1
|
Agbaje A, Dakum P, Daniel O, Chukwuma A, Chijoke-Akaniro O, Okpokoro E, Akingbesote S, Anyomi C, Adekunle A, Alege A, Gbadamosi M, Babalola O, Mensah C, Eneogu R, Ihesie A, Adelekan A. Challenges of Screening and Investigations of Contacts of Patients with Tuberculosis in Oyo and Osun States, Nigeria. Trop Med Infect Dis 2024; 9:144. [PMID: 39058186 PMCID: PMC11281629 DOI: 10.3390/tropicalmed9070144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024] Open
Abstract
Tuberculosis (TB) remains a significant public health challenge in Nigeria, with high rates of transmission and low case detection rates. This paper presents the challenges of screening and investigation of contacts of patients with TB in Oyo and Osun State, Nigeria. This descriptive-qualitative study was conducted in eight Local Government Areas with high TB burdens. Twenty-four focus group discussions and 30 key informant interviews were conducted among TB patients, household TB contacts, and government TB staff, among others. Respondents ages ranged from 17-85 years with a mean of 42.08 ± 14.9 years, and (4.0%) had a postgraduate degree. This study identified that the majority of TB contacts who tested negative for TB were unwilling to be placed on TB preventive therapy because of the belief that only a sick person should take drugs. Also, hostility from the TB contacts to the contact tracers during the house-to-house screening of presumptive TB cases due to community stigma associated with TB was another existing gap reported in TB contact investigations. The findings emphasise the importance of tailored approaches in TB prevention and control, addressing challenges in testing and contact investigations; this necessitates investments in community engagement strategies to enhance the cooperation of TB contacts.
Collapse
Affiliation(s)
- Aderonke Agbaje
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Patrick Dakum
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Olugbenga Daniel
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Anyaike Chukwuma
- Department of Public Health, National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria; (A.C.); (O.C.-A.)
| | - Obioma Chijoke-Akaniro
- Department of Public Health, National Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria; (A.C.); (O.C.-A.)
| | - Evaezi Okpokoro
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Samuel Akingbesote
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Christian Anyomi
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Adekola Adekunle
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Abiola Alege
- Department of Prevention, Care, and Treatment, Society for Family Health, Abuja 900247, Nigeria;
| | - Moroof Gbadamosi
- Department of Public Health, Osun State Ministry of Health, Osogbo 230284, Nigeria;
| | - Olutunde Babalola
- Department of Public Health, Oyo State Ministry of Health, Ibadan 200214, Nigeria;
| | - Charles Mensah
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| | - Rupert Eneogu
- HIV, AIDS, and TB Unit, United States Agency for International Development, Abuja 900211, Nigeria; (R.E.); (A.I.)
| | - Austin Ihesie
- HIV, AIDS, and TB Unit, United States Agency for International Development, Abuja 900211, Nigeria; (R.E.); (A.I.)
| | - Ademola Adelekan
- Department of Prevention, Care and Treatment, Institute of Human Virology Nigeria, Abuja 900231, Nigeria; (A.A.); (P.D.); (O.D.); (E.O.); (S.A.); (C.A.); (C.M.)
| |
Collapse
|
2
|
Dirks LK, Bircher PM, González-Montalvo MDM, Kauffman AE, Prophete EJ, Bury MR, Spaulding AC. Video Directly Observed Therapy for Tuberculosis Treatment in Haitian Prisons: A Pattern of Group Adherence. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.29.23299977. [PMID: 38234774 PMCID: PMC10793512 DOI: 10.1101/2023.12.29.23299977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Classification Research paper. Purpose Haitian provincial prisons historically were strapped to provide directly observed therapy (DOT) for persons with TB (PwTB) due to healthcare understaffing. A non-governmental organization addressed this gap via correctional officer-administered video DOT (VDOT). Approach A 16-month, quasi-experimental trial of officer-facilitated VDOT started in March 2019 at four prisons. Officers delivered doses directly without video when VDOT was inaccessible. Healthcare staff remotely tracked VDOT adherence asynchronously. Three fully-staffed prisons were controls. Our primary objective was to measure VDOT effectiveness for PwTB who began VDOT within 2 weeks of starting treatment. Our secondary objective was to measure program reach, implementation and maintenance through July 2023. Findings Reach-55 PwTB on VDOT met study criteria. Effectiveness: median/mean VDOT adherence for 55 individuals enrolled in the pilot were 70.8% and 60.2% respectively. Median/mean total adherence, including doses delivered by officers, were 100% and 93.5%. Implementation: VDOT adherence varied by site but not demographic characteristics; similarity of adherence patterns between subjects within a facility was high. Nursing staff reported that adherence in controls was 100%. Correctional officers reported high comfort with the program technology. Maintenance: Since the pilot, 387 PwTB have received TB medications via VDOT in the Haitian prison system. Originality VDOT for PwTB in low-resource Haitian prisons enabled close monitoring and follow-up; it could expand treatment options elsewhere. Total adherence neared that in control prisons. VDOT adherence varied by treatment day predominately in a group pattern, reflecting facility-level, rather than individual-level, factors.
Collapse
|
3
|
Fanfan D, Rodríguez C, Stacciarini JMR. Strès ak Pwoblèm Pap Janm Fini: Deciphering migration-related stress from the perspectives of Haitian immigrants in Florida. Transcult Psychiatry 2023; 60:717-732. [PMID: 37097922 DOI: 10.1177/13634615231164524] [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: 04/26/2023]
Abstract
Relocating and starting a new life in a foreign country may entail a constellation of new stressors for Haitian immigrants; thus, research that enhances our understanding of how this vulnerable population contextualizes migration-related stress is necessary. The objectives of this study were to: (a) identify what factors are associated with migration-related stress, and (b) describe which and why specific migration-related stressors were most significant from the perspective of those suffering from high migration-related stress post migration via the stress proliferation lens of the stress process model. In this mixed-methods, sequential, explanatory pilot study, first-generation Haitian immigrants (N = 76) were recruited to operationalize migration-related stress, using the Demands of Immigration Scale (DIS). Participants (n = 8), who scored 25 or higher on the DIS, completed an in-depth audio-recorded follow-up interview that consisted of open-ended questions and a stressor-ranking questionnaire. Descriptive statistics, Pearson correlations, multiple linear regression (quantitative), and thematic analysis with a double-coded approach (qualitative) were employed to analyze the data. Female gender, older age, English fluency, and migration after the age of 18 years were associated with higher migration-related stress. However, only gender and English fluency predicted migration-related stress. In interviews, participants ranked five migration-related stressors as most stressful: language barriers, financial strains, loss of social networks, family conflicts, and exposure to discrimination/stigma. A nuanced depiction of migration-related stressors and proliferation mechanisms of migration-related stress may help identify areas where support and preventive efforts should be directed to improve social integration, stress levels, and mental well-being among immigrants.
Collapse
Affiliation(s)
- Dany Fanfan
- College of Nursing, University of Florida, Gainesville, FL
| | | | | |
Collapse
|
4
|
Azhar S, Rahman R, Wernick LJ, Tripathi S, Cohen M, Maschi T. Race, masks, residency and concern regarding COVID-19 transmission. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1716-1735. [PMID: 36256889 PMCID: PMC9874564 DOI: 10.1002/jcop.22953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 05/23/2023]
Abstract
To explore sociodemographic predictors for concern regarding COVID-19 transmission and how these factors interact with the identities of others, we conducted a web-based survey where we asked 568 respondents in the United States to indicate their level of COVID-19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID-19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID-19. Individuals who self-reported themselves to be at high risk for COVID-19 were more likely to be concerned about COVID-19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID-19 concern.
Collapse
Affiliation(s)
- Sameena Azhar
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Rahbel Rahman
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Laura J. Wernick
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Saumya Tripathi
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Margaret Cohen
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| | - Tina Maschi
- Graduate School of Social ServiceFordham UniversityNew YorkNew YorkUSA
| |
Collapse
|
5
|
Rahman R, Azhar S, Wernick LJ, Huang D, Maschi T, Rosenblatt C, Patel R. COVID-19 stigma and depression across race, ethnicity and residence. SOCIAL WORK IN HEALTH CARE 2023; 62:121-142. [PMID: 36934345 DOI: 10.1080/00981389.2023.2193263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/02/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.
Collapse
Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Sameena Azhar
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Laura J Wernick
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Debbie Huang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Tina Maschi
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Cassidy Rosenblatt
- Graduate School of Social Service, Fordham University, New York, New York, United States
| | - Rupal Patel
- Graduate School of Social Service, Fordham University, New York, New York, United States
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Redwood L, Mitchell EMH, Nguyen TA, Viney K, Duong L, Phạm HT, Nguyen BH, Nguyen VN, Fox GJ. Adaptation and validation of the Van Rie tuberculosis stigma scale in Vietnam. Int J Infect Dis 2021; 114:97-104. [PMID: 34715359 DOI: 10.1016/j.ijid.2021.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Tuberculosis (TB) stigma contributes to diagnostic delay, disease concealment, and reduced wellbeing for affected individuals. Despite the availability of several TB stigma scales, most high-TB burden countries do not have a culturally validated version available. This study evaluated the Van Rie TB stigma scale (VTSS) among people with TB in Vietnam. METHODS This study consisted of two phases. In phase 1, the VTSS was culturally and linguistically adapted to the Vietnamese context. In phase 2, people with TB were invited to complete a survey containing the VTSS, a depression scale, and a quality of life scale. The data analysis included confirmatory factor analysis (CFA), exploratory factor analysis (EFA), construct validity, and floor or ceiling effects. RESULTS In phase 1, items were reworded from the third person to the first person. The TB/HIV co-infection items (items 7 and 11) were the least relevant for people with TB (62% and 73% relevance, respectively). In phase 2, the CFA demonstrated adequate goodness-of-fit indices (GFI = 0.88, CFI = 0.96, RMSEA = 0.058); however several of the item factor loadings were low. The EFA demonstrated good internal consistency (α = 0.85) and revealed one dominant factor. Construct validity was low. CONCLUSIONS The VTSS demonstrated good psychometric properties in Vietnam. Depending on the purpose of the scale, the HIV co-infection items and item 10 could be considered for removal.
Collapse
Affiliation(s)
- Lisa Redwood
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia 2006; The Woolcock Institute of Medical Research, Glebe, NSW, Australia 2037.
| | - Ellen M H Mitchell
- Department of Public Health, Institute for Tropical Medicine, Antwerp, Belgium
| | - Thu Anh Nguyen
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia 2006; The Woolcock Institute of Medical Research, Glebe, NSW, Australia 2037
| | - Kerri Viney
- Research School of Population Health, Australian National University, Canberra, Australia; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; School of Public Health, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Linh Duong
- The Woolcock Institute of Medical Research, Glebe, NSW, Australia 2037
| | | | | | | | - Greg J Fox
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, NSW, Australia 2006; The Woolcock Institute of Medical Research, Glebe, NSW, Australia 2037
| |
Collapse
|
8
|
Bolster-Foucault C, Ho Mi Fane B, Blair A. Structural determinants of stigma across health and social conditions: a rapid review and conceptual framework to guide future research and intervention. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 41:85-115. [PMID: 33688694 DOI: 10.24095/hpcdp.41.3.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stigma has been identified as a key determinant of health and health inequities because of its effects on access to health-enabling resources and stress exposure. Though existing reports offer in-depth summaries of the mechanisms through which stigma influences health, a review of evidence on the upstream drivers of stigma across health and social conditions has been missing. The objective of this review is to summarize known structural determinants of stigma experienced across health and social conditions in developed country settings. METHODS We conducted a rapid review of the literature. English- and French-language peer-reviewed and grey literature works published after 2008 were identified using MEDLINE, Embase, PsycINFO, Google and Google Scholar. Titles and abstracts were independently screened by two reviewers. Information from relevant publications was extracted, and a thematic analysis of identified determinants was conducted to identify broad domains of structural determinants. A narrative synthesis of study characteristics and identified determinants was conducted. RESULTS Of 657 publications identified, 53 were included. Ten domains of structural determinants of stigma were identified: legal frameworks, welfare policies, economic policies, social and built environments, media and marketing, pedagogical factors, health care policies and practices, biomedical technology, diagnostic frameworks and public health interventions. Each domain is defined and summarized, and a conceptual framework for how the identified domains relate to the stigma process is proposed. CONCLUSION At least 10 domains of structural factors influence the occurrence of stigma across health and social conditions. These domains can be used to structure policy discussions centred on ways to reduce stigma at the population level.
Collapse
Affiliation(s)
- Claire Bolster-Foucault
- Public Health Agency of Canada, Montréal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | | | - Alexandra Blair
- Public Health Agency of Canada, Montréal, Quebec, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Tuberculosis related stigma. MARMARA MEDICAL JOURNAL 2021. [DOI: 10.5472/marumj.854373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Stadtmüller S, Menold N, Schröder J, Ehlers S. [Barriers and Potential Improvements in the Diagnosis and Treatment of Asylum Seekers with Tuberculosis in Germany: A Qualitative Study]. DAS GESUNDHEITSWESEN 2020; 82:877-884. [PMID: 33049792 DOI: 10.1055/a-1186-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Since 2014, the number of new cases of tuberculosis (TB) has risen in Germany by about 20%. This coincides with a large number of people applying for asylum in Germany. Some of them are from countries in which TB is much more prevalent than in Germany. The objectives of this contribution are to identify and explain barriers in the diagnosis and treatment of asylum seekers with TB and potential improvements in those fields. Data are derived from 14 problem-centred interviews that were carried out with doctors and staff from public health offices, representing the views of experts in the field of health care. On the one hand, the results suggest that structural factors are responsible for some of the barriers mentioned by the experts. For example, the restricted access to health care for asylum seekers leads to a delayed diagnosis since they visit the doctor too late (if at all). Accordingly, a nationwide implementation of an electronic health card for asylum seekers was proposed. On the other hand, individual and cultural factors play important roles as well. To those belong language barriers: they not only complicate history taking and diagnosis, but also educating patients about their disease and therapy. Moreover, the lack of knowledge concerning the German health care system increases the risk of treatment interruptions. To alleviate those problems, experts propose to carry out train-the-trainer-programmes and to install "guides" who pilot asylum seekers with TB through the German health care system.
Collapse
Affiliation(s)
| | - Natalja Menold
- Institut für Soziologie, Technische Universität Dresden, Dresden
| | - Jette Schröder
- GESIS - Leibniz-Institut für Sozialwissenschaften, Mannheim
| | | |
Collapse
|
11
|
Wouters E, Sommerland N, Masquillier C, Rau A, Engelbrecht M, Van Rensburg AJ, Kigozi G, Ponnet K, Van Damme W. Unpacking the dynamics of double stigma: how the HIV-TB co-epidemic alters TB stigma and its management among healthcare workers. BMC Infect Dis 2020; 20:106. [PMID: 32028895 PMCID: PMC7006097 DOI: 10.1186/s12879-020-4816-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV and tuberculosis (TB) are intricably interlinked in South Africa. The social aspects of this co-epidemic remain relatively unexplored. More specifically, no research has quantitatively explored the double stigma associated with HIV and TB in this context, and more specifically the impact of the co-epidemic on [1] the stigmatisation of TB and [2] the TB stigma mangement strategy of covering (i.e. the use of TB as a cover for having HIV). The current study aims to address this research gap by disentangling the complex mechanisms related to HIV-TB stigma. METHODS Using Structural Equation Modelling (SEM), data of 882 health care workers (HCWs) in the Free State province, South Africa, are analysed to investigate the link between the stigmatization of HIV and TB and the stigma management by those affected. The current study focuses on health care workers (HCWs), as both TB and HIV have a severe impact on this professional group. RESULTS The results demonstrate that the perceived link between the epidemics is significantly associated with double HIV-TB stigmatization. Furthermore, the link between the illnesses and the double stigma are driving the stigmatization of TB. Finally, the link between HIV and TB as well as the stigmatization of both diseases by colleagues are associated with an increased use of covering as a stigma management strategy. CONCLUSIONS This is the first quantitative study disentagling the mediating role of double stigma in the context of the co-epidemic as well as the impact of the co-epidemic on the social connotations of TB. The results stress the need for an integrated approach in the fight against HIV and TB recognizing the intertwined nature of the co-epidemic, not only in medical-clinical terms, but also in its social consequences. TRIAL REGISTRATION South African National Clinical Trials Register, registration ID: DOH-27-1115-5204. Prospectively registered on 26 August 2015.
Collapse
Affiliation(s)
- Edwin Wouters
- Department of Sociology and Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium.
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa.
| | - Nina Sommerland
- Department of Sociology and Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Caroline Masquillier
- Department of Sociology and Centre for Population, Family and Health, University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Asta Rau
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa
| | | | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, Republic of South Africa
| | - Koen Ponnet
- Department of Communication Sciences, Media, Innovation and Communication Technologies, Ghent University, Ghent, Belgium
| | - Wim Van Damme
- International Health Policy, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
12
|
Hidiroglu S, Sarioz A, Ozdemir M, Luleci NE, Karavus M. Perceived Stigmatization Levels of Patients with Tuberculosis Applying to Tuberculosis Dispensaries in Istanbul. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/marusbed.546574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
13
|
A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
Collapse
|
14
|
Strong AE, Schwartz DA. Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection. ACTA ACUST UNITED AC 2019. [PMCID: PMC7123537 DOI: 10.1007/978-3-319-97637-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
|
15
|
Zwerling A, Dowdy D, von Delft A, Taylor H, Merritt MW. Incorporating social justice and stigma in cost-effectiveness analysis: drug-resistant tuberculosis treatment. Int J Tuberc Lung Dis 2018; 21:69-74. [PMID: 29025487 DOI: 10.5588/ijtld.16.0839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Novel therapies for multidrug-resistant tuberculosis (MDR-TB) are likely to be expensive. The cost of novel drugs (e.g., bedaquiline, delamanid) may be so prohibitively high that a traditional cost-effectiveness analysis (CEA) would rate regimens containing these drugs as not cost-effective. Traditional CEA may not appropriately account for considerations of social justice, and may put the most disadvantaged populations at greater risk. Using the example of novel drug regimens for MDR-TB, we propose a novel methodology, 'justice-enhanced CEA', and demonstrate how such an approach can simultaneously assess social justice impacts alongside traditional cost-effectiveness ratios. Justice-enhanced CEA, as we envision it, is performed in three steps: 1) systematic data collection about patients' lived experiences, 2) use of empirical findings to inform social justice assessments, and 3) incorporation of data-informed social justice assessments into a decision analytic framework that includes traditional CEA. These components are organized around a core framework of social justice developed by Bailey et al. to compare impacts on disadvantage not otherwise captured by CEA. Formal social justice assessments can produce three composite levels: 'expected not to worsen…', 'may worsen…', and 'expected to worsen clustering of disadvantage'. Levels of social justice impact would be assessed for each major type of outcome under each policy scenario compared. Social justice assessments are then overlaid side-by-side with cost-effectiveness assessments corresponding to each branch pathway on the decision tree. In conclusion, we present a 'justice-enhanced' framework that enables the incorporation of social justice concerns into traditional CEA for the evaluation of new regimens for MDR-TB.
Collapse
Affiliation(s)
- A Zwerling
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - D Dowdy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A von Delft
- TB Proof, Cape Town, South Africa, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - H Taylor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - M W Merritt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| |
Collapse
|
16
|
Crispim JDA, Touso MM, Yamamura M, Popolin MP, Garcia MCDC, Santos CBD, Palha PF, Arcêncio RA. Cultural adaptation of the Tuberculosis-related stigma scale to Brazil. CIENCIA & SAUDE COLETIVA 2018; 21:2233-42. [PMID: 27383356 DOI: 10.1590/1413-81232015217.10582015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/24/2015] [Indexed: 11/21/2022] Open
Abstract
The process of stigmatization associated with TB has been undervalued in national research as this social aspect is important in the control of the disease, especially in marginalized populations. This paper introduces the stages of the process of cultural adaptation in Brazil of the Tuberculosis-related stigma scale for TB patients. It is a methodological study in which the items of the scale were translated and back-translated with semantic validation with 15 individuals of the target population. After translation, the reconciled back-translated version was compared with the original version by the project coordinator in Southern Thailand, who approved the final version in Brazilian Portuguese. The results of the semantic validation conducted with TB patients enable the identification that, in general, the scale was well accepted and easily understood by the participants.
Collapse
Affiliation(s)
- Juliane de Almeida Crispim
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Michelle Mosna Touso
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Mellina Yamamura
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Marcela Paschoal Popolin
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Maria Concebida da Cunha Garcia
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Cláudia Benedita Dos Santos
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Pedro Fredemir Palha
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| | - Ricardo Alexandre Arcêncio
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Av. Bandeirantes 3900, Vila Monte Alegre. 14040-902 Ribeirão Preto SP Brasil.
| |
Collapse
|
17
|
Wouters E, Rau A, Engelbrecht M, Uebel K, Siegel J, Masquillier C, Kigozi G, Sommerland N, Yassi A. The Development and Piloting of Parallel Scales Measuring External and Internal HIV and Tuberculosis Stigma Among Healthcare Workers in the Free State Province, South Africa. Clin Infect Dis 2017; 62 Suppl 3:S244-54. [PMID: 27118854 DOI: 10.1093/cid/civ1185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The dual burden of tuberculosis and human immunodeficiency virus (HIV) is severely impacting the South African healthcare workforce. However, the use of on-site occupational health services is hampered by stigma among the healthcare workforce. The success of stigma-reduction interventions is difficult to evaluate because of a dearth of appropriate scientific tools to measure stigma in this specific professional setting. METHODS The current pilot study aimed to develop and test a range of scales measuring different aspects of stigma-internal and external stigma toward tuberculosis as well as HIV-in a South African healthcare setting. The study employed data of a sample of 200 staff members of a large hospital in Bloemfontein, South Africa. RESULTS Confirmatory factor analysis produced 7 scales, displaying internal construct validity: (1) colleagues' external HIV stigma, (2) colleagues' actions against external HIV stigma, (3) respondent's external HIV stigma, (4) respondent's internal HIV stigma, (5) colleagues' external tuberculosis stigma, (6) respondent's external tuberculosis stigma, and (7) respondent's internal tuberculosis stigma. Subsequent analyses (reliability analysis, structural equation modeling) demonstrated that the scales displayed good psychometric properties in terms of reliability and external construct validity. CONCLUSIONS The study outcomes support the use of the developed scales as a valid and reliable means to measure levels of tuberculosis- and HIV-related stigma among the healthcare workforce in a resource-limited context. Future studies should build on these findings to fine-tune the instruments and apply them to larger study populations across a range of different resource-limited healthcare settings with high HIV and tuberculosis prevalence.
Collapse
Affiliation(s)
- Edwin Wouters
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Asta Rau
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Kerry Uebel
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Jacob Siegel
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Masquillier
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Nina Sommerland
- Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Belgium
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
18
|
de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, Janssen S, Spijker R, Shaw B, Hill RA, Zumla A, van der Werf MJ, Sandgren A, Grobusch MP. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. THE LANCET. INFECTIOUS DISEASES 2017; 17:e128-e143. [PMID: 28291721 DOI: 10.1016/s1473-3099(16)30531-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 10/11/2016] [Accepted: 11/03/2016] [Indexed: 01/25/2023]
Abstract
Tuberculosis disproportionately affects hard-to-reach populations, such as homeless people, migrants, refugees, prisoners, or drug users. These people often face challenges in accessing quality health care. We did a systematic review of the qualitative literature to identify barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by people from hard-to-reach populations in all European Union (EU), European Economic Area, EU candidate, and Organisation for Economic Co-operation and Development countries. The 12 studies included in this review mainly focused on migrants. Views on perceived susceptibility to and severity of tuberculosis varied widely and included many misconceptions. Stigma and challenges regarding access to health care were identified as barriers to tuberculosis diagnosis and treatment uptake, whereas support from nurses, family, and friends was a facilitator for treatment adherence. Further studies are required to identify barriers and facilitators to the improved identification and management of tuberculosis in hard-to-reach populations to inform recommendations for more effective tuberculosis control programmes.
Collapse
Affiliation(s)
- Sophia G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anne L Cremers
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Charlotte C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick F Greve
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Benjamin J Visser
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Bélard
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Saskia Janssen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - René Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Beth Shaw
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK
| | - Ruaraidh A Hill
- National Institute for Health and Care Excellence, Piccadilly Plaza, Manchester, UK; Health Services Research, University of Liverpool, Liverpool, UK
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Andreas Sandgren
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
19
|
Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries. Int J Infect Dis 2017; 56:90-100. [DOI: 10.1016/j.ijid.2016.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022] Open
|
20
|
Heuvelings CC, de Vries SG, Grobusch MP. Tackling TB in low-incidence countries: improving diagnosis and management in vulnerable populations. Int J Infect Dis 2017; 56:77-80. [PMID: 28062228 DOI: 10.1016/j.ijid.2016.12.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/30/2022] Open
Abstract
In low tuberculosis incidence regions, tuberculosis is mainly concentrated among hard-to-reach populations like migrants, homeless people, drug or alcohol abusers, prisoners and people living with HIV. To be able to eliminate tuberculosis from these low incidence regions tuberculosis screening and treatment programs should focus on these hard-to-reach populations. Here we discuss the barriers and facilitators of health care-seeking, interventions improving tuberculosis screening uptake and interventions improving treatment adherence in these hard-to-reach populations.
Collapse
Affiliation(s)
- C C Heuvelings
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - S G de Vries
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| |
Collapse
|
21
|
Touso MM, Popolin MP, Crispim JDA, Freitas IMD, Rodrigues LBB, Yamamura M, Pinto IC, Monroe AA, Palha PF, Ferraudo AS, Villa TCS, Arcêncio RA. [Social stigma and the families of patients with tuberculosis: a study based on cluster and multiple correspondence analysis]. CIENCIA & SAUDE COLETIVA 2016; 19:4577-86. [PMID: 25351323 DOI: 10.1590/1413-812320141911.46062013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/20/2013] [Indexed: 11/22/2022] Open
Abstract
The social stigma associated with TB is a challenge facing management of the area of public health care. The aim of this study was to investigate the social stigma in families of patients with TB and identify the profile of those who are affected by the event in relation to socioeconomic and demographic conditions. It is a cross-sectional study that was conducted in 2011 in the city of Ribeirão Preto, state of São Paulo, Brazil, with a sample of 110 individuals. The data were analyzed using the univariate descriptive technique and cluster and multiple correspondence assessment. The stigmatized groups tend to have lower scholarity, incipient access to the media and little understanding about TB, as opposed to those that have higher educational levels, continuous access to the media, consider themselves well informed and show proactive attitudes to deal with the disease. The identification of varied profiles highlights the need to develop health interventions to cater to the singularities of families with respect to the social stigma of the disease.
Collapse
Affiliation(s)
- Michelle Mosna Touso
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Marcela Paschoal Popolin
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Juliane de Almeida Crispim
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Isabela Moreira de Freitas
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ludmila Barbosa Bandeira Rodrigues
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Mellina Yamamura
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ione Carvalho Pinto
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Aline Aparecida Monroe
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Pedro Fredemir Palha
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | | | - Tereza Cristina Scatena Villa
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| | - Ricardo Alexandre Arcêncio
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
| |
Collapse
|
22
|
Bliss JR, Njenga M, Stoltzfus RJ, Pelletier DL. Stigma as a barrier to treatment for child acute malnutrition in Marsabit County, Kenya. MATERNAL & CHILD NUTRITION 2016; 12:125-38. [PMID: 25989353 PMCID: PMC6860141 DOI: 10.1111/mcn.12198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute malnutrition affects millions of children each year, yet global coverage of life-saving treatment through the community-based management of acute malnutrition (CMAM) is estimated to be below 15%. We investigated the potential role of stigma as a barrier to accessing CMAM. We surveyed caregivers bringing children to rural health facilities in Marsabit County, Kenya, divided into three strata based on the mid-upper arm circumference of the child: normal status (n = 327), moderate acute malnutrition (MAM, n = 241) and severe acute malnutrition (SAM, n = 143). We used multilevel mixed effects logistic regression to estimate the odds of reporting shame as a barrier to accessing health care. We found that the most common barriers to accessing child health care were those known to be universally problematic: women's time and labour constraints. These constituted the top five most frequently reported barriers regardless of child acute malnutrition status. In contrast, the odds of reporting shame as a barrier were 3.64 (confidence interval: 1.66-8.03, P < 0.05) times higher in caregivers of MAM and SAM children relative to those of normal children. We conclude that stigma is an under-recognized barrier to accessing CMAM and may constrain programme coverage. In light of the large gap in coverage of CMAM, there is an urgent need to understand the sources of acute malnutrition-associated stigma and adopt effective means of de-stigmatization.
Collapse
|
23
|
Arcêncio RA, de Almeida Crispim J, Touso MM, Popolin MP, Rodrigues LBB, de Freitas IM, Yamamura M, Neto MS. Preliminary validation of an instrument to assess social support and tuberculosis stigma in patients' families. Public Health Action 2015; 4:195-200. [PMID: 26400810 DOI: 10.5588/pha.13.0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Ribeirão Preto, São Paulo, Brazil. OBJECTIVE To develop and validate a preliminary instrument for assessing social support and tuberculosis (TB) stigma in families of TB patients. DESIGN A literature review on social support and TB stigma was used to generate the theoretical domains for the instrument. A focus group was then conducted with TB patients and their families to revise the domains. Reviewers were invited to judge the appropriateness of the items in the instrument. A cross-sectional survey was carried out among 110 family members to assess the factorial structure using principal component analysis and confirmatory factor analysis to assess construct validity. Reliability was assessed in terms of internal consistency using Cronbach's alpha. RESULTS After semantic validation and a pilot study, 23 items were selected for the scale. Examination of the factorial structure of the 16 items that were factorable using principal component analysis led to the extraction of two factors. The 16-item instrument was assessed for construct validity with confirmatory factor analysis, which confirmed a model with four items for each dimension. CONCLUSION The study analysed the psychometric properties of an instrument that is still in its preliminary stages. Other studies on a similar scale in the Brazilian setting are required.
Collapse
Affiliation(s)
- R A Arcêncio
- Department of Maternal-Infantile Nursing and Public Health
| | - J de Almeida Crispim
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M M Touso
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M P Popolin
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L B B Rodrigues
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - I M de Freitas
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M Yamamura
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M Santos Neto
- Nursing and Public Health Graduate Programme, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
24
|
Abstract
Tuberculosis (TB) researchers and clinicians, by virtue of the social disease they study, are drawn into an engagement with ways of understanding illness that extend beyond the strictly biomedical model. Primers on social science concepts directly relevant to TB, however, are lacking. The particularities of TB disease mean that certain social science concepts are more relevant than others. Concepts such as structural violence can seem complicated and off-putting. Other concepts, such as gender, can seem so familiar that they are left relatively unexplored. An intimate familiarity with the social dimensions of disease is valuable, particularly for infectious diseases, because the social model is an important complement to the biomedical model. This review article offers an important introduction to a selection of concepts directly relevant to TB from health sociology, medical anthropology and social cognitive theory. The article has pedagogical utility and also serves as a useful refresher for those researchers already engaged in this genre of work. The conceptual tools of health sociology, medical anthropology and social cognitive theory offer insightful ways to examine the social, historical and cultural dimensions of public health. By recognizing cultural experience as a central force shaping human interactions with the world, TB researchers and clinicians develop a more nuanced consideration of how health, illness and medical treatment are understood, interpreted and confronted.
Collapse
|
25
|
Daftary A, Padayatchi N. Social constraints to TB/HIV healthcare: accounts from coinfected patients in South Africa. AIDS Care 2012; 24:1480-6. [PMID: 22530855 DOI: 10.1080/09540121.2012.672719] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There is a growing imperative to improve the coordination and collaboration of tuberculosis (TB) and HIV healthcare services in response to escalating rates of TB/HIV coinfection. Patient-specific challenges associated with the delivery of TB/HIV care have been minimally explored in this regard. As part of a larger study conducted in South Africa, this article highlights coinfected patients' experiences with TB and HIV healthcare in light of their broader social environments. Qualitative, in-depth interviews were conducted with 40 adult, coinfected patients (24 women and 16 men) and eight key-informant healthcare workers at three urban/peri-urban, ambulatory, public health clinics in the high-burden province of KwaZulu-Natal. Transcribed interviews were analyzed under a modified grounded theory approach to capture subjective meanings of healthcare experience subsequent to patients' codiagnosis with TB and HIV. Emerging analytic themes highlighted critical sociomedical constraints to TB/HIV care in relation to patients' income and employment, eligibility for social assistance and antiretroviral treatment, fears around illness disclosure, social and material support, and treatment adherence. Patients' healthcare experiences were bound by their poor access to essential resources, multiple life responsibilities, disparate gender roles, limits within the healthcare system, and the stigmatizing social symbolism of their illness. Overlapping social inequalities perpetuated coinfected patients' experiences with stigma and collectively mediated their health decisions around disclosure, adherence, and retention in medical care. The study urges a contextualized understanding of the social challenges associated with TB/HIV healthcare and helps inform more patient-sensitive and socially responsive interventions against the co-epidemic.
Collapse
Affiliation(s)
- Amrita Daftary
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | |
Collapse
|
26
|
Daftary A. HIV and tuberculosis: the construction and management of double stigma. Soc Sci Med 2012; 74:1512-9. [PMID: 22444460 DOI: 10.1016/j.socscimed.2012.01.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/23/2012] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
Abstract
Mitigation of the tuberculosis (TB) and HIV syndemic is undermined by critical clinical, operational and social challenges of which the social aspects have been least explored. This paper examines the lived experience of TB disease and HIV from the perspective of affected individuals to analyze how they may think about their dual illness; how they understand their illness with TB in relation to HIV, and vice versa; and how they characterize their (stigmatized) experiences in the context of their perceptions and identities. From February-August 2009, qualitative, semi-structured interviews were conducted with 40 adults with HIV and TB disease at three ambulatory clinics in KwaZulu-Natal, South Africa. Subjective meanings of illness experience were analyzed using modified grounded-theory. Emergent themes on illness perception and disclosure revealed how patients constructed dichotomous identities associated with TB and HIV through social constructs of moral susceptibility and (im)permanence. Each identity was associated with relatively disparate degrees of stigma as a product of labeling, negative stereotyping and discrimination. HIV bore the least desirable identity and invoked the greatest stigma. However, the confluence of the two epidemics rendered TB symbolic and symptomatic of HIV, and enhanced the visibility of AIDS. Dual illness thus introduced a paradox to patients' identity constructions, and produced a unique, overlapping double stigma. This facilitated new forms of stigma against TB, and aggravated existing stigma against HIV. It also conferred visibility to some forms of extra-pulmonary TB. Patients managed their double stigmas through novel forms of information sharing that relied on segregating their dual illness identities. Patients deflected the dominant stigma of HIV through concurrent processes of HIV 'othering' - their symbolic distancing from persons affected by HIV, and 'covering' - their selective disclosure of illness (and identity associated) with TB over that of HIV. Findings call for greater consideration to the complex role of stigma in the delivery of TB/HIV healthcare.
Collapse
|
27
|
Kipp AM, Pungrassami P, Stewart PW, Chongsuvivatwong V, Strauss RP, Van Rie A. Study of tuberculosis and AIDS stigma as barriers to tuberculosis treatment adherence using validated stigma scales. Int J Tuberc Lung Dis 2012; 15:1540-5, i. [PMID: 22008770 DOI: 10.5588/ijtld.10.0273] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to tuberculosis (TB) treatment is important for TB control. The effect of stigma on adherence has not been well quantified. OBJECTIVE To identify the effects of TB and acquired immune-deficiency syndrome (AIDS) stigma on missed doses during TB treatment. DESIGN Validated TB and AIDS stigma scales assessing perceived and experienced/felt stigma were administered in a prospective cohort of 459 TB patients at TB treatment initiation and after 2 months. Repeated measures and multivariable models estimated the effects of stigma on the rate of missed doses. RESULTS Fifty-six per cent of patients missed no doses, and associations between stigma and missed doses were minimal. Heterogeneity of effects was observed, how- ever, with higher experienced and felt TB stigma increasing missed doses among women (adjusted RR 1.22, 95%CI 1.10-1.34) and human immunodeficiency virus (HIV) co-infected patients (aRR 1.39, 95%CI 1.13-1.72). Experienced and felt AIDS stigma also increased missed doses among HIV co-infected patients (aRR 1.43, 95%CI 1.31-1.56). CONCLUSION Stigma has a minimal effect in this population with good adherence. Among women and HIV co-infected patients, however, experienced and felt stigma, and not perceived stigma, increased the rate of missed doses. Further research is needed to determine if stigma or coping interventions among these subgroups would improve adherence.
Collapse
Affiliation(s)
- A M Kipp
- University of North Carolina, Chapel Hill, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Schaetti C, Chaignat CL, Hutubessy R, Khatib AM, Ali SM, Schindler C, Weiss MG. Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar. HUMAN VACCINES 2011; 7:1299-308. [PMID: 22108036 DOI: 10.4161/hv.7.12.18012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite improvements in sanitation and water supply, cholera remains a serious public health burden. Vaccination is included among recommendations for cholera control. Cultural concepts of illness are likely to affect vaccine acceptance. This study examined social and cultural determinants of anticipated acceptance of an oral cholera vaccine (OCV) prior to a mass vaccination campaign in Zanzibar. Using a cultural epidemiological approach, 356 unaffected adult residents were studied with vignette-based semi-structured interviews. Anticipated acceptance was high for a free OCV (94%), but declined with increasing price. Logistic regression models examined social and cultural determinants of anticipated acceptance at low (USD 0.9), medium (USD 4.5) and high (USD 9) price. Models including somatic symptoms (low and high price), social impact (low and medium) and perceived causes (medium and high) explained anticipated OCV acceptance better than models containing only socio-demographic characteristics. Identifying thirst with cholera was positively associated with anticipated acceptance of the low-priced OCV, but acknowledging the value of home-based rehydration was negatively associated. Concern about spreading the infection to others was positively associated at low price among rural respondents. Confidence in the health system response to cholera outbreaks was negatively associated at medium price among peri-urban respondents. Identifying witchcraft as cause of cholera was negatively associated at medium and high price. Anticipated acceptance of free OCVs is nearly universal in cholera-endemic areas of Zanzibar; pre-intervention assessments of community demand for OCV should not only consider the social epidemiology, but also examine local socio-cultural features of cholera-like illness that explain vaccine acceptance.
Collapse
Affiliation(s)
- Christian Schaetti
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | | | | | | | | | | | | |
Collapse
|
29
|
Kipp AM, Pungrassami P, Nilmanat K, Sengupta S, Poole C, Strauss RP, Chongsuvivatwong V, Van Rie A. Socio-demographic and AIDS-related factors associated with tuberculosis stigma in southern Thailand: a quantitative, cross-sectional study of stigma among patients with TB and healthy community members. BMC Public Health 2011; 11:675. [PMID: 21878102 PMCID: PMC3223813 DOI: 10.1186/1471-2458-11-675] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 08/30/2011] [Indexed: 11/22/2022] Open
Abstract
Background Tuberculosis (TB) remains one of the most important infectious diseases worldwide. A comprehensive approach towards disease control that addresses social factors including stigma is now advocated. Patients with TB report fears of isolation and rejection that may lead to delays in seeking care and could affect treatment adherence. Qualitative studies have identified socio-demographic, TB knowledge, and clinical determinants of TB stigma, but only one prior study has quantified these associations using formally developed and validated stigma scales. The purpose of this study was to measure TB stigma and identify factors associated with TB stigma among patients and healthy community members. Methods A cross-sectional study was performed in southern Thailand among two different groups of participants: 480 patients with TB and 300 healthy community members. Data were collected on socio-demographic characteristics, TB knowledge, and clinical factors. Scales measuring perceived TB stigma, experienced/felt TB stigma, and perceived AIDS stigma were administered to patients with TB. Community members responded to a community TB stigma and community AIDS stigma scale, which contained the same items as the perceived stigma scales given to patients. Stigma scores could range from zero to 30, 33, or 36 depending on the scale. Three separate multivariable linear regressions were performed among patients with TB (perceived and experience/felt stigma) and community members (community stigma) to determine which factors were associated with higher mean TB stigma scores. Results Only low level of education, belief that TB increases the chance of getting AIDS, and AIDS stigma were associated with higher TB stigma scores in all three analyses. Co-infection with HIV was associated with higher TB stigma among patients. All differences in mean stigma scores between index and referent levels of each factor were less than two points, except for incorrectly believing that TB increases the chance of getting AIDS (mean difference of 2.16; 95% CI: 1.38, 2.94) and knowing someone who died from TB (mean difference of 2.59; 95% CI: 0.96, 4.22). Conclusion These results suggest that approaches addressing the dual TB/HIV epidemic may be needed to combat TB stigma and that simply correcting misconceptions about TB may have limited effects.
Collapse
Affiliation(s)
- Aaron M Kipp
- University of North Carolina, Department of Epidemiology, Chapel Hill, North Carolina, USA.
| | | | | | | | | | | | | | | |
Collapse
|