing social determinants, and more specificity in measuring them, can move us forward towards better incorporating social determinants in decision-making for health. In this paper, first, we summarize the evolution of the social framing of health. Second, we describe how the social determinants are conceptualized and contextualized differently at the global, national, and local levels. With this, we seek to demonstrate the importance of analyzing and understanding SDoH relative to the contexts in which they are experienced. Third, we problematize the gap in data across contexts on different dimensions of social determinants and describe data that could be curated to better understand the influence of social determinants at the local and national levels. Fourth, we describe the necessity of using data to understand social determinants and inform decision-making to improve health. Our overall goal is to provide a path for our collective understanding of the foundational causes of health, facilitated by advances in data access and quality, and realized through improved decision-making.
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Affiliation(s)
- Olivia Biermann
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Catherine K. Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Sherine Shawky
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- The Social Research Center, The American University in Cairo, Cairo, Egypt
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- OECD, Paris, France
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- African Population and Health Research Center, Nairobi, Kenya
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
- Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
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Zimmer AJ, Heitkamp P, Malar J, Dantas C, O'Brien K, Pandita A, Waite RC. Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective. J Clin Tuberc Other Mycobact Dis 2021; 24:100248. [PMID: 34189276 PMCID: PMC8225462 DOI: 10.1016/j.jctube.2021.100248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Facility-based directly observed therapy (DOT) has been the standard for treating people with TB since the early 1990s. As the commitment to promote a people-centred model of care for TB grows, the use of facility-based DOT has been questioned as issues of freedom, privacy, and human rights have been raised. The disruptions caused by the COVID-19 pandemic and ensuing lockdown measures have fast-tracked the need to find alternative methods to provide treatment to people with TB. In this study, we present quantitative and qualitative findings from a global community-based survey on the challenges of administering facility-based DOT during a pandemic as well as potential alternatives. Our results found that decreased access to transportation, the fear of COVID-19, stigmatization due to overlapping symptoms, and punitive measures against quarantine violations have made it difficult for persons with TB to receive treatment at facilities, particularly in low-resource settings. Potential replacements included greater focus on community-based DOT, home delivery of treatment, multi-month dispensing, and video DOT strategies. Our study highlights the need for TB programs to re-evaluate their approach to providing treatment to people with TB, and that these changes must be made in consultation with people affected by TB and TB survivors to provide a true people-centred model of care.
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Affiliation(s)
- Alexandra J. Zimmer
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Petra Heitkamp
- McGill International TB Centre, Montreal, Canada
- TB PPM Learning Network, Research Institute of the McGill University Health Centre, Canada
| | | | | | - Kate O'Brien
- We are TB/National TB Controllers Association, Smryna, USA
| | - Aakriti Pandita
- Division of Infectious Diseases, University of Colorado School of Medicine, Denver, USA
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Berra TZ, Bruce ATI, Alves YM, Ramos ACV, Giacomet CL, Arcêncio RA. Impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection: temporal trends and vulnerable territories. Rev Lat Am Enfermagem 2021; 29:e3441. [PMID: 34287540 PMCID: PMC8294793 DOI: 10.1590/1518.8345.4412.3441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE to assess the impact of the GeneXpert® MTB/RIF rapid molecular test on tuberculosis detection, to analyze the temporal trend of the event and to identify vulnerable territories in a Brazilian municipality. METHOD an ecological study carried out in Ribeirão Preto, São Paulo, Brazil, a municipality considered a priority in tuberculosis control due to the high number of cases. To classify the temporal trend, the Prais-Winsten method and the Interrupted Time Series were used to identify changes in the disease incidence. Kernel intensity analysis was applied to identify vulnerable areas. RESULTS the temporal trend of tuberculosis decreased by 18.1%/year and by 6.9%/year for children under 15 years old. The North District decreased by 6.67%/year and the East District increased by 17.5%/year in the incidence of tuberculosis. Resistant tuberculosis, after the implementation of the Rapid Molecular Test, increased by 0.6% per year. The South and West Districts showed a higher density of cases, with a range from 45 to 79 tuberculosis cases per square kilometer (km2). CONCLUSION although resistant tuberculosis is not a problem in the scenario, the study showed an increase in its incidence, which puts it on alert. The use of spatial analysis enabled the identification of priority areas, putting them in evidence for health surveillance actions.
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Affiliation(s)
- Thaís Zamboni Berra
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Fundação de Amparo à Pesquisa do Estado de
São Paulo (FAPESP), Brazil
| | - Alexandre Tadashi Inomata Bruce
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Conselho Nacional de Desenvolvimento
Científico e Tecnológico (CNPq), Brazil
| | - Yan Mathias Alves
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Antônio Carlos Vieira Ramos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
| | - Clóvis Luciano Giacomet
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
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49
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Parmer J, Macario E, Tatum K, Brackett A, Allen L, Picard R, DeLuca N, Dowling M. Latent tuberculosis infection: Misperceptions among non-U.S.-born-populations from countries where tuberculosis is common. Glob Public Health 2021; 17:1728-1742. [PMID: 34228584 PMCID: PMC8733044 DOI: 10.1080/17441692.2021.1947342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTThe Centers for Disease Control and Prevention works to eliminate tuberculosis (TB) disease by finding and treating cases of TB disease and expanding latent tuberculosis infection (LTBI) testing and treatment to prevent TB disease. Approximately 70% of reported TB cases in the United States occur among non-U.S.-born persons. We conducted 15 focus groups with U.S. residents born in the six most common countries of birth among non-U.S.-born TB patients: Mexico, the Philippines, India, Vietnam, China and Guatemala. Participants reacted to 39 messages on LTBI and TB disease risk factors, the Bacille Calmette-Guérin (BCG) vaccine, and LTBI testing and treatment. There was low awareness of LTBI, the TB blood test, and how the TB blood test is not affected by prior BCG vaccination. Several participants thought TB disease is contracted by sharing kitchenware. Some felt negatively targeted when presented with information about countries where TB disease is more common than the U.S. Findings highlight the need for communication aimed at increasing LTBI testing and treatment to include messages framed in ways that will be resonant and actionable to populations at risk. Focus groups revealed LTBI misconceptions which highlight areas for targeted education to decrease TB stigma and increase LTBI testing and treatment.
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Affiliation(s)
- John Parmer
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katharine Tatum
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Department of Sociology, Emory University, Atlanta, GA, USA.,Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | | | - Leeanna Allen
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Nick DeLuca
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly Dowling
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA
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50
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Thomas BE, Kumar JV, Periyasamy M, Khandewale AS, Hephzibah Mercy J, Raj EM, Kokila S, Walgude AS, Gaurkhede GR, Kumbhar JD, Ovung S, Paul M, Rajkumar BS, Subbaraman R. Acceptability of the Medication Event Reminder Monitor for Promoting Adherence to Multidrug-Resistant Tuberculosis Therapy in Two Indian Cities: Qualitative Study of Patients and Health Care Providers. J Med Internet Res 2021; 23:e23294. [PMID: 34110300 PMCID: PMC8262665 DOI: 10.2196/23294] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/27/2020] [Accepted: 04/30/2021] [Indexed: 01/22/2023] Open
Abstract
Background Patients with multidrug-resistant tuberculosis (MDR-TB) face challenges adhering to medications, given that treatment is prolonged and has a high rate of adverse effects. The Medication Event Reminder Monitor (MERM) is a digital pillbox that provides pill-taking reminders and facilitates the remote monitoring of medication adherence. Objective This study aims to assess the MERM’s acceptability to patients and health care providers (HCPs) during pilot implementation in India’s public sector MDR-TB program. Methods From October 2017 to September 2018, we conducted qualitative interviews with patients who were undergoing MDR-TB therapy and were being monitored with the MERM and HCPs in the government program in Chennai and Mumbai. Interview transcripts were independently coded by 2 researchers and analyzed to identify the emergent themes. We organized findings by using the Unified Theory of Acceptance and Use of Technology (UTAUT), which outlines 4 constructs that predict technology acceptance—performance expectancy, effort expectancy, social influence, and facilitating conditions. Results We interviewed 65 patients with MDR-TB and 10 HCPs. In patient interviews, greater acceptance of the MERM was related to perceptions that the audible and visual reminders improved medication adherence and that remote monitoring reduced the frequency of clinic visits (performance expectancy), that the device’s organization and labeling of medications made it easier to take them correctly (effort expectancy), that the device facilitated positive family involvement in the patient’s care (social influences), and that remote monitoring made patients feel more cared for by the health system (facilitating conditions). Lower patient acceptance was related to problems with the durability of the MERM’s cardboard construction and difficulties with portability and storage because of its large size (effort expectancy), concerns regarding stigma and the disclosure of patients’ MDR-TB diagnoses (social influences), and the incorrect understanding of the MERM because of suboptimal counseling (facilitating conditions). In their interviews, HCPs reported that MERM implementation resulted in fewer in-person interactions with patients and thus allowed HCPs to dedicate more time to other tasks, which improved job satisfaction. Conclusions Several features of the MERM support its acceptability among patients with MDR-TB and HCPs, and some barriers to patient use could be addressed by improving the design of the device. However, some barriers, such as disease-related stigma, are more difficult to modify and may limit use of the MERM among some patients with MDR-TB. Further research is needed to assess the accuracy of MERM for measuring adherence, its effectiveness for improving treatment outcomes, and patients’ sustained use of the device in larger scale implementation.
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Affiliation(s)
- Beena E Thomas
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - J Vignesh Kumar
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Murugesan Periyasamy
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Amit Subhash Khandewale
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - J Hephzibah Mercy
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - E Michael Raj
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - S Kokila
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Apurva Shashikant Walgude
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Gunjan Rahul Gaurkhede
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Jagannath Dattatraya Kumbhar
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Senthanro Ovung
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Mariyamma Paul
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - B Sathyan Rajkumar
- Department of Social and Behavioural Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.,Center for Global Public Health, Tufts University School of Medicine, Boston, MA, United States.,Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, United States
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