1
|
Mlambo LM, Milovanovic M, Hanrahan CF, Motsomi KW, Morolo MT, Mohlamonyane MP, Albaugh NW, Ahmed K, Martinson NA, Dowdy DW, West NS. The impact of ethical implications intertwined with tuberculosis household contact investigation: a qualitative study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.27.24309538. [PMID: 38978659 PMCID: PMC11230326 DOI: 10.1101/2024.06.27.24309538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background Household contact investigation (HCI) is an effective and widely used approach to identify persons with tuberculosis (TB) disease and infection, globally. Despite widespread recommendations for the use of HCI, there remains poor understanding of the impact on and value of contact investigation for participants. Further, how HCI as a practice impacts psychosocial factors, including stigma and possible unintended disclosure of illness among persons with TB, their families, and communities, is largely unknown. Methods This exploratory qualitative study nested within a randomized trial (ClinicalTrials.gov: NCT04520113, 17 August 2020) was conducted in South Africa to understand the impacts of HCI on index patients living with TB and their household contact persons in two rural districts in the Limpopo province (Vhembe and Capricorn) and Soshanguve, a peri-urban township in Gauteng province. People with TB and household members of people with TB were recruited to participate in in-depth interviews and focus group discussions using semi-structured guides. We explored individual, interpersonal, and community-level perceptions of potential impacts of household contact investigation to elucidate their perceptions of HCI. Thematic analysis identified key themes. Results Twenty-four individual interviews and six focus group discussions (n=39 participants) were conducted. Participants viewed HCI as an effective approach to finding TB cases, helpful in educating households about TB symptoms and reducing barriers to health-related services. At the interpersonal level, HCI aided people with TB in safely disclosing their TB status to family members and facilitated family and social support for accountability. The introduction of HIV testing during HCI was reported by some participants as making household members slightly uncomfortable, decreasing interest in household members being tested for TB. HCI negatively impacted community-level TB and HIV-related stigma due to healthcare worker visibility at home. Conclusion Our data suggests varying impacts of HCI on people with TB, their families and interpersonal relationships, and communities, highlighting the importance of considering approaches that address concerns about community stigma and HIV testing to enhance acceptance of HCI.
Collapse
Affiliation(s)
- LM Mlambo
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - M Milovanovic
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
- African Potential Group, Johannesburg, South Africa
| | - CF Hanrahan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - KW Motsomi
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - MT Morolo
- Setshaba Research Centre, Soshanguve, South Africa
| | - MP Mohlamonyane
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - NW Albaugh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - K Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - NA Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, Maryland, United States of America
| | - DW Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - NS. West
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev 2024; 3:CD014756. [PMID: 38511668 PMCID: PMC10955804 DOI: 10.1002/14651858.cd014756.pub2] [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: 03/22/2024]
Abstract
BACKGROUND Active case finding (ACF) refers to the systematic identification of people with tuberculosis in communities and amongst populations who do not present to health facilities, through approaches such as door-to-door screening or contact tracing. ACF may improve access to tuberculosis diagnosis and treatment for the poor and for people remote from diagnostic and treatment facilities. As a result, ACF may also reduce onward transmission. However, there is a need to understand how these programmes are experienced by communities in order to design appropriate services. OBJECTIVES To synthesize community views on tuberculosis active case finding (ACF) programmes in low- and middle-income countries. SEARCH METHODS We searched MEDLINE, Embase, and eight other databases up to 22 June 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. We did not include grey literature. SELECTION CRITERIA This review synthesized qualitative research and mixed-methods studies with separate qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards ACF programmes for tuberculosis in any endemic low- or middle-income country, with no time restrictions. DATA COLLECTION AND ANALYSIS Due to the large volume of studies identified, we chose to sample studies that had 'thick' description and that investigated key subgroups of children and refugees. We followed standard Cochrane methods for study description and appraisal of methodological limitations. We conducted thematic synthesis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE-CERQual approach, and produced a conceptual model to display how the different findings interact. MAIN RESULTS We included 45 studies in this synthesis, and sampled 20. The studies covered a broad range of World Health Organization (WHO) regions (Africa, South-East Asia, Eastern Mediterranean, and the Americas) and explored the views and experiences of community members, community health workers, and clinical staff in low- and middle-income countries endemic for tuberculosis. The following five themes emerged. • ACF improves access to diagnosis for many, but does little to help communities on the edge. Tuberculosis ACF and contact tracing improve access to health services for people with worse health and fewer resources (High confidence). ACF helps to find this population, exposed to deprived living conditions, but is not sensitive to additional dimensions of their plight (High confidence) and out-of-pocket costs necessary to continue care (High confidence). Finally, migration and difficult geography further reduce communities' access to ACF (High confidence). • People are afraid of diagnosis and its impact. Some community members find screening frightening. It exposes them to discrimination along distinct pathways (isolation from their families and wider community, lost employment and housing). HIV stigma compounds tuberculosis stigma and heightens vulnerability to discrimination along these same pathways (High confidence). Consequently, community members may refuse to participate in screening, contact tracing, and treatment (High confidence). In addition, people with tuberculosis reported their emotional turmoil upon diagnosis, as they anticipated intense treatment regimens and the prospect of living with a serious illness (High confidence). • Screening is undermined by weak health infrastructure. In many settings, a lack of resources results in weak services in competition with other disease control programmes (Moderate confidence). In this context of low investment, people face repeated tests and clinic visits, wasted time, and fraught social interaction with health providers (Moderate confidence). ACF can create expectations for follow-up health care that it cannot deliver (High confidence). Finally, community education improves awareness of tuberculosis in some settings, but lack of full information impacts community members, parents, and health workers, and sometimes leads to harm for children (High confidence). • Health workers are an undervalued but important part of ACF. ACF can feel difficult for health workers in the context of a poorly resourced health system and with people who may not wish to be identified. In addition, the evidence suggests health workers are poorly protected against tuberculosis and fear they or their families might become infected (Moderate confidence). However, they appear to be central to programme success, as the humanity they offer often acts as a driving force for retaining people with tuberculosis in care (Moderate confidence). • Local leadership is necessary but not sufficient for ensuring appropriate programmes. Local leadership creates an intrinsic motivation for communities to value health services (High confidence). However, local leadership cannot guarantee the success of ACF and contact tracing programmes. It is important to balance professional authority with local knowledge and rapport (High confidence). AUTHORS' CONCLUSIONS Tuberculosis active case finding (ACF) and contact tracing bring a diagnostic service to people who may otherwise not receive it, such as those who are well or without symptoms and those who are sick but who have fewer resources and live further from health facilities. However, capturing these 'missing cases' may in itself be insufficient without appropriate health system strengthening to retain people in care. People who receive a tuberculosis diagnosis must contend with a complex and unsustainable cascade of care, and this affects their perception of ACF and their decision to engage with it.
Collapse
Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nancy Medley
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Susanna S van Wyk
- Centre for Evidence-based Health Care, Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London, London, UK
- Faculty of the Humanities, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
4
|
Scott M, Watermeyer J, Wessels TM. "We are just not sure what that means or if it's relevant": Uncertainty when gathering family history information in South African prenatal genetic counseling consultations. Soc Sci Med 2024; 342:116555. [PMID: 38176214 DOI: 10.1016/j.socscimed.2023.116555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
Uncertainty impacts the process of health communication. The management and tolerance of uncertainty during healthcare discussions have gained renewed focus due to the growing challenge of obtaining and delivering complex health information, and the offer of health services in diverse contexts. Prenatal genetic counseling (GC) provides education, support and testing options for patients and couples facing a genetic or congenital diagnosis or risk during pregnancy. Gathering detailed and accurate family history information is essential to determine a patient's genetic risk. In South Africa, contextual factors such as patient literacy, language diversity, limited written patient health records, and a lack of familiarity with GC services may increase the potential for misunderstandings during GC consultations. This study uses a qualitative sociolinguistic approach to analyse 9 video-recorded South African prenatal GC consultations to understand the impact of uncertainty on the process of gathering family history information. The findings reveal uncertainty is introduced in different ways during family history taking. This includes when patients have no knowledge about their family history; when they have some knowledge but the details are unclear; or when patients have knowledge but the details are confusing. Uncertainty can lead to interactional trouble in the form of knowledge asymmetries, interrogative questioning, reversals in epistemic authority, and the potential for mistrust. Suggestions are made for how genetic specialists can manage uncertainty in GC family history taking. These include recognizing contextual sources of uncertainty, understanding how patients may respond to uncertainty and being aware of personal responses to moments of discomfort. Specific communication training recommendations and video-based sociolinguistic methods to enhance reflection and communication practice are highlighted. These approaches may enhance the effectiveness of GC communication and strengthen patient-specialist relationships, especially in diverse settings.
Collapse
Affiliation(s)
- Megan Scott
- The Health Communication Research Unit (HCRU), School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jennifer Watermeyer
- The Health Communication Research Unit (HCRU), School of Human & Community Development, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Tina-Marie Wessels
- Division of Human Genetics, Department of Pathology, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Mainga T, Gondwe M, Mactaggart I, Stewart RC, Shanaube K, Ayles H, Bond V. Qualitative study of patient experiences of mental distress during TB investigation and treatment in Zambia. BMC Psychol 2022; 10:179. [PMID: 35854324 PMCID: PMC9295264 DOI: 10.1186/s40359-022-00881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background The mental health and TB syndemic is a topic that remains under-researched with a significant gap in acknowledging and recognizing patient experiences, particularly in the sub-Saharan African region. In this qualitative study conducted in Zambia, we aimed to explore the lived mental health experiences of TB patients focusing on their multi-layered drivers of distress, and by so doing highlighting contextual factors that influence mental distress in TB patients in this setting.
Methods The study draws on qualitative data collected in 2018 as part of the Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for active TB trial (TREATS) being conducted in Zambia. The data was collected through in-depth interviews with former TB patients (n = 80) from 8 urban communities participating in the TREATS trial. Thematic analysis was conducted. Additional quantitative exploratory analysis mapping mental distress symptoms on demographic, social, economic and TB characteristics of participants was conducted.
Results Most participants (76%) shared that they had experienced some form of mental distress during their TB investigation and treatment period. The reported symptoms ranged in severity. Some participants reported mild distress that did not disrupt their daily lives or ability to adhere to their TB medication, while other participants reported more severe symptoms of distress, for example, 15% of participants shared that they had suicidal ideation and thoughts of self-harm during their time on treatment. Mental distress was driven by unique interactions between individual, social and health level factors most of which were inextricably linked to poverty. Mental distress caused by individual level drivers such as TB morbidity often abated once participants started feeling better, however social, economic and health system level drivers of distress persisted during and beyond TB treatment. Conclusion The findings illustrate that mental distress during TB is driven by multi-layered and intersecting stresses, with the economic stress of poverty often being the most powerful driver. Measures are urgently needed to support TB patients during the investigation and treatment phase, including increased availability of mental health services, better social security safety nets during TB treatment, and interventions targeting TB, HIV and mental health stigma. Trial registration ClinicalTrials.gov NCT03739736. Trial registration date: November 14, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00881-x.
Collapse
Affiliation(s)
- T Mainga
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia. .,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - M Gondwe
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - I Mactaggart
- Department of Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - R C Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK.,Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - K Shanaube
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia
| | - H Ayles
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - V Bond
- Zambart, University of Zambia School of Public Health, Ridgeway, Zambia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| | | | | |
Collapse
|
10
|
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
|
11
|
Murray EJ, Dodd PJ, Marais B, Ayles H, Shanaube K, Schaap A, White RG, Bond V. Sociological variety and the transmission efficiency of Mycobacterium tuberculosis: a secondary analysis of qualitative and quantitative data from 15 communities in Zambia. BMJ Open 2021; 11:e047136. [PMID: 34907038 PMCID: PMC8671921 DOI: 10.1136/bmjopen-2020-047136] [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 Selected Zambian communities formed part of a cluster randomised trial: the Zambia and South Africa TB and AIDS Reduction study (ZAMSTAR). There was wide variability in the prevalence of Mycobacterium tuberculosis infection and tuberculosis (TB) disease across these communities. We sought to clarify whether specific communities could have been more/less vulnerable to M. tuberculosis transmission as a result of sociological variety relevant to transmission efficiency. DESIGN We conducted a mixed methods secondary analysis using existing data sets. First, we analysed qualitative data to categorise and synthesise patterns of socio-spatial engagement across communities. Second, we compared emergent sociological variables with a measure of transmission efficiency: the ratio of the annual risk of infection to TB prevalence. SETTING ZAMSTAR communities in urban and peri-urban Zambia, spanning five provinces. PARTICIPANTS Fifteen communities, each served by a health facility offering TB treatment to a population of at least 25 000. TB notification rates were at least 400 per 100 000 per annum and HIV seroprevalence was estimated to be high. RESULTS Crowding, movement, livelihoods and participation in recreational activity differed across communities. Based on 12 socio-spatial indicators, communities were qualitatively classified as more/less spatially crowded and as more/less socially 'open' to contact with others, with implications for the presumptive risk of M. tuberculosis transmission. For example, watching video shows in poorly ventilated structures posed a presumptive risk in more socially open communities, while outdoor farming and/or fishing were particularly widespread in communities with lower transmission measures. CONCLUSIONS A dual dynamic of 'social permeability' and crowding appeared relevant to disparities in M. tuberculosis transmission efficiency. To reduce transmission, certain socio-spatial aspects could be adjusted (eg, increasing ventilation on transport), while more structural aspects are less malleable (eg, reliance on public transport). We recommend integrating community level typologies with genome sequencing techniques to further explore the significance of 'social permeability'. TRIAL REGISTRATION NUMBER ISRCTN36729271.
Collapse
Affiliation(s)
| | - Peter J Dodd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Ben Marais
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Helen Ayles
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Albertus Schaap
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard G White
- TB Modelling Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Kallon II, Swartz A, Colvin CJ, MacGregor H, Zwama G, Voce AS, Grant AD, Kielmann K. Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212133. [PMID: 34831888 PMCID: PMC8620186 DOI: 10.3390/ijerph182212133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
Background: Although many healthcare workers (HCWs) are aware of the protective role that mask-wearing has in reducing transmission of tuberculosis (TB) and other airborne diseases, studies on infection prevention and control (IPC) for TB in South Africa indicate that mask-wearing is often poorly implemented. Mask-wearing practices are influenced by aspects of the environment and organisational culture within which HCWs work. Methods: We draw on 23 interviews and four focus group discussions conducted with 44 HCWs in six primary care facilities in the Western Cape Province of South Africa. Three key dimensions of organisational culture were used to guide a thematic analysis of HCWs’ perceptions of masks and mask-wearing practices in the context of TB infection prevention and control. Results: First, HCW accounts address both the physical experience of wearing masks, as well as how mask-wearing is perceived in social interactions, reflecting visual manifestations of organisational culture in clinics. Second, HCWs expressed shared ways of thinking in their normalisation of TB as an inevitable risk that is inherent to their work and their localization of TB risk in specific areas of the clinic. Third, deeper assumptions about mask-wearing as an individual choice rather than a collective responsibility were embedded in power and accountability relationships among HCWs and clinic managers. These features of organisational culture are underpinned by broader systemic shortcomings, including limited availability of masks, poorly enforced protocols, and a general lack of role modelling around mask-wearing. HCW mask-wearing was thus shaped not only by individual knowledge and motivation but also by the embodied social dimensions of mask-wearing, the perceptions that TB risk was normal and localizable, and a shared underlying tendency to assume that mask-wearing, ultimately, was a matter of individual choice and responsibility. Conclusions: Organisational culture has an important, and under-researched, impact on HCW mask-wearing and other PPE and IPC practices. Consistent mask-wearing might become a more routine feature of IPC in health facilities if facility managers more actively promote engagement with TB-IPC guidelines and develop a sense of collective involvement and ownership of TB-IPC in facilities.
Collapse
Affiliation(s)
- Idriss I. Kallon
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (I.I.K.); (A.S.)
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (I.I.K.); (A.S.)
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912, USA
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (I.I.K.); (A.S.)
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02912, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
- Correspondence:
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton BN1 9RE, UK;
| | - Gimenne Zwama
- Institute of Global Health & Development, Queen Margaret University, Musselburgh EH21 6UU, UK; (G.Z.); (K.K.)
| | - Anna S. Voce
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
- Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Karina Kielmann
- Institute of Global Health & Development, Queen Margaret University, Musselburgh EH21 6UU, UK; (G.Z.); (K.K.)
- Department of Public Health, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| |
Collapse
|
13
|
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: 28] [Impact Index Per Article: 9.3] [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.
Collapse
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
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Wademan DT, Mainga T, Gondwe M, Ayles H, Shanaube K, Mureithi L, Bond V, Hoddinott G. 'TB is a disease which hides in the body': Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa. Glob Public Health 2021; 17:1713-1727. [PMID: 34187320 DOI: 10.1080/17441692.2021.1940235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These 'former TB patients' are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and 'staining', participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease.
Collapse
Affiliation(s)
- Dillon T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tila Mainga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Melleh Gondwe
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Kwame Shanaube
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Linda Mureithi
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
16
|
Medley N, Taylor M, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nancy Medley
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Melissa Taylor
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Susanna S van Wyk
- Centre for Evidence-based Health Care, Epidemiology and Biostatistics, Department of Global Health; Faculty of Medicine and Health Sciences, Stellenbosch University; Cape Town South Africa
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education; University College London; London UK
- Faculty of the Humanities; University of Johannesburg; Johannesburg South Africa
| |
Collapse
|
17
|
Ntenda PAM, Mussa R, Gowelo S, Sixpence A, Bauleni A, Simbeye A, Matengeni A, Matola E, Banda G, Stanley CC, Banda S, Nkoka O. Determinants of self-reported correct knowledge about tuberculosis transmission among men and women in Malawi: evidence from a nationwide household survey. BMC Infect Dis 2021; 21:132. [PMID: 33516174 PMCID: PMC7847566 DOI: 10.1186/s12879-021-05836-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Correct knowledge about transmission of tuberculosis (TB) can influence better health-seeking behaviors, and in turn, it can aid TB prevention in society. Therefore, this study aimed to examine the prevalence and predictors of self-reported correct knowledge about TB transmission among adults in Malawi. METHODS We conducted a secondary analysis of the data obtained from the Malawi Demographic and Health Survey, 2015/16 (MDHS 2015/16). Questions regarding self-reported TB transmission were computed to evaluate the correct knowledge about TB transmission. The factors associated with the correct knowledge about Tb were assessed using univariate and multivariable logistic regression. RESULTS Overall, the prevalence of correct knowledge about TB transmission in the general population of Malawian adults was 61.5%. Specifically, the prevalence of correct knowledge about TB transmission was 63.6 and 60.8% in men and women, respectively. Those aged 35-44 years, having secondary or high education, belonging to the richest household, being exposed to mass media, being in professional/technical/managerial, having knowledge that "TB can be cured", and those living in urban areas were significantly associated with correct knowledge about TB transmission. CONCLUSIONS The findings of this study show that if appropriate strategies for TB communication and education to address the rural masses, young individuals, poor individuals, and individuals in the agriculture sector are put it place, can enhance TB prevention in Malawi.
Collapse
Affiliation(s)
- Peter A. M. Ntenda
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Razak Mussa
- Centre for Reproduction Health (CRH), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Steve Gowelo
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Andy Bauleni
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Atusayi Simbeye
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alfred Matengeni
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Ernest Matola
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Godfrey Banda
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Christopher C. Stanley
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Susan Banda
- School of Public Health and Family Medicine (SPHFM), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Owen Nkoka
- School of Public Health (SPH), Taipei Medical University (TMU), No. 250, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan
- Institute for Health Research and Communication (IHRC), P.O Box 1958, Lilongwe, Malawi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
18
|
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]
|
19
|
Chen X, Du L, Wu R, Xu J, Ji H, Zhang Y, Zhu X, Zhou L. Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study. BMC Public Health 2021; 21:6. [PMID: 33397334 PMCID: PMC7780403 DOI: 10.1186/s12889-020-10055-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022] Open
Abstract
Background The stigma of tuberculosis (TB) poses a significant challenge to TB control because it leads to delayed diagnosis and non-adherence. However, few studies on TB-related stigma have been completed in China. The aim of the current study was to explore the status of TB-related stigma and its associated predictive factors among TB patients in Dalian, Northeast China. Methods An institution-based, cross-sectional survey was conducted among outpatients at Dalian Tuberculosis Hospital in Liaoning Province, Northeast China. Data were collected by using a questionnaire that measured TB-related stigma, treatment status, anxiety, social support, doctor-patient communication and so on. A multiple linear regression model was used to determine the predictors of TB-related stigma. Results A total of 601 eligible participants were recruited. The mean score for TB-related stigma was 9.07, and the median score was 10. The average scores for anxiety, social support and doctor-patient communication were 4.03, 25.41 and 17.17, respectively. Multiple linear regression analysis revealed that patients who were female (β = 1.19, 95% CI: 0.38–2.01, P < 0.05), had self-assessed moderate or severe disease (β = 1.08, 95% CI: 0.12–2.03 and β = 1.36, 95% CI: 0.03–2.70, respectively, P < 0.05), and had anxiety (β = 0.38, 95% CI: 0.30–0.46, P < 0.001) were more likely to have a greater level of TB-related stigma than their counterparts. However, a significantly lower level of TB-related stigma was observed in patients with good social support (β = − 0.25, 95% CI: − 0.33--0.17, P < 0.001) and doctor-patient communication (β = − 0.14, 95% CI: − 0.29--0.00, P < 0.05). Conclusions This study showed that stigma among TB patients was high. Targeted attention should be paid to female patients and patients with moderate or severe disease in TB stigma-related interventions. Moreover, the important role of social support and doctor-patient communication in reducing TB-related stigma should also be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10055-2.
Collapse
Affiliation(s)
- Xu Chen
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Liang Du
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Jia Xu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Yu Zhang
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044
| | - Ling Zhou
- School of Public Health, Dalian Medical University, 9 Western Section, Lvshun South Street, Lvshunkou District, Dalian, People's Republic of China, 116044.
| |
Collapse
|
20
|
Mbuthia GW, Nyamogoba HDN, Chiang SS, McGarvey ST. Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study. PLoS One 2020; 15:e0240457. [PMID: 33057420 PMCID: PMC7561176 DOI: 10.1371/journal.pone.0240457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community. METHODS This hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data. RESULTS The internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not. CONCLUSION There is a need to implement stigma reduction interventions in order to improve TB program outcomes.
Collapse
Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Silvia S. Chiang
- Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States of America
| | - Stephen T. McGarvey
- International Health Institute, and Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States of America
| |
Collapse
|
21
|
Viljoen L, Myburgh H, Reynolds L. "It Stays Between Us": Managing Comorbidities and Public/Private Dichotomies in HPTN071 (POPART) Trial Communities. Med Anthropol 2020; 40:280-293. [PMID: 33000972 DOI: 10.1080/01459740.2020.1820501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In contexts of scarcity, managing comorbidities is a complex process, shaped by divergent understandings of causes, prognoses, and social meanings of illness. Drawing on research with one young South African woman living with HIV and epilepsy, and 13 other people with comorbidities, we describe how concepts of "public" and "private" shape the management of co-morbid conditions. Despite narratives of HIV "normalization," participants labored to keep their HIV status private, while sharing other illness experiences more publicly. We challenge simple dichotomies between public and private spheres and emphasize the need for more fluid understandings of how people negotiate social space.
Collapse
Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University.,Department of Sociology and Social Anthropology, Stellenbosch University
| | - Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University.,Amsterdam Institute for Social Science Research
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Stellenbosch University
| |
Collapse
|
22
|
Teo AKJ, Prem K, Tuot S, Ork C, Eng S, Pande T, Chry M, Hsu LY, Yi S. Mobilising community networks for early identification of tuberculosis and treatment initiation in Cambodia: an evaluation of a seed-and-recruit model. ERJ Open Res 2020; 6:00368-2019. [PMID: 32391397 PMCID: PMC7196668 DOI: 10.1183/23120541.00368-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background and objectives The effects of active case finding (ACF) models that mobilise community networks for early identification and treatment of tuberculosis (TB) remain unknown. We investigated and compared the effect of community-based ACF using a seed-and-recruit model with one-off roving ACF and passive case finding (PCF) on the time to treatment initiation and identification of bacteriologically confirmed TB. Methods In this retrospective cohort study conducted in 12 operational districts in Cambodia, we assessed relationships between ACF models and: 1) the time to treatment initiation using Cox proportional hazards regression; and 2) the identification of bacteriologically confirmed TB using modified Poisson regression with robust sandwich variance. Results We included 728 adults with TB, of whom 36% were identified via the community-based ACF using a seed-and-recruit model. We found community-based ACF using a seed-and-recruit model was associated with shorter delay to treatment initiation compared to one-off roving ACF (hazard ratio 0.81, 95% CI 0.68-0.96). Compared to one-off roving ACF and PCF, community-based ACF using a seed-and-recruit model was 45% (prevalence ratio (PR) 1.45, 95% CI 1.19-1.78) and 39% (PR 1.39, 95% CI 0.99-1.94) more likely to find and detect bacteriologically confirmed TB, respectively. Conclusion Mobilising community networks to find TB cases was associated with early initiation of TB treatment in Cambodia. This approach was more likely to find bacteriologically confirmed TB cases, contributing to the reduction of risk of transmission within the community.
Collapse
Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,Dept of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sovannary Tuot
- KHANA Centre for Population Health Research, Phnom Penh, Cambodia
| | - Chetra Ork
- KHANA Centre for Population Health Research, Phnom Penh, Cambodia
| | - Sothearith Eng
- KHANA Centre for Population Health Research, Phnom Penh, Cambodia
| | - Tripti Pande
- McGill International TB Centre, Montreal, Canada
| | - Monyrath Chry
- Cambodia Anti-Tuberculosis Association, Phnom Penh, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,KHANA Centre for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| |
Collapse
|
23
|
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: 12] [Impact Index Per Article: 3.0] [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
|
24
|
Enane LA, Eby J, Arscott-Mills T, Argabright S, Caiphus C, Kgwaadira B, Steenhoff AP, Lowenthal ED. TB and TB-HIV care for adolescents and young adults. Int J Tuberc Lung Dis 2020; 24:240-249. [PMID: 32127110 PMCID: PMC7307717 DOI: 10.5588/ijtld.19.0416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana.OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10-24 years).DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis.RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening.CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.
Collapse
Affiliation(s)
- L A Enane
- Division of Infectious Diseases, Botswana-UPenn Partnership, Gaborone, Botswana
| | - J Eby
- Department of Pediatrics, Boston Children's Hospital and Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - T Arscott-Mills
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine
| | - S Argabright
- University of Pennsylvania, Philadelphia, PA, USA
| | - C Caiphus
- Botswana National TB Programme, Ministry of Health, Gaborone, Botswana
| | - B Kgwaadira
- Botswana National TB Programme, Ministry of Health, Gaborone, Botswana
| | - A P Steenhoff
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, University of Pennsylvania Perelman School of Medicine
| | - E D Lowenthal
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, Botswana-UPenn Partnership, Gaborone, Botswana, Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
25
|
Shen K, Yang NS, Huang W, Fitzpatrick TS, Tang W, Zhao Y, Wang Y, Li L, Tucker JD. A crowdsourced intervention to decrease hepatitis B stigma in men who have sex with men in China: A cohort study. J Viral Hepat 2020; 27:135-142. [PMID: 31571341 PMCID: PMC8163661 DOI: 10.1111/jvh.13213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Stigma against people with hepatitis B virus (HBV) is a barrier to prevention, diagnosis and treatment of HBV in China. Our study examined an innovative intervention to reduce HBV stigma among men who have sex with men (MSM) in China. We extracted data from a randomized controlled trial conducted in May 2018, where the intervention consisted of crowdsourced images and videos to promote viral hepatitis testing and reduce HBV stigma. HBV stigma was assessed using a 20-item scale at baseline and four weeks post-enrolment. Participants were divided into three groups based on their exposure to intervention: full exposure, partial exposure and no exposure. Linear regression was used to determine associations between baseline stigma and participant characteristics. Data from 470 MSM were analysed. Mean participant age was 25 years old and 56% had less education than a college bachelor's degree. Full exposure to intervention was associated with significant stigma reduction (adjusted beta = -3.49; 95% CI = -6.11 to -0.87; P = .01), while partial exposure led to stigma reduction that was not statistically significant. The mean stigma score was 50.6 (SD ± 14.7) at baseline, and stigma was most prominent regarding physical contact with HBV carriers. Greater HBV stigma was associated with not having a recent doctor's visit (adjusted beta = 4.35, 95% CI = 0.19 to 8.52; P = .04). In conclusion, crowdsourcing can decrease HBV stigma among MSM in China and may be useful in anti-stigma campaigns for vulnerable populations in low- and middle-income countries.
Collapse
Affiliation(s)
- Karen Shen
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Nancy S. Yang
- University of Minnesota Medical School – Twin Cities, Minneapolis, MN, USA
| | - Wenting Huang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Thomas S. Fitzpatrick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Yang Zhao
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,School of Social Science, University of Queensland, Brisbane, Queensland, Australia
| | - Yehua Wang
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Linghua Li
- Center for Infectious Diseases, Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill, Project China, Guangzhou, China,Social Entrepreneurship to Spur Health Global, Guangzhou, China,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
26
|
Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Delayed diagnosis and treatment of pulmonary tuberculosis in high-burden countries: a systematic review protocol. BMJ Open 2019; 9:e029807. [PMID: 31289094 PMCID: PMC6629411 DOI: 10.1136/bmjopen-2019-029807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Countries identified to bear the highest tuberculosis (TB) incidence account for approximately 85% of the global TB burden. TB is curable, yet nearly 40% of TB cases remained undiagnosed hence delaying treatment and perpetuating transmission. This systematic review aimed to review current evidence on factors associated with delayed diagnosis and treatment of TB in the high TB-burden countries. METHODS AND ANALYSIS This systematic review will incorporate qualitative and observational study designs published between 2008 and 2018. Articles will be retrieved from major databases including PubMed, EMBASE, CINAHL and PsycINFO. Reference lists of key articles, including relevant systematic reviews and meta-analysis, will be screened for additional studies. Two independent reviewers will screen and select studies, extract data and assess the quality and risk of bias of each study. Study-specific estimates will be pooled by meta-analysis, and effect sizes will be presented as OR and their 95% CI. Levels of heterogeneity will be evaluated using chi-square statistic Q and I2. Publication bias will be assessed using forest plots and Egger's tests. Qualitative findings and sample quotes will be extracted. Textual references to the topics of interest will be retrieved and categorised using qualitative thematic analysis. We will triangulate quantitative and qualitative findings for a complete understanding of the reasons for delayed TB diagnosis and treatment. Results will be presented by geographical region. ETHICS AND DISSEMINATION This study will be conducted based on published data. This systematic review may provide insights into the reasons for delayed TB diagnosis in high-burden countries. These findings will also inform future research and key stakeholders in developing interventions to reach these undiagnosed cases effectively. Findings from this review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42018107237.
Collapse
Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Center for Population Health Research, KHANA, Phnom Penh, Cambodia
| |
Collapse
|
27
|
Tuot S, Teo AKJ, Cazabon D, Sok S, Ung M, Ly S, Choub SC, Yi S. Acceptability of active case finding with a seed-and-recruit model to improve tuberculosis case detection and linkage to treatment in Cambodia: A qualitative study. PLoS One 2019; 14:e0210919. [PMID: 31265458 PMCID: PMC6605634 DOI: 10.1371/journal.pone.0210919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background With support of the national tuberculosis (TB) program, KHANA (a local non-governmental organization in Cambodia) has implemented an innovative approach using a seed-and-recruit model to actively find TB cases in the community. The model engaged community members including TB survivors as seed and newly diagnosed people with TB as recruiters to recruit presumptive TB cases in their social network in a snowball approach for screening and linkage to treatment. This study aimed to explore the acceptability of the active case finding with the seed-and-recruit model in detecting new TB cases and determine the characteristics of successful seeds. Methods This qualitative study was conducted in four provinces (Banteay Meanchey, Kampong Chhnang, Siem Reap, and Takeo) in Cambodia in 2017. Fifty-six in-depth interviews and ten focus group discussions (with a total of 64 participants) were conducted with selected beneficiaries and key stakeholders at different levels to gain insights into the acceptability, strengths, and challenges in implementing the model and the characteristics of successful seeds. Transcripts were coded and content analyses were performed. Results The seed-and-recruit active case finding model was generally well-received by the study participants. They saw the benefits of engaging TB survivors and utilizing their social network to find new TB cases in the community. The social embeddedness of the model within the local community was one of the major strengths. The success of the model also hinges on the integration with existing health facilities. Having an extensive social network, being motivated, and having good knowledge about TB were important characteristics of successful seeds. Study participants reported challenges in motivating the presumptive TB cases for screening, logistic capacities, and high workload during the implementation. However, there was a general consensus that the model ought to be expanded. Conclusions These findings indicate that the seed-and-recruit model is well-accepted by the beneficiaries and key stakeholders. Further studies are needed to more comprehensively evaluate the impacts and cost-effectiveness of the model for future expansion in Cambodia as well as in other resource-limited settings.
Collapse
Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Faculty of Social Science and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Danielle Cazabon
- McGill International TB Centre, McGill University Health Centre, Montréal, Canada
| | - Say Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Faculty of Social Science and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Mengieng Ung
- Humanities and Social Studies Education Academic Group, National Institute of Education, Nanyang Technology University, Singapore, Singapore
| | - Sangky Ly
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Center for Global Health Research, Touro University California, Vallejo, the United States of America
- * E-mail:
| |
Collapse
|
28
|
Bond V, Ngwenya F, Murray E, Ngwenya N, Viljoen L, Gumede D, Bwalya C, Mantantana J, Hoddinott G, Dodd PJ, Ayles H, Simwinga M, Wallman S, Seeley J. Value and Limitations of Broad Brush Surveys Used in Community-Randomized Trials in Southern Africa. QUALITATIVE HEALTH RESEARCH 2019; 29:700-718. [PMID: 30556470 PMCID: PMC6533803 DOI: 10.1177/1049732318809940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We describe and reflect on a rapid qualitative survey approach called "Broad Brush Survey" (BBS) used in six community-randomized trials (CRTs)/studies in Zambia and South Africa (2004-2018) to document, compare, classify, and communicate community features systematically for public health and multidisciplinary research ends. BBS is based on a set sequence of participatory qualitative methods and fieldwork carried out prior to a CRT intervention and/or research by social scientists to generate rapid community profiles using four key indicators: physical features, social organization, networks, and community narratives. Profiling makes apparent similarities and differences, enabling comparison across communities and can be facilitated by an ideal model of open-closed systems. Findings have provided practical outputs (e.g., community profiles) and academic opportunities (e.g., community typologies). The BBS approach enables complex social landscapes to be incorporated in CRTs. This method has proven to be useful, adaptable and to have multidisciplinary appeal.
Collapse
Affiliation(s)
- Virginia Bond
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Virginia Bond, Department of Global Health and Development, Faculty of Public Health and Policy, LSHTM, 15-17 Tavistock Place, London, WC1H9SH.Emails: ;
| | - Fredrick Ngwenya
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Emma Murray
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Nothando Ngwenya
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Lario Viljoen
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Dumile Gumede
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Chiti Bwalya
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Jabulile Mantantana
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Peter J. Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Helen Ayles
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Musonda Simwinga
- Zambart, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Sandra Wallman
- Department of Anthropology, University College London, London, United Kingdom
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| |
Collapse
|
29
|
Zarova C, Chiwaridzo M, Tadyanemhandu C, Machando D, Dambi JM. The impact of social support on the health-related quality of life of adult patients with tuberculosis in Harare, Zimbabwe: a cross-sectional survey. BMC Res Notes 2018; 11:795. [PMID: 30400994 PMCID: PMC6219075 DOI: 10.1186/s13104-018-3904-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Tuberculosis (TB) is the second prime cause of mortality in Sub-Saharan Africa and remains a major worldwide public health problem. Unfortunately, patients with TB are at risk of poor mental health. However, patients who receive an adequate amount of social support are likely to have improved health outcomes. The study was done to establish how social support influences the health-related quality of life (HRQoL) of patients with TB in Harare, Zimbabwe. Data were collected from 332 TB patients and were analysed through structural equation modelling. RESULTS The mean age of the participants was 40.1 (SD 12.5) years and most were; males (53%), married (57.8%), educated (97.3%), unemployed (40.7%), stayed with family (74.4%), and reported of less than average levels of income (51.5%). Patients received the most significant amount of social support from the family. Patients also presented with lower HRQoL as they considerably reported of pain, anxiety and depression. The final model accounted for 68.8% of the variance. Despite methodological limitations, the study findings suggest that social support optimises patients' HRQoL. Based on the patients' responses, it was noted that patients presented with lower mental health, therefore, there is a need to develop and implement patient wellness interventions.
Collapse
Affiliation(s)
- Calvin Zarova
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Matthew Chiwaridzo
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700, South Africa
| | - Catherine Tadyanemhandu
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Debra Machando
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe.,Department of Psychology, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa
| | - Jermaine M Dambi
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, P.O Box A178, Avondale, Harare, Zimbabwe. .,School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700, South Africa.
| |
Collapse
|
30
|
Daftary A, Mitchell EMH, Reid MJA, Fekadu E, Goosby E. To End TB, First-Ever High-Level Meeting on Tuberculosis Must Address Stigma. Am J Trop Med Hyg 2018; 99:1114-1116. [PMID: 30226149 PMCID: PMC6221214 DOI: 10.4269/ajtmh.18-0591] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022] Open
Abstract
World leaders gather to consolidate their commitment to ending tuberculosis (TB). Vital to the success of renewed efforts is an overdue recognition of the pervasive and pernicious influence of TB stigma. TB stigma is sustained in structures, policies, traditions, and norms. Innovative modifications to infection control, drug dispensing, and surveillance practices are required to increase demand for TB screening and effective therapeutic alliances among those diagnosed. The authors argue that reducing TB stigma requires a scientific and inclusive process, with prominent roles for TB survivors and a willingness to integrate and learn from other stigmatized conditions.
Collapse
Affiliation(s)
- Amrita Daftary
- Department of Epidemiology and Biostatistics, McGill International TB Centre, McGill University, Montreal, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)-Medical Research Council TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Rotterdam, Netherlands
| | - Michael J. A. Reid
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California
| | | | - Eric Goosby
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California
- United Nations Special Envoy for Tuberculosis, San Francisco, California
| |
Collapse
|
31
|
Camlin CS, Seeley J. Qualitative research on community experiences in large HIV research trials: what have we learned? J Int AIDS Soc 2018; 21 Suppl 7:e25173. [PMID: 30334379 PMCID: PMC6192898 DOI: 10.1002/jia2.25173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/20/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Very few pragmatic and community-level effectiveness trials integrate the use of qualitative research over all stages of the trial, to inform trial design, implementation optimization, results interpretation and post-trial policy recommendations. This is despite the growing demand for mixed methods research from funding agencies and awareness of the vital importance of qualitative and mixed methods research for understanding trial successes and challenges. DISCUSSION We offer examples from work we have been involved in to illustrate how qualitative research conducted within trials can reveal vital contextual factors that influence implementation and outcomes, can enable an informed adaptation of trials as they are being conducted and can lead to the formulation of theory regarding the social and behavioural pathways of intervention, while also enabling community engagement in trial design and implementation. These examples are based on published findings from qualitative studies embedded within two ongoing large-scale studies demonstrating the population-level impacts of universal HIV testing and treatment strategies in southern and eastern Africa, and a qualitative study conducted alongside a clinical trial testing the adaptation, acceptability and experience of short-cycle therapy in children and adolescents living with HIV. CONCLUSIONS We advocate for the integration of qualitative with clinical and survey research methods in pragmatic clinical and community-level trials and implementation studies, and for increasing visibility of qualitative and mixed methods research in medical journals. Qualitative research from trials ideally should be published along with clinical outcome data, either integrated into the "main" trial papers or published concurrently in the same journal issue. Integration of qualitative research within trials can help not only to understand the why behind success or failure of interventions in different contexts, but also inform the adaptation of interventions that can facilitate their success, and lead to new alternative strategies and to policy changes that may be vital for achieving public health goals, including the end of AIDS.
Collapse
Affiliation(s)
- Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive SciencesCenter for AIDS Prevention StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Janet Seeley
- Department of Global Health and DevelopmentLondon School of Hygiene & Tropical MedicineLondonUK
| |
Collapse
|
32
|
Franklin S, Mouliom A, Sinkala E, Kanunga A, Helova A, Dionne-Odom J, Turan JM, Vinikoor M. Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study. BMJ Open 2018; 8:e022522. [PMID: 30244215 PMCID: PMC6157559 DOI: 10.1136/bmjopen-2018-022522] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia. DESIGN We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV. SETTING A university hospital in Lusaka, Zambia. PARTICIPANTS 79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion. OUTCOMES AND ANALYSIS Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach. RESULTS Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients' knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection. CONCLUSIONS HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa. TRIALS REGISTRATION NUMBER NCT03158818.
Collapse
Affiliation(s)
- Sarah Franklin
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amina Mouliom
- School of Pharmacy, Southwestern Oklahoma State University, Weatherford, Oklahoma, USA
| | - Edford Sinkala
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Annie Kanunga
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Anna Helova
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Vinikoor
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
33
|
TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam. REPORTS 2018. [DOI: 10.3390/reports1020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child’s chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.
Collapse
|
34
|
Methicillin-Resistant Staphylococcus aureus: The Effects Are More Than Skin Deep. J Pediatr 2018; 199:158-165. [PMID: 29759849 PMCID: PMC6063792 DOI: 10.1016/j.jpeds.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess the psychosocial effects of a methicillin-resistant Staphylococcus aureus (MRSA) diagnosis on the households of children with MRSA skin and soft tissue infection (SSTI). STUDY DESIGN We constructed and administered an interview to the primary caregiver within the home of a child with a history of MRSA SSTI. RESULTS Seventy-six households were enrolled. Survey responses were analyzed and grouped into 4 themes: health behavior changes, disclosure, social interactions, and knowledge/awareness. The most common theme was disclosure; 91% of participants reported sharing their child's MRSA diagnosis with someone outside of the household. Forty-two percent of respondents reported a change in the manner in which household contacts interacted as a result of the index patient's MRSA diagnosis, including isolating the index patient from other children in the household. Many households reported adopting enhanced personal hygiene behaviors and environmental cleaning routines. Thirty-eight percent of participating households reported altering how they interact with people outside of their home, largely to avoid spreading MRSA to vulnerable individuals. In addition, many participants perceived that others regarded them with caution, especially at daycare, whereas other affected households were excluded from family gatherings. CONCLUSION Primary caregivers of children with MRSA SSTI reported changing their health behaviors, altering their interactions with people outside of their home, and feeling isolated by others in response to their child's MRSA diagnosis. The findings of our study highlight a need for community interventions and education to prevent the negative psychosocial repercussions associated with MRSA.
Collapse
|
35
|
Viljoen L, Ndubani R, Bond V, Seeley J, Reynolds L, Hoddinott G. Community narratives about women and HIV risk in 21 high-burden communities in Zambia and South Africa. Int J Womens Health 2017; 9:861-870. [PMID: 29238230 PMCID: PMC5716400 DOI: 10.2147/ijwh.s143397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Public health researchers repeatedly represent women as a group vulnerable to ill health. This has been particularly true in the field of HIV research, where women are disproportionately affected by HIV in terms of disease burden and the social effects of the epidemic. Although women have been the focus of many prevention and treatment programs, structural barriers to implementation of these targeted programs persist. In this article we explore how high HIV-burden communities in South Africa and Zambia engage with the concepts of "woman" and "HIV risk". The data are drawn from participatory storytelling activities completed with 604 participants across 78 group discussions between December 2012 and May 2013. During discussions we found that participants made use of the core archetypal caricatures of "goodness," "badness," and "vulnerability" when describing women's HIV risk. Community members shifted between these categories in their characterizations of women, as they acknowledged the multiple roles women play, internalized different stories about women, and sometimes shifted register in the same stories. Findings suggest that health implementers, in consultation with community members, should consider the multiple positions women occupy and how this impacts the wider community's understandings of women and "risk". This approach of taking on board community understandings of the complexity of HIV risk can inform the design and implementation of HIV prevention and care programs by rendering programs more focused and in-line with community needs.
Collapse
Affiliation(s)
- Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoda Ndubani
- Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Lusaka, Zambia
| | - Virginia Bond
- Zambia AIDS-related Tuberculosis Project (Zambart), School of Medicine, Lusaka, Zambia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lindsey Reynolds
- Population Studies and Training Center, Brown University, Providence, RI, USA
- Department of Sociology and Social Anthropology, 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, Cape Town, South Africa
| |
Collapse
|
36
|
X-pert MTB/RIF ® Diagnosis of Twin Infants with Tuberculosis in Da Nang, Viet Nam. J Clin Med 2017; 6:jcm6100096. [PMID: 29039758 PMCID: PMC5664011 DOI: 10.3390/jcm6100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/16/2022] Open
|
37
|
Lee LY, Tung HH, Chen SC, Fu CH. Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients. J Clin Nurs 2017; 26:4813-4821. [PMID: 28370819 DOI: 10.1111/jocn.13837] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Li-Yun Lee
- National Taipei University of Nursing and Health Sciences; Taipei Taiwan
- China Medical University Beigang Hospital; Yunlin County Taiwan
| | - Heng-Hsin Tung
- National Taipei University of Nursing and Health Sciences; Taipei Taiwan
- Tungs’ Taichung MetroHarbor Hospital; Taipei Taiwan
| | - Shu-Ching Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Chiung-Hui Fu
- China Medical University Beigang Hospital; Yunlin County Taiwan
| |
Collapse
|
38
|
López-Hernández Y, Patiño-Rodríguez O, García-Orta ST, Pinos-Rodríguez JM. Mass spectrometry applied to the identification of Mycobacterium tuberculosis and biomarker discovery. J Appl Microbiol 2017; 121:1485-1497. [PMID: 27718305 DOI: 10.1111/jam.13323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/28/2016] [Accepted: 08/08/2016] [Indexed: 12/31/2022]
Abstract
An adequate and effective tuberculosis (TB) diagnosis system has been identified by the World Health Organization as a priority in the fight against this disease. Over the years, several methods have been developed to identify the bacillus, but bacterial culture remains one of the most affordable methods for most countries. For rapid and accurate identification, however, it is more feasible to implement molecular techniques, taking advantage of the availability of public databases containing protein sequences. Mass spectrometry (MS) has become an interesting technique for the identification of TB. Here, we review some of the most widely employed methods for identifying Mycobacterium tuberculosis and present an update on MS applied for the identification of mycobacterial species.
Collapse
Affiliation(s)
| | - O Patiño-Rodríguez
- CONACyT, Centro de Desarrollo de Productos Bióticos del Instituto Politécnico Nacional, Morelos, México
| | - S T García-Orta
- Centro de Biociencias, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - J M Pinos-Rodríguez
- Centro de Biociencias, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| |
Collapse
|
39
|
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
|
40
|
Barnabishvili M, Ulrichs T, Waldherr R. Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries. Acta Trop 2016; 161:106-13. [PMID: 27311390 DOI: 10.1016/j.actatropica.2016.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Direct transmission of mutated tuberculosis (TB) strains is among major contributors to the worldwide epidemic of Drug-Resistant Tuberculosis. Expanding access to TB-services and decreasing diagnostic delays are acknowledged as potential solutions. We aimed to summarize evidence about links between health care acceptability barriers and TB diagnostic delays. Scoping and systematic review approaches were combined to determine the depth/breadth of the literature, identify gaps, and synthesize findings. METHODS Electronic data-bases, key journals, other relevant electronic sources, and references of relevant articles were selected as potential sources through a preliminary search and expertś advice. Titles and abstracts of 4046 initial records and 1796 references were screened against preliminarily developed and post-hoc inclusion/exclusion criteria. Author, year of publication, study location, study aims, overview of methods, study population, intervention type, outcomes measures and results of each included paper were extracted. Methodological quality of studies was assessed. Narrative synthesis of the study results was conducted through the thematic analysis approach. RESULTS Patients' negative expectations, doubts about quality of services/medications and burden of stigma, as well as providers' discriminative attitudes towards patients' characteristics (age, gender, ethnicity) were reported as major barriers. Scarcity and unequal distribution of the literature and lack of attention to all potential acceptability barriers were found as major gaps in the current research. CONCLUSION Overall, study findings indicate the significance of acceptability barriers' role in TB diagnostic delays. Emerging character of the field is demonstrated. Recommendations about further research directions are outlined.
Collapse
Affiliation(s)
- Maia Barnabishvili
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany.
| | - Timo Ulrichs
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany.
| | - Ruth Waldherr
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany.
| |
Collapse
|
41
|
Barnabishvili M, Ulrichs T, Waldherr R. Data on the descriptive overview and the quality assessment details of 12 qualitative research papers. Data Brief 2016; 8:1059-68. [PMID: 27508265 PMCID: PMC4969085 DOI: 10.1016/j.dib.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 06/29/2016] [Accepted: 07/07/2016] [Indexed: 10/27/2022] Open
Abstract
This data article presents the supplementary material for the review paper "Role of acceptability barriers in delayed diagnosis of Tuberculosis: Literature review from high burden countries" (Barnabishvili et al., in press) [1]. General overview of 12 qualitative papers, including the details about authors, years of publication, data source locations, study objectives, overview of methods, study population characteristics, as well as the details of intervention and the outcome parameters of the papers are summarized in the first two tables included to the article. Quality assessment process of the methodological strength of 12 papers and the results of the critical appraisal are further described and summarized in the second part of the article.
Collapse
Affiliation(s)
- Maia Barnabishvili
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany
| | - Timo Ulrichs
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany
| | - Ruth Waldherr
- Berlin School of Public Health, Charité Universitätsmedizin Berlin, Seestr. 73, 13347 Berlin, Germany
| |
Collapse
|
42
|
Loveday M, Sunkari B, Marais BJ, Master I, Brust JCM. Dilemma of managing asymptomatic children referred with 'culture-confirmed' drug-resistant tuberculosis. Arch Dis Child 2016; 101:608-13. [PMID: 27044259 PMCID: PMC4996348 DOI: 10.1136/archdischild-2015-310186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The diagnosis of drug-resistant tuberculosis (DR-TB) in children is challenging and treatment is associated with many adverse effects. OBJECTIVE We aimed to assess if careful observation, without initiation of second-line treatment, is safe in asymptomatic children referred with 'culture-confirmed' DR-TB. SETTING KwaZulu-Natal, South Africa-an area with high burdens of HIV, TB and DR-TB. DESIGN, INTERVENTION AND MAIN OUTCOME MEASURES We performed an outcome review of children with 'culture-confirmed' DR-TB who were not initiated on second-line TB treatment, as they were asymptomatic with normal chest radiographs on examination at our specialist referral hospital. Children were followed up every other month for the first year, with a final outcome assessment at the end of the study. RESULTS In total, 43 asymptomatic children with normal chest radiographs were reviewed. The median length of follow-up until final evaluation was 549 days (IQR 259-722 days); most (34; 83%) children were HIV uninfected. Resistance patterns included 9 (21%) monoresistant and 34 (79%) multidrug-resistant (MDR) strains. Fifteen children (35%) had been treated with first-line TB treatment, prior to presentation at our referral hospital. At the final evaluation, 34 (80%) children were well, 7 (16%) were lost to follow-up, 1 (2%) received MDR-TB treatment and 1 (2%) died of unknown causes. The child who received MDR-TB treatment developed new symptoms at the 12-month review and responded well to second-line treatment. CONCLUSIONS Bacteriological evaluation should not be performed in the absence of any clinical indication. If drug-resistant Mycobacterium tuberculosis is detected in an asymptomatic child with a normal chest radiograph, close observation may be an appropriate strategy, especially in settings where potential laboratory error and poor record keeping are constant challenges.
Collapse
Affiliation(s)
- Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Babu Sunkari
- Drug-resistant TB Unit, King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban, South Africa.
| | - Ben J Marais
- Clinical School, Children’s Hospital at Westmead, University of Sydney, Australia.
| | - Iqbal Master
- Drug-resistant TB Unit, King Dinuzulu Hospital, KwaZulu-Natal Department of Health, Durban, South Africa.
| | - James CM Brust
- Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, USA.
| |
Collapse
|
43
|
Marais BJ. The global tuberculosis situation and the inexorable rise of drug-resistant disease. Adv Drug Deliv Rev 2016; 102:3-9. [PMID: 26855302 DOI: 10.1016/j.addr.2016.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 01/06/2023]
Abstract
The highly cost-effective DOTS strategy helped to bring the global tuberculosis (TB) epidemic under control in many parts of the world; however, the emergence and spread of drug-resistant strains pose a major threat to these gains. Molecular epidemiology studies, together with recent genomic evidence, provide proof that some drug-resistant strains are highly transmissible with documented epidemic spread. The potential for epidemic replacement of drug-susceptible with drug-resistant strains provides strong motivation for renewed emphasis on TB drug and vaccine development. It also reflects the need for enhanced infection control measures in health care and congregate settings, especially in TB endemic areas. The exploration of preventive therapy options for close contacts of patients with infectious drug-resistant TB also warrants further exploration, in an attempt to break the transmission cycle. Increased population mobility and large scale cross-border migration imply that the inexorable rise of drug-resistant TB is not geographically confined; it is a global concern that poses a very real threat to TB endemic and non-endemic settings. Failure to find new solutions will compromise traditional TB control efforts and derail momentum toward future TB elimination.
Collapse
|
44
|
Marais B, Outhred A, Zumla A. Engaging high and low burden countries in the “TB end game”. Int J Infect Dis 2016; 45:100-2. [DOI: 10.1016/j.ijid.2016.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 12/12/2022] Open
|
45
|
Atif M, Javaid S, Farooqui M, Sarwar MR. Rights and Responsibilities of Tuberculosis Patients, and the Global Fund: A Qualitative Study. PLoS One 2016; 11:e0151321. [PMID: 26998830 PMCID: PMC4801178 DOI: 10.1371/journal.pone.0151321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Implementation of the Charter to protect patients' rights is an important criterion to achieve patient-centered approach and receive financial support from the Global Fund. Our study aims to explore the knowledge of tuberculosis (TB) patients about their rights and responsibilities at the Chest Disease Unit of the Bahawal Victoria Hospital, Bahawalpur, Pakistan. METHODS This was a qualitative study. The data from purposefully selected TB patients was collected by in-depth interviews. Eligibility criteria included confirmed diagnosis of TB and enrollment in the TB program. A pilot tested interview protocol was based upon the objectives of the study, and was used uniformly in each interview to maintain the consistency. The sample size was limited by applying the saturation criteria. All interviews were audiotaped and transcribed verbatim. Inductive thematic content analysis was applied to analyze the data and draw conclusions. RESULTS Out of the total 16 patients, four were female, and seven were illiterate. Eight patients were known cases of multi-drug resistant TB. Analysis of the data yielded seven themes; tuberculosis care services, moral support and stigmatization, dignity and privacy, complaints, fear of losing job, information sharing and compliance to the treatment plan, and contribution to eradicate TB. First five represented the rights section while latter two were related to the responsibilities section of the Charter. CONCLUSION Discriminatory access to TB care services and the right to privacy were two major concerns identified in this study. However, the respondents recognized their responsibilities as a TB patient. To ensure uninterrupted investment from the Global Fund, there is a need to implement fair TB care policies which support human rights-based approach.
Collapse
Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
- * E-mail:
| | - Sareema Javaid
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Maryam Farooqui
- Faculty of Pharmacy, Universiti Teknologi MARA (Bertam campus), Persiaran Pendidikan Bertam Perdana, Kepala Batas, Penang, Malaysia
| | - Muhammad Rehan Sarwar
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| |
Collapse
|
46
|
Naidoo P, Simbayi L, Labadarios D, Ntsepe Y, Bikitsha N, Khan G, Sewpaul R, Moyo S, Rehle T. Predictors of knowledge about tuberculosis: results from SANHANES I, a national, cross-sectional household survey in South Africa. BMC Public Health 2016; 16:276. [PMID: 26987759 PMCID: PMC4797251 DOI: 10.1186/s12889-016-2951-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 03/09/2016] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND South Africa is one of the 22 high tuberculosis burden countries that contribute 80% of the global tuberculosis cases. Tuberculosis is infectious and due to its rapid and easy transmission route poses a threat to population health. Considering the importance of social and psychological factors in influencing health outcomes, appraising knowledge and awareness of tuberculosis, remain vital for effective tuberculosis control. The main aim of this study was to investigate the factors that predict knowledge about tuberculosis among 18-64 year old adults in South Africa. METHODS A cross-sectional survey method was used. Multi-stage disproportionate, stratified cluster sampling was used to select households within enumeration areas stratified by province and locality type. Based on the Human Sciences Research Council 2007 master sample, 500 Enumerator Areas representative of the socio-demographic profile of South Africa were identified and a random sample of 20 households was randomly selected from each Enumerator Area, yielding an overall sample of 10,000 households. The tuberculosis module contained in the South African National Health And Nutrition Examination Survey I was the only module that examined the social determinants of an infectious disease. This module was questionnaire-based with no biomarkers obtained to screen for the presence of tuberculosis disease among the participants. Data was collected by administering a researcher developed individual level questionnaire. Simple and multiple linear regression was used to determine the independent variables associated with tuberculosis knowledge. RESULTS Half the sample (52.6%) was female and the majority of the respondents were black African (76.5%). More than two thirds (68.0%) resided in urban areas, 56.9% did not complete high school and half were not in formal employment. Significant predictors of tuberculosis knowledge were race, sex, completion of high school, being in employment, having a diagnosis of the disease in ones' life-time and learning about tuberculosis from television, brochures, health workers, and teachers. CONCLUSIONS To reduce the burden of tuberculosis in South Africa, media campaigns targeting both rural and urban communities should include conveying accurate information about the disease. Policy makers should also address structural barriers that vulnerable communities face.
Collapse
Affiliation(s)
- Pamela Naidoo
- />Population Health, Health Systems and Innovation Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X9182, Cape Town, 8000 South Africa
- />Department of Psychology, University of the Western Cape, Cape Town, South Africa
| | - Leickness Simbayi
- />HIV, AIDS, Sexually Transmitted Diseases and Tuberculosis (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, Cape Town, South Africa
- />Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Demetre Labadarios
- />Population Health, Health Systems and Innovation Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X9182, Cape Town, 8000 South Africa
| | - Yoliswa Ntsepe
- />HIV, AIDS, Sexually Transmitted Diseases and Tuberculosis (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, Cape Town, South Africa
| | - Nwabisa Bikitsha
- />Population Health, Health Systems and Innovation Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X9182, Cape Town, 8000 South Africa
| | - Gadija Khan
- />Population Health, Health Systems and Innovation Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X9182, Cape Town, 8000 South Africa
| | - Ronel Sewpaul
- />Population Health, Health Systems and Innovation Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, South Africa, Private Bag X9182, Cape Town, 8000 South Africa
| | - Sizulu Moyo
- />HIV, AIDS, Sexually Transmitted Diseases and Tuberculosis (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, Cape Town, South Africa
| | - Thomas Rehle
- />HIV, AIDS, Sexually Transmitted Diseases and Tuberculosis (HAST) Research Programme, Human Sciences Research Council, Pretoria, Durban and Cape Town, Cape Town, South Africa
- />Centre for Infectious Disease, Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
47
|
Horner J. From Exceptional to Liminal Subjects: Reconciling Tensions in the Politics of Tuberculosis and Migration. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:65-73. [PMID: 26757725 DOI: 10.1007/s11673-016-9700-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
Controlling the movement of potentially infectious bodies has been central to Australian immigration law. Nowhere is this more evident than in relation to tuberculosis (TB), which is named as a ground for refusal of a visa in the Australian context. In this paper, I critically examine the "will to knowledge" that this gives rise to. Drawing on a critical analysis of texts, including interviews with migrants diagnosed with TB and healthcare professionals engaged in their care (n=19), I argue that this focus on border policing, rather than resettlement and the broader social determinants of health that drive current rates of TB, paradoxically renders migrants diagnosed with TB as liminal subjects in the post-arrival phase. This raises ethical issues about who "matters," as well as dilemmas about what constitutes adequate care for the "Other," both of which go to the heart of the political economy of migration.
Collapse
Affiliation(s)
- Jed Horner
- Australian Human Rights Centre, Faculty of Law, UNSW Australia, UNSW Law Building, University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
48
|
Trinh QM, Nguyen HL, Nguyen VN, Nguyen TVA, Sintchenko V, Marais BJ. Tuberculosis and HIV co-infection-focus on the Asia-Pacific region. Int J Infect Dis 2016; 32:170-8. [PMID: 25809776 DOI: 10.1016/j.ijid.2014.11.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is the leading opportunistic disease and cause of death in patients with HIV infection. In 2013 there were 1.1 million new TB/HIV co-infected cases globally, accounting for 12% of incident TB cases and 360,000 deaths. The Asia-Pacific region, which contributes more than a half of all TB cases worldwide, traditionally reports low TB/HIV co-infection rates. However, routine testing of TB patients for HIV infection is not universally implemented and the estimated prevalence of HIV in new TB cases increased to 6.3% in 2013. Although HIV infection rates have not seen the rapid rise observed in Sub-Saharan Africa, indications are that rates are increasing among specific high-risk groups. This paper reviews the risks of TB exposure and progression to disease, including the risk of TB recurrence, in this vulnerable population. There is urgency to scale up interventions such as intensified TB case-finding, isoniazid preventive therapy, and TB infection control, as well as HIV testing and improved access to antiretroviral treatment. Increased awareness and concerted action is required to reduce TB/HIV co-infection rates in the Asia-Pacific region and to improve the outcomes of people living with HIV.
Collapse
Affiliation(s)
- Q M Trinh
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia; Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
| | - H L Nguyen
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - V N Nguyen
- Vietnam National Lung Hospital, Hanoi, Vietnam
| | - T V A Nguyen
- Tuberculosis Laboratory, Vietnam National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - V Sintchenko
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia; Centre for Infectious Disease and Microbiology - Public Health, ICPMR, Westmead Hospital, Sydney, Australia
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), The University of Sydney, Sydney, Australia
| |
Collapse
|
49
|
Kwobah CM, Braitstein P, Koech JK, Simiyu G, Mwangi AW, Wools-Kaloustian K, Siika AM. Factors Associated with Late Engagement to HIV Care in Western Kenya: A Cross-Sectional Study. J Int Assoc Provid AIDS Care 2015; 15:505-511. [PMID: 25589304 DOI: 10.1177/2325957414567682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Late presentation of patients contributes significantly to the high mortality reported in HIV -care and treatment programs in sub-Saharan Africa. METHODS A cross-sectional study was conducted to assess factors associated with late engagement to HIV care at the Academic Model Providing Access to Healthcare in western Kenya. Late engagement was defined as baseline CD4 ≤100 cells/mm3. RESULTS Of the 10 533 participants included in the analysis, 67% were female and mean age was 36.7 years. Overall, 23% of the participants presented late. Factors associated with late engagement included male gender (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.35-1.75), older age (AOR: 1.62, 95% CI: 1.02-2.56), and longer travel time to clinic (AOR: 1.18, 95% CI: 1.04-1.34). CONCLUSION Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.
Collapse
Affiliation(s)
- Charles Meja Kwobah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya .,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
| | - Julius K Koech
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Gilbert Simiyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ann W Mwangi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Behavioral Sciences, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abraham M Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| |
Collapse
|
50
|
Maffacciolli R, Hahn GV, Rossetto M, Almeida CPBD, Manica ST, Paiva TS, Oliveira DLLCD. [Using the notion of vulnerability in the production of knowledge about tuberculosis: integrative review]. Rev Gaucha Enferm 2015; 36 Spec No:247-53. [PMID: 27057726 DOI: 10.1590/1983-1447.2015.esp.51537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 08/05/2015] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE to identify how the notion of vulnerability is used in national and international scientific publications that address the problem of tuberculosis. METHOD an integrative review of literature published in the databases of the Biblioteca Virtual em Saúde, the United States National Library of Medicine and the Biblioteca Digital Brasileira de Teses e Dissertações, considering the descriptors Tuberculosis and Vulnerability in Portuguese and English. RESULTS we selected fifty-eight studies published between 1992 and February 2014, which resulted in three categories of analysis. CONCLUSION the link between tuberculosis and the notion of vulnerability has not been sufficiently consolidated in national and international literature. This creates an obstacle for the achievement of the epistemological transformations and pragmatic measures that are required to obtain better results from interventions in the field.
Collapse
Affiliation(s)
- Rosana Maffacciolli
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Maíra Rossetto
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Silvia Troyahn Manica
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Tiago Sousa Paiva
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil
| | | |
Collapse
|