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Farhat M, Cox H, Ghanem M, Denkinger CM, Rodrigues C, Abd El Aziz MS, Enkh-Amgalan H, Vambe D, Ugarte-Gil C, Furin J, Pai M. Drug-resistant tuberculosis: a persistent global health concern. Nat Rev Microbiol 2024; 22:617-635. [PMID: 38519618 DOI: 10.1038/s41579-024-01025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/25/2024]
Abstract
Drug-resistant tuberculosis (TB) is estimated to cause 13% of all antimicrobial resistance-attributable deaths worldwide and is driven by both ongoing resistance acquisition and person-to-person transmission. Poor outcomes are exacerbated by late diagnosis and inadequate access to effective treatment. Advances in rapid molecular testing have recently improved the diagnosis of TB and drug resistance. Next-generation sequencing of Mycobacterium tuberculosis has increased our understanding of genetic resistance mechanisms and can now detect mutations associated with resistance phenotypes. All-oral, shorter drug regimens that can achieve high cure rates of drug-resistant TB within 6-9 months are now available and recommended but have yet to be scaled to global clinical use. Promising regimens for the prevention of drug-resistant TB among high-risk contacts are supported by early clinical trial data but final results are pending. A person-centred approach is crucial in managing drug-resistant TB to reduce the risk of poor treatment outcomes, side effects, stigma and mental health burden associated with the diagnosis. In this Review, we describe current surveillance of drug-resistant TB and the causes, risk factors and determinants of drug resistance as well as the stigma and mental health considerations associated with it. We discuss recent advances in diagnostics and drug-susceptibility testing and outline the progress in developing better treatment and preventive therapies.
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Affiliation(s)
- Maha Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Helen Cox
- Institute of Infectious Disease and Molecular Medicine, Wellcome Centre for Infectious Disease Research and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Marwan Ghanem
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mirna S Abd El Aziz
- Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Debrah Vambe
- National TB Control Programme, Manzini, Eswatini
| | - Cesar Ugarte-Gil
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
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Chong N, Azwa I, Hassan AA, Mousavi ME, Wong PL, Ng RX, Saifi R, Basri S, Omar SFS, Walters SM, Collier ZK, Haddad MS, Altice FL, Kamarulzaman A, Earnshaw VA. HIV Activist Identity, Commitment, and Orientation Scale (HAICOS): Psychometric Evaluation to Assess Clinician's Propensity Towards HIV Activism in Malaysia. AIDS Behav 2024; 28:2780-2792. [PMID: 38806844 DOI: 10.1007/s10461-024-04381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/30/2024]
Abstract
HIV activism has a long history of advancing HIV treatment and is critical in dismantling HIV-related stigma. This study evaluated the psychometric quality of the HIV Activist Identity, Commitment, and Orientation Scale (HAICOS) to assess clinicians' propensity towards HIV activism in Malaysia. From November 2022 to March 2023, 74 general practitioners and primary care physicians in Malaysia participated in the study. The exploratory factor analysis (EFA) extracted an internally consistent three-factor solution with 13 items: (1) HIV activist identity and commitment, orientation towards (2) day-to-day, and (3) structural activism. The Cronbach's alpha value was 0.91, and intra-class correlation coefficient for test-retest reliability was 0.86. Stigma-related (prejudice and discrimination intent) and clinical practice (comfort in performing clinical tasks with key populations and knowledge about HIV pre-exposure prophylaxis) measures supported the construct validity of the scale. The study provided concise, structurally valid, and reliable measures to evaluate HIV activism among clinicians.
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Affiliation(s)
- Norman Chong
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia.
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Asfarina Amir Hassan
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
| | | | - Pui Li Wong
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rong Xiang Ng
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rumana Saifi
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sazali Basri
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | | | - Suzan M Walters
- School of Global Public Health, Department of Epidemiology, New York University, New York, USA
- Center for Drug Use and HIV/HCV Research, New York, USA
| | - Zachary K Collier
- Department of Educational Psychology, University of Connecticut, Connecticut, USA
| | - Marwan S Haddad
- Center for Key Populations, Community Health Center, Inc., Middletown Connecticut, USA
| | - Frederick L Altice
- Yale School of Public Health, Yale University, New Haven, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, USA
| | - Adeeba Kamarulzaman
- Center of Excellence for Research in AIDS (CERiA), Universiti Malaya, Level 17, Wisma R&D, Jalan Pantai Baharu, Kuala Lumpur, 59990, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, New York, USA
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Kilima SP, Mubyazi GM, Moolla A, Ntinginya NE, Sabi I, Mwanyonga SP, Evans D. Perceived access to social support during and after TB treatment in Mbeya and Songwe regions, Tanzania: perspectives from TB patients and survivors set against health care providers. FRONTIERS IN HEALTH SERVICES 2024; 4:1273739. [PMID: 39091518 PMCID: PMC11292734 DOI: 10.3389/frhs.2024.1273739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/14/2024] [Indexed: 08/04/2024]
Abstract
Introduction Pulmonary tuberculosis (PTB) remains a life-threatening disease in Tanzania, with negative physical, financial, economic and psychosocial consequences to individuals and the society. It mainly lowers the quality of life of patients, survivors and their families, especially those in the poorest and socially deprived categories. Objectives To report and discuss a qualitative study that assessed the nature of social support desired and received by PTB patients and survivors. Participants were given a chance to share their experiences and their perceptions on whether the social support they desired had an impact on their treatment-seeking behaviour and treatment adherence. Methods Face-to-face interviews were conducted with the three aforementioned groups, purposively selected at a TB clinic between October 2020 and March 2021. The questions covered topics related to the types of social support desired and the sources of support during and after treatment, if any. Interviews were concluded until no new information was obtained. Data analysis was facilitated using NVivo 12 software. Results Participants pointed out a need for psychosocial, financial, and material support during and after treatment. However, they sometimes miss support from family/household members or the rest of the community. Because of this experience, they lived with difficulties, facing hardships when required to pay out of pocket for transport during the care-seeking. Survivors testified experience of a denial of support by even their close relatives who regarded them as no longer needing it after recovering. Patients and survivors also reported experience of social isolation as they were believed able to transmit PTB infections. Limited psychological support at the contacted TB clinics was another experience reported. TB clinic staff's experiences confirmed almost all the experiences shared by their clients. With limited support, resilience and self-care were identified as key mechanisms for coping. Conclusion Complete recovery from PTB is possible, but reverting to a normal life is difficult without social support. Policies and programs need to increase opportunities for social support for TB patients and survivors. Doing so is likely to improve TB-related treatment, care-seeking practices, and adherence.
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Affiliation(s)
- Stella P. Kilima
- Department of Research Publications and Documentation, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Godfrey M. Mubyazi
- Department of Research Publications and Documentation, National Institute for Medical Research (NIMR), Dar es Salaam, Tanzania
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nyanda E. Ntinginya
- Department of TB and Emerging Diseases, NIMR, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Issa Sabi
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simeon P. Mwanyonga
- Department of TB and Emerging Diseases, NIMR, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Foster I, Biewer A, Vanqa N, Makanda G, Tisile P, Hayward SE, Wademan DT, Anthony MG, Mbuyamba R, Galloway M, Human W, van der Westhuizen HM, Friedland JS, Medina-Marino A, Schoeman I, Hoddinott G, Nathavitharana RR. "This is an illness. No one is supposed to be treated badly": community-based stigma assessments in South Africa to inform tuberculosis stigma intervention design. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:41. [PMID: 38919729 PMCID: PMC11194205 DOI: 10.1186/s44263-024-00070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
Background Though tuberculosis (TB)-related stigma is a recognized barrier to care, interventions are lacking, and gaps remain in understanding the drivers and experiences of TB-related stigma. We undertook community-based mixed methods stigma assessments to inform stigma intervention design. Methods We adapted the Stop TB Partnership stigma assessment tool and trained three peer research associates (PRAs; two TB survivors, one community health worker) to conduct surveys with people with TB (PWTB, n = 93) and caregivers of children with TB (n = 24) at peri-urban and rural clinic sites in Khayelitsha, Western Cape, and Hammanskraal, Gauteng Province, South Africa. We descriptively analyzed responses for each stigma experience (anticipated, internal, and enacted), calculated stigma scores, and undertook generalized linear regression analysis. We conducted 25 in-depth interviews with PWTB (n = 21) and caregivers of children with TB (n = 4). Using inductive thematic analysis, we performed open coding to identify emergent themes, and selective coding to identify relevant quotes. Themes were organized using the Constraints, Actions, Risks, and Desires (CARD) framework. Results Surveys revealed almost all PWTB (89/93, 96%) experienced some form of anticipated, internal, and/or enacted stigma, which affected engagement throughout the care cascade. Participants in the rural setting (compared to peri-urban) reported higher anticipated, internal, and enacted stigma (β-coefficient 0.72, 0.71, 0.74). Interview participants described how stigma experiences, including HIV intersectional stigma, act individually and together as key constraints to impede care, leading to decisions not to disclose a TB diagnosis, isolation, and exclusion. Stigma resilience arose through the understanding that TB can affect anyone and should not diminish self-worth. Risks of stigma, driven by fears related to disease severity and infectiousness, led to care disengagement and impaired psychological well-being. Participants desired counselling, identifying a specific role for TB survivors as peer counselors, and community education. Conclusions Stigma is highly prevalent and negatively impacts TB care and the well-being of PWTB, warranting its assessment as a primary outcome rather than an intermediary contributor to poor outcomes. Multi-component, multi-level stigma interventions are needed, including counseling for PWTB and education for health workers and communities. Such interventions must incorporate contextual differences based on gender or setting, and use survivor-guided messaging to foster stigma resilience. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00070-5.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- International Development Research Center, Global Health Program, Ottawa, Canada
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Sally E. Hayward
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Michaile G. Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Jon S. Friedland
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
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Fuady A, Arifin B, Yunita F, Rauf S, Fitriangga A, Sugiharto A, Yani FF, Nasution HS, Putra IWGAE, Mansyur M, Wingfield T. Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002489. [PMID: 38190416 PMCID: PMC10773931 DOI: 10.1371/journal.pgph.0002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6-64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0-50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0-50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94-4.03), those LTFU (aB 2.86; 0.85-4.87), males (aB 1.73; 0.59-2.87), those losing or changing job due to TB (aB 2.09; 0.31-3.88) and those living in a rural area (aB 1.41; 0.19-2.63). Depression was identified in 41.5% (95% CI 37.7-45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15-1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.
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Affiliation(s)
- Ahmad Fuady
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Sulawesi Selatan, Indonesia
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Ferdiana Yunita
- Department of Community Medicine, Faculty of Medicine, Universitas Gunadarma, Depok, Indonesia
| | - Saidah Rauf
- Department of Nursing, Politeknik Kesehatan Kemenkes Ambon, Maluku, Indonesia
| | - Agus Fitriangga
- Department of Community Medicine, Faculty of Medicine, Universitas Tanjungpura, Pontianak, West Kalimantan, Indonesia
| | - Agus Sugiharto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Finny Fitry Yani
- Department of Child Health, Faculty of Medicine, Universitas Andalas, Padang, West Sumatera, Indonesia
- Department of Paediatric, Dr. M. Djamil General Hospital, Padang, West Sumatera, Indonesia
| | - Helmi Suryani Nasution
- Department of Public Health, Faculty of Medicine and Health Sciences, Universitas Jambi, Jambi, Indonesia
| | - I. Wayan Gede Artawan Eka Putra
- Department of Public Health and Prevention Medicine, Faculty of Medicine, Universitas Udayana, Kota Denpasar, Bali, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tom Wingfield
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institute, Stockholm, Sweden
- Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, Liverpool, United Kingdom
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Klamser PP, Zachariae A, Maier BF, Baranov O, Jongen C, Schlosser F, Brockmann D. Inferring country-specific import risk of diseases from the world air transportation network. PLoS Comput Biol 2024; 20:e1011775. [PMID: 38266041 PMCID: PMC10843136 DOI: 10.1371/journal.pcbi.1011775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 02/05/2024] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Disease propagation between countries strongly depends on their effective distance, a measure derived from the world air transportation network (WAN). It reduces the complex spreading patterns of a pandemic to a wave-like propagation from the outbreak country, establishing a linear relationship to the arrival time of the unmitigated spread of a disease. However, in the early stages of an outbreak, what concerns decision-makers in countries is understanding the relative risk of active cases arriving in their country-essentially, the likelihood that an active case boarding an airplane at the outbreak location will reach them. While there are data-fitted models available to estimate these risks, accurate mechanistic, parameter-free models are still lacking. Therefore, we introduce the 'import risk' model in this study, which defines import probabilities using the effective-distance framework. The model assumes that airline passengers are distributed along the shortest path tree that starts at the outbreak's origin. In combination with a random walk, we account for all possible paths, thus inferring predominant connecting flights. Our model outperforms other mobility models, such as the radiation and gravity model with varying distance types, and it improves further if additional geographic information is included. The import risk model's precision increases for countries with stronger connections within the WAN, and it reveals a geographic distance dependence that implies a pull- rather than a push-dynamic in the distribution process.
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Affiliation(s)
- Pascal P. Klamser
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - Adrian Zachariae
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - Benjamin F. Maier
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
- DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
- Copenhagen Center for Social Data Science, University of Copenhagen, Copenhagen, Denmark
| | - Olga Baranov
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Clara Jongen
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - Frank Schlosser
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
| | - Dirk Brockmann
- Department of Biology, Institute for Theoretical Biology, Humboldt‐Universität zu Berlin, Berlin, Germany
- Robert Koch Institute, Berlin, Germany
- Center Synergy of Systems (SynoSys), Center for Interdisciplinary Digital Sciences, Technische Universität Dresden, Dresden, Germany
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Choi Y, Fox AM. Communities at Risk for Mpox and Stigmatizing Policies: A Randomized Survey, Republic of Korea, 2022. Am J Public Health 2023; 113:1120-1127. [PMID: 37471675 PMCID: PMC10484134 DOI: 10.2105/ajph.2023.307347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objectives. To estimate the impact of communicating to the public that men who have sex with men (MSM) are most at risk for mpox on potential stigmatization and risk perception. Methods. We conducted a survey experiment randomizing exposure to messages about mpox among a sample of the South Korean public (n = 1500) in July 2022. We randomized respondents to receive an informational message about mpox that was (1) a neutral informational message about mpox that did not highlight its origins or risk groups (control group), (2) a message explaining that the virus originated in Africa, or (3) a message emphasizing that MSM are most at risk. Results. We found that emphasizing that MSM are most at risk increases support for policies that would restrict lesbian, gay, bisexual, transgender/-sexual, queer or questioning-related events by about 7 percentage points compared with the control condition. However, the message describing African origins did not affect support for restricting travel from Africa. Neither changed risk perceptions or willingness to be vaccinated against mpox. Conclusions. Messages aimed at educating the public about most at-risk groups may trigger increased stigmatization of those groups in ways that could contribute to unnecessary persecution. (Am J Public Health. 2023;113(10):1120-1127. https://doi.org/10.2105/AJPH.2023.307347).
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Affiliation(s)
- Yongjin Choi
- Yongjin Choi is with the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Ashley M. Fox is with the Department of Public Administration and Policy, University at Albany, State University of New York, Albany
| | - Ashley M Fox
- Yongjin Choi is with the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. Ashley M. Fox is with the Department of Public Administration and Policy, University at Albany, State University of New York, Albany
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8
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Atkins S, Heimo L, Carter DJ, Ribas Closa M, Vanleeuw L, Chenciner L, Wambi P, Sidney-Annerstedt K, Egere U, Verkuijl S, Brands A, Masini T, Viney K, Wingfield T, Lönnroth K, Boccia D. The socioeconomic impact of tuberculosis on children and adolescents: a scoping review and conceptual framework. BMC Public Health 2022; 22:2153. [PMID: 36419146 PMCID: PMC9686126 DOI: 10.1186/s12889-022-14579-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) has been repeatedly shown to have socioeconomic impacts in both individual-level and ecological studies; however, much less is known about this effect among children and adolescents and the extent to which being affected by TB during childhood and adolescence can have life-course implications. This paper describes the results of the development of a conceptual framework and scoping review to review the evidence on the short- and long-term socioeconomic impact of tuberculosis on children and adolescents. OBJECTIVES To increase knowledge of the socioeconomic impact of TB on children and adolescents. METHODS We developed a conceptual framework of the socioeconomic impact of TB on children and adolescents, and used scoping review methods to search for evidence supporting or disproving it. We searched four academic databases from 1 January 1990 to 6 April 2021 and conducted targeted searches of grey literature. We extracted data using a standard form and analysed data thematically. RESULTS Thirty-six studies (29 qualitative, five quantitative and two mixed methods studies) were included in the review. Overall, the evidence supported the conceptual framework, suggesting a severe socioeconomic impact of TB on children and adolescents through all the postulated pathways. Effects ranged from impoverishment, stigma, and family separation, to effects on nutrition and missed education opportunities. TB did not seem to exert a different socioeconomic impact when directly or indirectly affecting children/adolescents, suggesting that TB can affect this group even when they are not affected by the disease. No study provided sufficient follow-up to observe the long-term socioeconomic effect of TB in this age group. CONCLUSION The evidence gathered in this review reinforces our understanding of the impact of TB on children and adolescents and highlights the importance of considering effects during the entire life course. Both ad-hoc and sustainable social protection measures and strategies are essential to mitigate the socioeconomic consequences of TB among children and adolescents.
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Affiliation(s)
- S Atkins
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - L Heimo
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - D J Carter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - M Ribas Closa
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - L Vanleeuw
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - L Chenciner
- Royal Free London NHS Foundation Trust, London, UK
| | - P Wambi
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - K Sidney-Annerstedt
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - U Egere
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Verkuijl
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A Brands
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Masini
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - K Viney
- WHO Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - T Wingfield
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - K Lönnroth
- WHO Collaborating Centre On Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - D Boccia
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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9
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Foster I, Galloway M, Human W, Anthony M, Myburgh H, Vanqa N, Wademan DT, Makanda G, Tisile P, Schoeman I, Hoddinott G, Nathavitharana RR. Analysing interventions designed to reduce tuberculosis-related stigma: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000989. [PMID: 36962638 PMCID: PMC10022226 DOI: 10.1371/journal.pgph.0000989] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/08/2022] [Indexed: 03/17/2023]
Abstract
Stigma is a critical barrier for TB care delivery; yet data on stigma reduction interventions is limited. This review maps the available literature on TB stigma reduction interventions, using the Health Stigma and Discrimination framework and an implementation analysis to identify research gaps and inform intervention design. Using search terms for TB and stigma, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data, conducted a quality assessment, and assessed implementation. Results were categorized by socio-ecological level, then sub-categorized by the stigma driver or manifestation targeted. After screening 1865 articles, we extracted data from nine. Three studies were implemented at the individual and interpersonal level using a combination of TB clubs and interpersonal support to target internal and anticipated stigma among persons with TB. Two studies were implemented at the interpersonal level using counselling or a video based informational tool delivered to households to reduce stigma drivers and manifestations. Three studies were implemented at the organizational level, targeting drivers of stigma among healthcare workers (HW) and enacted stigma among HWs. One study was implemented at the community level using an educational campaign for community members. Stakeholder consultation emphasized the importance of policy level interventions and education on the universality of risk to destigmatize TB. Review findings suggest that internal and anticipated TB stigma may be addressed effectively with interventions targeted towards individuals using counselling or support groups. In contrast, enacted TB stigma may be better addressed with information-based interventions implemented at the organizational or community level. Policy level interventions were absent but identified as critical by stakeholders. Implementation barriers included the lack of high-quality training and integration with mental health services. Three key gaps must be addressed in future research: consistent stigma definitions, standardized stigma measurement, and measurement of implementation outcomes.
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Affiliation(s)
- Isabel Foster
- TB Proof, Cape Town, South Africa
- Global Health, International Development Research Centre, Ottawa, Canada
| | | | | | - Michaile Anthony
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Dillon T. Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America
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10
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Medina-Marino A, Bezuidenhout D, Ngcelwane N, Cornell M, Wainberg M, Beyrer C, Bekker LG, Daniels J. Qualitative Identification of Intervention Preferences to Support Men's Engagement and Retention in TB Care in South Africa. Am J Mens Health 2022; 16:15579883221129349. [PMID: 36218175 PMCID: PMC9558889 DOI: 10.1177/15579883221129349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Globally and in South African specifically, men account for 56% and 62% of all tuberculosis (TB) cases, respectively. Men are at increased risk of not accessing TB testing or treatment, and having poor treatment outcomes. Unfortunately, no interventions exist to address these issues. Toward the development of targeted, patient-centered TB care and support interventions, we used semistructured interviews to explored men's social network composition, TB testing behaviors, disclosure and treatment support, clinical experiences, and TB's influence on daily living. Data were analyzed using a thematic approach guided by the Network Individual Resource Model to identify mental and tangible resources influential and preferred during engagement in TB treatment. Men emphasized the desire for peer-to-peer support to navigate TB-related stigma and unhealthy masculinity norms. Men advocated for awareness events to educate communities about their challenges with TB. Men strongly suggested that interventions be delivered in familiar locations where men congregate. Since 2022, no TB treatment support interventions have included the preferred components or delivery modes described by men in our study. To improve men's TB-related health outcomes, the global TB community must identify and address men's unique challenges when designing interventions.
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Affiliation(s)
- Andrew Medina-Marino
- Division of Men’s Health, Desmond Tutu
HIV Centre, University of Cape Town, Cape Town, South Africa,Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA,Research Unit, Foundation for
Professional Development, East London, South Africa,Andrew Medina-Marino, Division of Men’s
Health, Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7915, South
Africa.
| | - Dana Bezuidenhout
- Research Unit, Foundation for
Professional Development, East London, South Africa,Department of Epidemiology, Mailman
School of Public Health, Columbia University, New York City, NY, USA
| | - Nondumiso Ngcelwane
- Buffalo City Health District, Eastern
Cape Provincial Department of Health, Bisho, South Africa
| | - Morna Cornell
- School of Public Health & Family
Medicine, University of Cape Town, Cape Town, South Africa
| | - Milton Wainberg
- Department of Psychiatry, Columbia
University Vagelos College of Physicians and Surgeons, New York City, NY, USA,New York State Psychiatric Institute,
New York City, NY, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke
University, Durham, NC, USA,Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health
Innovation, Arizona State University, Phoenix, AZ, USA
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11
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Zhou M. COVID-19-related stigma and its impact on psychological distress: A cross-sectional study in Wuhan, China. Health Sci Rep 2022; 5:e758. [PMID: 35949673 PMCID: PMC9358535 DOI: 10.1002/hsr2.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims Health-related stigma arises from the perceived association between a person or group of certain characteristics and a specific disease. Coronavirus disease 2019 (COVID-19) has brought about stigma targeted at individuals and groups who are perceived to be connected with the virus. Wuhan of China was not only the locale where the first COVID-19 cases were detected in the world but was also the hardest hit across China. Methods Using new data (N = 1153) from a survey conducted in Wuhan in August 2020, this cross-sectional study aims to reveal the stigma experienced by residents in Wuhan during the COVID-19 pandemic and the impact of this experienced stigma on psychological distress, specifically posttraumatic stress disorder. Results 69.47% (95% confidence interval (CI): 66.81%─72.13%) of the surveyed Wuhan residents have experienced some forms of stigma related to COVID-19. The average posttraumatic stress disorder score based on the impact of event scale-revised is 20.28 (95% CI: 19.096─21.468) out of 88. In particular, 27.75% (95% CI: 25.17%─30.34%) of the respondents display clinically significant distress symptoms. Moreover, this stigma not only aggravates individuals' posttraumatic stress disorder score by 10.652 (95% CI: 8.163─13.141) but also elevates the chance of developing clinically significant distress symptoms. Specifically, the probability of clinical distress is significantly higher (p < 0.001) among those who have experienced stigma (33.66%) than those who have no such experiences (12.62%). Conclusion The public should be aware of the distress-inducing impact of stigma related to COVID-19 and prevent it from causing more harm to certain individuals and groups.
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Affiliation(s)
- Min Zhou
- Department of SociologyUniversity of VictoriaVictoriaCanada
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12
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Wilson D, Lan Cook AW, Shubber Z. The global HIV response at 40. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:93-99. [PMID: 35901302 DOI: 10.2989/16085906.2022.2083975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
It is helpful to divide the global HIV response into three phases: The first, from about 1980 to 2000, represents "Calamity". The second, from roughly 2000 to 2015 represents "Hope." The third, from 2015, is unfolding and may be termed "Choices" - and these choices may be severely constrained by COVID, so "Constrained Choices in an era of COVID" may prove more apt. As we take stock of HIV at 40, there are positive lessons for the wider health response - and challenging reflections for the wider impact of the global HIV response. The positive lessons include: (1) the importance of activism; (2) the role of scientific progress and innovation; (3) the impact of evidence in concentrating resources on proven approaches; (4) the importance of surveillance to understanding transmission dynamics; (5) the use of epidemic intelligence to guide precision implementation; (6) the focus on implementation cascades (diagnosis, linkage, adherence, disease suppression); and finally (7) an overarching execution and results focus.Given this remarkable legacy, it seems churlish to ask whether the HIV response could have achieved more. Yet, consider these approximate figures. Development assistance for HIV totals about 100 billion dollars, 70 billion from the USA matched by roughly 100 billion in domestic resources. For 200 billion dollars, should we not have achieved more than 23 million people initiating treatment (very crudely, 10 000 dollars per person on treatment)? Much of the hundred billion dollars of development assistance (roughly half) focused on about a dozen priority countries in eastern and southern African. The larger PEPFAR recipients, with populations of roughly 50 million, each received 5 billion dollars or more cumulatively. And there are further Global Fund contributions of an additional billion dollars in many of these countries. For 6 billion dollars per country, should we have expected more?The World Bank Human Capital Project posits that to maximize human capital formation, countries must ensure that their children survive, are well nourished and stimulated, learn skills and live long, productive lives. Using the Human Capital Index (a composite index based on these factors), South Africa - the largest HIV financing recipient - ranks 126th of 157 countries, below Haiti, Ghana, the Congo Republic, Senegal and Benin. Consider how many recipients of major HIV development finance fall into the bottom fifth: Namibia, Botswana, Eswatini (formerly Swaziland), Malawi, South Africa, Tanzania, Zambia, Uganda, Lesotho, Ethiopia, Mozambique, Cote D'Ivoire and Nigeria. Of course, causality is unresolved and there are several possible explanations: (1) low human capital formation may increase HIV transmission; (2) the HIV epidemic may have intergenerational impacts; (3) the all-consuming focus on HIV may have displaced other health, education and development priorities. Yet, it remains hard to see these data and to argue that successful HIV responses among the largest HIV financing recipients strengthened their wider health sector and human development outcomes.A plausible principle emerges. Narrowly targeted disease-specific emergency responses may lead to disease-specific gains but do not improve governance or national systems capacity or wider disease or development outcomes. This is not to undermine the emergency origins of the HIV response; 2021 is not 2000 and it is unlikely that we would have 23 million people initiating treatment without an emergency response. Yet, there are reasons (intensified by COVID), to suggest that we must pivot towards long-term, integrated, developmental, nationally owned and financed, systems-orientated responses - particularly when both development assistance and national budgets are likely to be constrained in an era of COVID.
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El-Sadr WM, Platt J, Bernitz M, Reyes M. Contact Tracing: Barriers and Facilitators. Am J Public Health 2022; 112:1025-1033. [PMID: 35653650 DOI: 10.2105/ajph.2022.306842] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Contact tracing-the process of identifying, isolating, and managing infected persons and their contacts-is a recognized public health measure for controlling the transmission of infectious diseases. In the context of the COVID-19 pandemic, contact tracing has received intense attention. We provide a brief overview of the history of contact tracing during several major disease outbreaks in the past century: syphilis and other sexually transmitted infections, HIV infection, tuberculosis, Ebola virus disease, and COVID-19. Our discussion on the barriers to and facilitators of contact tracing offers a perspective on societal and institutional roles and dynamics, stigma as a major barrier to effective tracing efforts, and how the nature and epidemiology of the infection itself can affect its success. We explore the evolution and adaptation of contact tracing and provide insights for future programming and research. (Am J Public Health. Published online ahead of print June 2, 2022: e1-e9. https://doi.org/10.2105/AJPH.2022.306842).
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Affiliation(s)
- Wafaa M El-Sadr
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Joey Platt
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Melanie Bernitz
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Melissa Reyes
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
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14
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Machida M, Kikuchi H, Kojima T, Nakamura I, Saito R, Nakaya T, Hanibuchi T, Takamiya T, Odagiri Y, Fukushima N, Amagasa S, Watanabe H, Inoue S. Unwillingness to cooperate with COVID-19 contact tracing in Japan. Public Health 2022; 210:34-40. [PMID: 35870319 PMCID: PMC9212382 DOI: 10.1016/j.puhe.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/06/2022] [Accepted: 06/10/2022] [Indexed: 11/27/2022]
Abstract
Objectives Contact tracing for COVID-19 relies heavily on the cooperation of individuals with authorities to provide information of contact persons. However, few studies have clarified willingness to cooperate and motivation to provide information for contact tracing. This study sought to describe willingness to cooperate and motivation to report contact persons for COVID-19 contact tracing among citizens in Japan, and to assess any associated sociodemographic factors. Study design Cross-sectional study. Methods This was an online-based survey using quota sampling. Participants were asked about their willingness to cooperate in reporting contacts for COVID-19 contact tracing if they tested positive. Participants also responded to questions regarding their reasons for cooperating or not cooperating and provided sociodemographic data. Multiple logistic regression analysis was performed to clarify associations between sociodemographic factors and willingness to cooperate. Results This study included 2844 participants. The proportion of participants who were not willing to cooperate in reporting contacts was 27.6%, with their main reasons being concerns about causing trouble for the other person and being criticised for revealing their names. Willingness to cooperate was lower among men, young adults and those with an educational level less than a university degree. Conclusions To improve the effectiveness of contact tracing, educational campaigns, such as reducing the fear and stigma associated with COVID-19, may be important. Furthermore, it is essential to understand that individuals may have contacts whom they do not wish to disclose to others and to be considerate when handling such situations.
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15
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Fatah FZ, Furin J, Pai M. When it comes to stopping tuberculosis, what is actually "missing"? PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000319. [PMID: 36962376 PMCID: PMC10021630 DOI: 10.1371/journal.pgph.0000319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Farahdiba Zalika Fatah
- Indonesian Young Coalition for Tuberculosis (IMUT), and Yarsi University, Jakarta, Indonesia
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Madhukar Pai
- School of Population and Global Health, and McGill International TB Centre, McGill University, Montreal, Canada
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16
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Ozturk A. Stigmatization spreads faster than the virus. Viruses do not discriminate, and neither should we." Combatting the stigmatization surrounding coronavirus disease (COVID-19) pandemic. Perspect Psychiatr Care 2021; 57:2030-2034. [PMID: 33931855 PMCID: PMC8242440 DOI: 10.1111/ppc.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/23/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022] Open
Abstract
Infectious diseases are one of the most important problems of the last century. Epidemics have caused the stigmatization of managers, healthcare professionals, and those likely to be infected throughout history. Although many infectious diseases caused stigmas both in the past and today, a new name is added to the list of epidemics in various regions in the world each year and the masses become alerted. The latest disease added to the list is the new coronavirus (COVID-19). Today, because of the COVID-19 pandemic, which has influenced the whole world, the risk of social stigmatization reappears. In this context, it is very important to take the necessary measures to prevent stigmatization and to plan the interventions.
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Affiliation(s)
- Ayfer Ozturk
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartin, Turkey
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17
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Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res 2021; 22:251. [PMID: 34556113 PMCID: PMC8459488 DOI: 10.1186/s12931-021-01841-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world's TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. METHODS We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. RESULTS This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were-patient delay (LIC/LMIC: 28 (95% CI 20-30); UMIC: 10 (95% CI 10-20), health system delay (LIC/LMIC: 14 (95% CI 2-28); UMIC: 4 (95% CI 2-4), and treatment delay (LIC/LMIC: 14 (95% CI 3-84); UMIC: 0 (95% CI 0-1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. CONCLUSIONS This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore.
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, USA
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It is time for us all to embrace person-centred language for people in prison and people who were formerly in prison. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103455. [PMID: 34560625 DOI: 10.1016/j.drugpo.2021.103455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
The use of person-centred language is well accepted regarding substance use and infectious disease healthcare and research, and appropriate acronyms have become commonplace, e.g., "people who inject drugs (PWID)" has mostly replaced phrases like "injecting drugs users". However, the use of the term's 'prisoner' or 'prisoners' remains common. Although less common, terms such as 'offenders' and 'inmates' are also still used on occasion. This persists despite calls from people with lived experience of incarceration, and fellow academics, to stop using these terms. Given the considerable overlap between substance use, infectious diseases, and incarceration, in this commentary we discuss how they interact, including the stigma that is common to each. We propose that using person-centred language (i.e., people in prison or people formerly in prison) needs to become the default language used when presenting research related to people in prison or people formerly in prison. This is a much-needed step in efforts to overcome the continued stigma that people in prison face while incarcerated from prison officers and other employees, including healthcare providers. Likewise, overcoming stigma, including legalised discrimination, that follows people who were formerly in prison upon gaining their freedom is critical, as this impacts their health and related social determinants, including employment and housing.
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Kerkhoff AD, Kagujje M, Nyangu S, Mateyo K, Sanjase N, Chilukutu L, Eshun-Wilson I, Geng EH, Havlir DV, Muyoyeta M. Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment. PLoS One 2021; 16:e0252095. [PMID: 34464392 PMCID: PMC8407587 DOI: 10.1371/journal.pone.0252095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. METHODS We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). RESULTS Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. CONCLUSIONS Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kondwelani Mateyo
- University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
| | - Nsala Sanjase
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Nathavitharana RR, van der Westhuizen A, van der Westhuizen HM, Mishra H, Sampson A, Meintjes J, Nardell E, McDowell A, Theron G. "If I've got latent TB, I would like to get rid of it": Derivation of the CARD (Constraints, Actions, Risks, and Desires) Framework informed by South African healthcare worker perspectives on latent tuberculosis treatment. PLoS One 2021; 16:e0254211. [PMID: 34407070 PMCID: PMC8372902 DOI: 10.1371/journal.pone.0254211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Healthcare workers (HWs) have at least twice the risk of tuberculosis (TB) compared to the general population. There is growing emphasis on latent TB infection (LTBI) in high-risk populations. Yet we know little about HWs' perspectives of LTBI testing and treatment to inform implementation in high-incidence settings. We developed a qualitative networked approach to analyze HWs' perspectives on LTBI testing and treatment. METHODS We conducted 22 in-depth interviews with nurse and physician stakeholders, who had been recruited as part of a larger study evaluating TB transmission risk in HWs at Tygerberg Hospital, Cape Town, South Africa. We performed open coding to identify emergent themes and selective coding to identify relevant text citations. We used thematic analysis to inductively derive the CARD (Constraints, Actions, Risks, Desires) framework. RESULTS All HWs desired to avoid developing TB but few felt this was actionable. Despite LTBI knowledge gaps, safety and cost concerns, most HWs reported hypothetical willingness to take LTBI treatment. The CARD framework showed that desire and action related to LTBI testing and treatment was clearly framed by the interactions between constraints, administrative action, and risk. The surprise HWs described on receiving a negative LTBI (Quantiferon-Plus) result suggests LTBI testing may recalibrate HWs' perceptions regarding the futility of actions to reduce their TB risk. CONCLUSIONS LTBI testing and treatment are acceptable to HWs and could counteract the perceived inevitability of occupational TB infection that currently may limit risk reduction action. This should be coupled with administrative leadership and infrastructural support. The CARD analytic framework is a helpful tool for implementation scientists to understand current practices within complex health systems. Application of CARD could facilitate the development of contextually-relevant interventions to address important public health problems such as occupational TB.
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Affiliation(s)
- Ruvandhi R. Nathavitharana
- Beth Israel Deaconess Medical Center/Harvard Medical School, Division of Infectious Diseases, Boston, MA, United States of America
- * E-mail: (RRN); (AvdW)
| | | | | | - Hridesh Mishra
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Annalean Sampson
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Jack Meintjes
- Unit for Infection Prevention and Control, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Edward Nardell
- Brigham & Women’s Hospital, Division of Global Health Equity, Boston, MA, United States of America
| | - Andrew McDowell
- Tulane University, Department of Anthropology, New Orleans, LA, United States of America
| | - Grant Theron
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
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21
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Coit J, Wong M, Galea JT, Mendoza M, Marin H, Tovar M, Chiang SS, Lecca L, Franke MF. Uncovering reasons for treatment initiation delays among children with TB in Lima, Peru. Int J Tuberc Lung Dis 2021; 24:1254-1260. [PMID: 33317668 DOI: 10.5588/ijtld.20.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Timely diagnosis and treatment of pediatric tuberculosis (TB) is critical to reducing mortality but remains challenging in the absence of adequate diagnostic tools. Even once a TB diagnosis is made, delays in treatment initiation are common, but for reasons that are not well understood.METHODS: To examine reasons for delay post-diagnosis, we conducted semi-structured interviews with Ministry of Health (MoH) physicians and field workers affiliated with a pediatric TB diagnostic study, and caregivers of children aged 0-14 years who were diagnosed with pulmonary TB in Lima, Peru. Interviews were analyzed using systematic comparative and descriptive content analysis.RESULTS: We interviewed five physicians, five field workers and 26 caregivers with children who initiated TB treatment < 7 days after diagnosis (n = 15) or who experienced a delay of ≥7 days (n = 11). Median time in delay from diagnosis to treatment initiation was 26 days (range 7-117). Reasons for delay included: health systems challenges (administrative hurdles, medication stock, clinic hours), burden of care on families and caregiver perceptions of disease severity.CONCLUSION: Reasons for delay in treatment initiation are complex. Interventions to streamline administrative processes and tools to identify and support families at risk for delays in treatment initiation are urgently needed.
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Affiliation(s)
- J Coit
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - M Wong
- Socios En Salud Sucursal, Lima, Peru
| | - J T Galea
- School of Social Work, University of South Florida, Tampa, FL, College of Public Health, University of South Florida, Tampa, FL
| | - M Mendoza
- Socios En Salud Sucursal, Lima, Peru
| | - H Marin
- Socios En Salud Sucursal, Lima, Peru
| | - M Tovar
- Socios En Salud Sucursal, Lima, Peru
| | - S S Chiang
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, Center for International Health Research, Rhode Island Hospital, Providence, RI, USA
| | - L Lecca
- Socios En Salud Sucursal, Lima, Peru
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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22
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Riccardi N, Villa S, Giacomelli A, Diaw MM, Ndiaye M, Gning L, Robbiano M, Alagna R, Saderi L, Biagio AD, Bassetti M, Cirillo DM, Sotgiu G, Codecasa LR, Sarr M, Besozzi G. Tuberculosis treatment outcomes in a rural area of Senegal: a decade of experience from 2010 to 2019 by StopTB Italia. Future Microbiol 2021; 16:399-407. [PMID: 33847143 DOI: 10.2217/fmb-2020-0238] [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: 11/21/2022] Open
Abstract
Background: Tuberculosis (TB) unevenly affects individuals across the globe, especially in rural areas of low-income countries. Aim of the study was to assess the impact of social protection to increase TB awareness on treatment outcomes among TB patients in a rural area of Senegal. Materials & methods: The study, conducted in Fimela district (Senegal) from 1 January 2010 to 31 December 2019 and the intervention started from 31 January 2013, includes activities to increase awareness, active case finding, active follow-up and social protection. Results: Overall, 435 subjects - mainly male and young - were included in the analysis. Among TB cases, 94% had pulmonary involvement, 87% had no previous TB history, and 6% resulted positive HIV. Improved outcome was observed once intervention began (from 71 to 91%, p < 0.001); whereas mortality decreased (from 15 to 5%; p < 0.001), especially for those HIV co-infected for whom TB mortality rate dropped from 70 to 29%. Conclusion: After beginning the cooperation program, TB treatment success increased as a result of the decline of mortality, especially in people living with HIV.
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Affiliation(s)
- Niccolò Riccardi
- Stop TB Italia, Milan, 20159, Italy.,Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, 37024, Italy
| | - Simone Villa
- Stop TB Italia, Milan, 20159, Italy.,Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, 20122, Italy
| | - Andrea Giacomelli
- Stop TB Italia, Milan, 20159, Italy.,III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milano, 20157, Italy
| | - Mama M Diaw
- Stop TB Italia, Milan, 20159, Italy.,Médecin coordonnateur lutte contre la TB, Région médicale de Thiès, Thiès, 21000, Sénégal
| | - Mamoud Ndiaye
- Stop TB Italia, Milan, 20159, Italy.,District Sanitaire de Diofior/Département de Fatick, Diofior, 23400, Sénégal
| | - Lamine Gning
- Stop TB Italia, Milan, 20159, Italy.,District Sanitaire de Diofior/Département de Fatick, Diofior, 23400, Sénégal
| | | | - Riccardo Alagna
- Stop TB Italia, Milan, 20159, Italy.,TB Supranational Reference Laboratory, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology & Medical Statistics Unit, Dept. of Medical, Surgical & Experimental Sciences, University of Sassari, Sassari, 07100, Italy
| | - Antonio Di Biagio
- Stop TB Italia, Milan, 20159, Italy.,Clinic of Infectious Diseases, IRCCS AOU San Martino-IST, Genoa, 16132, Italy
| | - Matteo Bassetti
- Stop TB Italia, Milan, 20159, Italy.,Clinic of Infectious Diseases, IRCCS AOU San Martino-IST, Genoa, 16132, Italy
| | - Daniela M Cirillo
- Stop TB Italia, Milan, 20159, Italy.,TB Supranational Reference Laboratory, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Giovanni Sotgiu
- Stop TB Italia, Milan, 20159, Italy.,Clinical Epidemiology & Medical Statistics Unit, Dept. of Medical, Surgical & Experimental Sciences, University of Sassari, Sassari, 07100, Italy
| | - Luigi R Codecasa
- Stop TB Italia, Milan, 20159, Italy.,Regional TB Reference Centre & Laboratory, Villa Marelli Institute/ASST Niguarda Ca' Granda, Milan, 20159, Italy
| | - Marie Sarr
- National TB Programme, Dakar, 10200, Senegal
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23
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Cox H, Loveday M. Building resilience needs to be central to treating drug-resistant tuberculosis. LANCET GLOBAL HEALTH 2021; 9:e381-e382. [PMID: 33740401 DOI: 10.1016/s2214-109x(21)00056-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Helen Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town 7925, South Africa; Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town 7925, South Africa.
| | - Marian Loveday
- South African Media HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa; CAPRISA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
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24
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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]
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25
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The contribution of stigma to the transmission and treatment of tuberculosis in a hyperendemic indigenous population in Brazil. PLoS One 2020; 15:e0243988. [PMID: 33326453 PMCID: PMC7743939 DOI: 10.1371/journal.pone.0243988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background The Guarani-Kaiowá are Brazil's second-largest indigenous group. Average annual tuberculosis (TB) incidence rates among the Guarani-Kaiowá are nearly 400/100,000 in Mato Grosso do Sul state, ten times the national average. Although stigma is considered crucial for TB control in indigenous communities, few studies have investigated TB stigma among indigenous populations. This study sought to understand the role of TB-related stigma and perceptions of TB in maintaining hyperendemic TB transmission in the Guarani-Kaiowá communities. Methods Various forms of stigma were explored through semi-structured interviews with 19 patients, 11 relatives, and 23 community members. Patients were identified from the registry of the healthcare service. Community members, selected by snowball sampling, were matched by gender and village of residence. Interviews were conducted in Guarani and Portuguese and later translated into English. Framework analysis was performed using NVivo. Results Traditional beliefs of a weakening of the body allowing the disease to enter were common, but the exact mechanism of transmission was unknown. Strong community/public stigma associated TB with uncleanliness, abuse, and irresponsibility. Anticipated stigma led to significant treatment delays for fear of exclusion and losing employment. While most patients felt supported by their families, nearly all patients related experienced/enacted stigma in the community such as gossip, avoidance, and social exclusion, leading to long-lasting internalized/self-stigma. Secondary stigmatization of relatives was widespread, and blanket latent TB infection (LTBI) treatment of patients’ households was a contributing factor in treatment delay. The healthcare service unnecessarily added to stigmatization by enforcing separate utensils and sleeping arrangements for patients. Conclusions Our findings suggest that stigma is a driver for treatment delay and continued transmission of TB in the community. The stigmatization of TB was rooted in a poor understanding of TB transmission, partly because of incorrect orientation by the healthcare service. Interventions to reduce TB-associated stigma are urgently needed.
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26
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Teo AKJ, Tan RKJ, Smyth C, Soltan V, Eng S, Ork C, Sok N, Tuot S, Hsu LY, Yi S. Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia. Open Forum Infect Dis 2020; 7:ofaa422. [PMID: 33134412 PMCID: PMC7585330 DOI: 10.1093/ofid/ofaa422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Stigma is a significant barrier to healthcare and a factor that drives the global burden of tuberculosis (TB). However, there is a scarcity of information on TB stigma in developing countries. We aimed to characterize, measure, and explore the determinants of TB stigma among people with TB in Cambodia. Methods We conducted a mixed-methods study between February and August 2019 using a triangulation convergent design—a cross-sectional survey (n = 730) and nested in-depth interviews (n = 31) among people with TB. Quantitative data were analyzed using descriptive statistics and generalized linear regression models. Qualitative transcripts were thematically analyzed. Results A total of 56% and 51% of participants experienced self-stigma and perceived stigma by the community, respectively. We found rural dwellers, knowledge of how TB is transmitted, and knowledge that anybody can get TB were associated with higher levels of self-stigma and perceived stigma by the community. Higher scores on knowledge of TB symptoms were inversely associated with both self-stigma and community stigma. Thematic analyses revealed accounts of experienced stigma, acts of intentional distancing and hiding TB diagnosis from others, and feelings of embarrassment and shame. Conclusions Tuberculosis stigma was prevalent, suggesting a need for the incorporation of stigma-reduction strategies in the national TB responses. These strategies should be contextualized and developed through community engagement. Future research should continue to measure the levels and dimensions of TB stigma among people with TB through behavioral surveillance using standardized tools.
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Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Chetra Ork
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Ngovlyly Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, 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, National University Health System, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, California, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
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27
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Bashorun AO, Linda C, Omoleke S, Kendall L, Donkor SD, Kinteh MA, Danso B, Leigh L, Kandeh S, D'Alessandro U, Adetifa IMO. Knowledge, attitude and practice towards tuberculosis in Gambia: a nation-wide cross-sectional survey. BMC Public Health 2020; 20:1566. [PMID: 33069220 PMCID: PMC7568354 DOI: 10.1186/s12889-020-09685-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background Early diagnosis and treatment of tuberculosis (TB) are the mainstay of global and national TB control efforts. However, the gap between expected and reported cases persists for various reasons attributable to the TB services and care-seeking sides of the TB care cascade. Understanding individual and collective perspectives of knowledge, attitudes, beliefs and other social circumstances around TB can inform an evidence-based approach in engaging communities and enhance their participation in TB case detection and treatment. Methods The study was conducted during the Gambian survey of TB prevalence. This was a nationwide cross-sectional multistage cluster survey with 43,100 participants aged ≥15 years in 80 clusters. The study sample, a random selection of 10% of the survey population within each cluster responded to a semi-structured questionnaire administered by trained fieldworkers to assess the knowledge, attitudes and practice of the participants towards TB. Overall knowledge, attitude and practice scores were dichotomised using the computed mean scores and analysed using descriptive, univariable and multivariable logistic regression. Results All targeted participants (4309) were interviewed. Majority were females 2553 (59.2%), married 2614 (60.7%), had some form of education 2457 (57%), and were unemployed 2368 (55%). Although 3617 (83.9%) of the participants had heard about TB, only 2883 (66.9%) were considered to have good knowledge of TB. Overall 3320 (77%) had unfavourable attitudes towards TB, including 1896 (44%) who indicated a preference for staying away from persons with TB rather than helping them. However, 3607(83.7%) appeared to have the appropriate health-seeking behaviours with regard to TB as 4157 (96.5%) of them were willing to go to the health facility if they had symptoms suggestive of TB. Conclusions About 3 in 10 Gambians had poor knowledge on TB, and significant stigma towards TB and persons with TB persists. Interventions to improve TB knowledge and address stigma are required as part of efforts to reduce the burden of undiagnosed TB in the country. Supplementary information Supplementary information accompanies this paper at 10.1186/s12889-020-09685-3.
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Affiliation(s)
- Adedapo Olufemi Bashorun
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia.
| | - Christopher Linda
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Semeeh Omoleke
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Lindsay Kendall
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Simon D Donkor
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Ma-Ansu Kinteh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Baba Danso
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Lamin Leigh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Sheriff Kandeh
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia
| | - Ifedayo Morayo O Adetifa
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, P.O. Box 273, Banjul, The Gambia.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Lau LL, Hung N, Dodd W, Lim K, Ferma JD, Cole DC. Social trust and health seeking behaviours: A longitudinal study of a community-based active tuberculosis case finding program in the Philippines. SSM Popul Health 2020; 12:100664. [PMID: 33015308 PMCID: PMC7522854 DOI: 10.1016/j.ssmph.2020.100664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Social trust is an important driver of health seeking behaviours and plays a particularly important role for diseases that have a high degree of stigma associated with them, such as tuberculosis (TB). Individuals experiencing poverty also face additional social and financial barriers in accessing care for TB. We examined an active case finding (ACF) initiative embedded in a program targeting those living in poverty (Transform) implemented by International Care Ministries (ICM), a Philippine-based non-governmental organization (NGO), and analyzed how different forms of social trust may affect the initial uptake of ACF. Methods Program monitoring data and a cross-sectional survey conducted at the beginning of Transform included six dimensions of social trust: satisfaction with family life, satisfaction with friendships, and level of trust in relatives, neighbours, pastor or religious leader, and local government officials. Amongst individuals suspected of having TB who received referrals post-screening, multilevel modelling examined the effects of social trust on rural health unit (RHU) attendance. Results Among the subset of 3350 individuals who received TB screening in 51 communities, 889 (26.5%) were symptom positive and required referral to the RHU, but only 24.1% of those who received referrals successfully attended the RHU. Multilevel regression analysis showed that for each unit increase on the Likert scale in baseline level of family satisfaction and level of trust in relatives, the odds of attending an RHU was 1.03 times (95% CI: 0.99, 1.07) and 1.06 times greater (95% CI: 1.00, 1.11), respectively, independent of other factors. Conclusion These results suggest that social trust in family members could play a valuable role in addressing stigma and rejection, both cited as barriers to higher screening rates. It is recommended that ACF programs that target TB, or other diseases that are stigmatized, prioritize trust-building as an important component of their intervention. Role of social trust on health clinic attendance among extreme poor examined. Effect of five relationship types in supporting tuberculosis testing explored. Trust in family relationships predicted greater health clinic testing. Health interventions for stigmatized diseases should prioritize trust-building.
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Affiliation(s)
- Lincoln L.H. Lau
- Dalla Lana School of Public Health, University of Toronto, Canada
- International Care Ministries Foundation Inc, Philippines
- School of Public Health and Health Systems, University of Waterloo, Canada
- Corresponding author. Unit 2001 Antel Global Corporate Center Julia Vargas Ave Ortigas Center Pasig City NCR Philippines.
| | - Natalee Hung
- International Care Ministries Foundation Inc, Philippines
| | - Warren Dodd
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Krisha Lim
- International Care Ministries Foundation Inc, Philippines
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Canada
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Abstract
Mathew Kavanagh and co-authors discuss law reform in the global tuberculosis response.
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30
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Sotgiu G, Dobler CC. Social stigma in the time of coronavirus disease 2019. Eur Respir J 2020; 56:13993003.02461-2020. [PMID: 32631833 PMCID: PMC7338401 DOI: 10.1183/13993003.02461-2020] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the lives of people around the globe since it appeared in Wuhan, China, at the beginning of December 2019. The burden of disease and its death toll have had an unprecedented impact on the healthcare, economic and financial systems of low-, middle- and high-income countries [1–3]. Peoples’ lives have been disrupted and negatively impacted by COVID-19-related suffering and lockdowns at community and household level. Addressing COVID-19-related stigmahttps://bit.ly/2CPuxO1
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Affiliation(s)
- Giovanni Sotgiu
- Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Claudia C Dobler
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia.,Dept of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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31
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Threats and Interventions During the Treatment of Tuberculosis in an Inner-city District. Arch Bronconeumol 2020; 57:330-337. [PMID: 32593536 DOI: 10.1016/j.arbres.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/14/2020] [Accepted: 05/24/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Since there are active drugs against tuberculosis (TB), the most effective control measures are to assure treatment adherence and to perform contact tracing. Given the long treatment duration and characteristics of some TB patients, threats that put at risk treatment adherence may appear. Identify and address them is essential to achieve the objectives of disease control. OBJECTIVES To identify the epidemiological characteristics of TB patients and the incidents and threats occurring during treatment, to describe the interventions performed to enhance treatment adherence and to determine if there are differences among native and foreign-born patients in the TB clinical unit of a referral hospital in the inner city of Barcelona. METHODS A descriptive, observational, cross-sectional study was performed. We recorded information on sociodemographic and clinical characteristics, incidents and interventions during treatment in all patients with TB diagnosed between September 2013 and August 2016. RESULTS 172 patients were included, 62.2% were foreign-born. The most common incidents and threats were medication-related complications (43.0%), missed follow-up visits (34.3%), communication problems (25.6%), comorbidities complications (23.8%), trips (19.2%), fear of social rejection (16.9%) and change of address (14.5%). The adherence-promoting interventions were: follow-up calls, directly observed treatment, medical and humanitarian reports, extra visits and cultural mediation. Incidents and interventions were more frequent in foreign-born patients, however there were no differences in treatment success among Spanish and foreign-born. CONCLUSION In this inner city several incidents occurred during TB treatment that can threaten adherence and are more common among foreign-born patients. Coordination among professionals from different healthcare settings was able to overcome obstacles in most cases and achieve TB treatment completion.
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MARTINI M, RICCARDI N, GIACOMELLI A, GAZZANIGA V, BESOZZI G. Tuberculosis: an ancient disease that remains a medical, social, economical and ethical issue. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E16-E18. [PMID: 32529100 PMCID: PMC7263063 DOI: 10.15167/2421-4248/jpmh2020.61.1s1.1475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
Affiliation(s)
- M. MARTINI
- Department of Health Sciences, University of Genoa, Italy
- UNESCO Chair “Anthropology of Health - Biosphere and Healing System”, University of Genoa, Italy
- StopTB Italia Onlus, Milan, Italy
| | - N. RICCARDI
- StopTB Italia Onlus, Milan, Italy
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
- Correspondence: Niccolò Riccardi, Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar (VR), Italy - E-mail:
| | - A. GIACOMELLI
- III Infectious Disease Unit, ASST-FBF-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, L. Sacco, University of Milan, Italy
| | - V. GAZZANIGA
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- President of Italian Society of Human Sciences in Medicine (SISUMed), Rome Italy
| | - G. BESOZZI
- StopTB Italia Onlus, Milan, Italy
- Villa Marelli Insitute, Niguarda Ca’ Granda Hospital, Milan, Italy
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Der JB, Grint D, Narh CT, Bonsu F, Grant AD. Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana. PLoS One 2020; 15:e0230604. [PMID: 32191768 PMCID: PMC7081980 DOI: 10.1371/journal.pone.0230604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Ghana’s national prevalence survey showed higher than expected tuberculosis (TB) prevalence, indicating that many people with TB are not identified and treated. This study aimed to identify gaps in the TB diagnostic cascade prior to starting treatment. Methods A prospective cohort study was conducted in urban and rural health facilities in south-east Ghana. Consecutive patients routinely identified as needing a TB test were followed up for two months to find out if sputum was submitted and/or treatment started. The causal effect of health facility location on submitting sputum was assessed before risk factors were investigated using logistic regression. Results A total of 428 persons (mean age 48 years, 67.3% female) were recruited, 285 (66.6%) from urban and 143 (33.4%) from rural facilities. Of 410 (96%) individuals followed up, 290 (70.7%) submitted sputum, among which 27 (14.1%) had a positive result and started treatment. Among those who visited an urban facility, 245/267(91.8%) submitted sputum, compared to 45/143 (31.5%) who visited a rural facility. Participants recruited at the urban facility were far more likely to submit a sputum sample (odds ratio (OR) 24.24, 95%CI 13.84–42.51). After adjustment for confounding, there was still a strong association between attending the urban facility and submitting sputum (adjusted OR (aOR) 9.52, 95%CI 3.87–23.40). Travel distance of >10 km to the laboratory was the strongest predictor of not submitting sputum (aOR 0.12, 95%CI 0.05–0.33). Conclusion The majority of presumptive TB patients attending a rural health facility did not submit sputum for testing, mainly due to the long travel distance to the laboratory. Bridging this gap in the diagnostic cascade may improve case detection.
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Affiliation(s)
- Joyce B. Der
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- * E-mail:
| | - Daniel Grint
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clement T. Narh
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg – University Mainz, Mainz, Germany
| | - Frank Bonsu
- Department of Disease Control and Prevention, National TB Control Program, Ghana Health Service, Accra, Ghana
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Amanullah F, Bacha JM, Fernandez LG, Mandalakas AM. Quality matters: Redefining child TB care with an emphasis on quality. J Clin Tuberc Other Mycobact Dis 2019; 17:100130. [PMID: 31788571 PMCID: PMC6880125 DOI: 10.1016/j.jctube.2019.100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Children have been neglected in the fight against tuberculosis (TB) for decades. Despite being the number one infectious disease killer, TB does not feature on the child survival agendas partly due to absent and inaccurate data. Quality is a missing ingredient in TB care in children, yet high rates of unfavorable TB outcomes highlight its importance in this age group. Quality care is particularly important for TB affected children in the absence of a point of care sensitive and specific diagnostic test. Using the current models of child TB care, it will take another 200 years to end TB. Without focusing on the quality of child TB care, the ambitious country specific United Nations High Level Meeting for TB targets will carry minimal impact. High TB burden countries must also adopt Universal Health Care (UHC) and ensure that quality TB care is made free and equitable for all children, adolescents and their affected families. We advocate for the importance of evaluating the quality of child TB care, and provide a basic framework for quality in child TB with special attention given to creating differentiated service delivery models for children and families affected by TB.
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Affiliation(s)
- Farhana Amanullah
- The Indus Hospital, Department of Pediatrics, Korangi Crossing, 4th Floor IHRC, Karachi, Pakistan
- Interactive Research and Development, Pakistan
- Corresponding author.
| | - Jason Michael Bacha
- Baylor International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
- Baylor College of Medicine Children's Foundation-Tanzania, Mbeya, Tanzania
- The Global Tuberculosis Program, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Lucia Gonzalez Fernandez
- The Global Tuberculosis Program, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- The International AIDS Society. Geneva. Switzerland
| | - Anna Maria Mandalakas
- The Global Tuberculosis Program, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Agins BD, Ikeda DJ, Reid MJA, Goosby E, Pai M, Cattamanchi A. Improving the cascade of global tuberculosis care: moving from the "what" to the "how" of quality improvement. THE LANCET. INFECTIOUS DISEASES 2019; 19:e437-e443. [PMID: 31447305 DOI: 10.1016/s1473-3099(19)30420-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/29/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022]
Abstract
Tuberculosis is preventable, treatable, and curable, yet it has the highest mortality rate of infectious diseases worldwide. Over the past decade, services to prevent, screen, diagnose, and treat tuberculosis have been developed and scaled up globally, but progress to end the disease as a public health threat has been slow, particularly in low-income and middle-income countries. In these settings, low-quality tuberculosis prevention, diagnostic, and treatment services frustrate efforts to translate use of existing tools, approaches, and treatment regimens into improved individual and public health outcomes. Increasingly sophisticated methods have been used to identify gaps in quality of tuberculosis care, but inadequate work has been done to apply these findings to activities that generate population-level improvements. In this Personal View, we contend that shifting the focus from the "what" to the "how" of quality improvement will require National Tuberculosis Programmes to change the way they organise, use data, implement, and respond to the needs and preferences of people with tuberculosis and at-risk communities.
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Affiliation(s)
- Bruce D Agins
- HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, CA, USA; Division of Global Epidemiology, University of California, San Francisco, CA, USA; Institute for Implementation Science in Population Health, City University of New York, NY, USA.
| | - Daniel J Ikeda
- HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, CA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael J A Reid
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Eric Goosby
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Canada
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
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Ikeda DJ, Basenero A, Murungu J, Jasmin M, Inimah M, Agins BD. Implementing quality improvement in tuberculosis programming: Lessons learned from the global HIV response. J Clin Tuberc Other Mycobact Dis 2019; 17:100116. [PMID: 31788558 PMCID: PMC6879975 DOI: 10.1016/j.jctube.2019.100116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The quality of care and treatment for tuberculosis (TB) is a major barrier in global efforts to end TB as a global health emergency. Despite a growing recognition of the need to measure, assure, and improve quality of TB services, implementation of quality improvement (QI) activities remains limited. Applying principles of systems thinking, continuous measurement, and root cause analysis, QI represents a proven approach for identifying and addressing performance gaps in healthcare delivery, with demonstrated success in low- and middle-income settings in the areas of HIV/AIDS, maternal, newborn, and child health, and infection control, among others. Drawing from lessons learned in the development of QI programming as part of the global response to HIV, we review key enablers to implementation that may assist NTPs in turning aspirations of high-quality service delivery into action. Under the umbrella of a formal quality management (QM) program, NTPs' attention to planning and coordination, commitment to tracking key processes of care, investment in QI capacity building, and integration of TB QI activities within efforts to advance universal health coverage provide a framework to sustainably implement QI activities.
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Affiliation(s)
- Daniel J Ikeda
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Joseph Murungu
- HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, Harare, Zimbabwe
| | - Margareth Jasmin
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Bruce D Agins
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,Institute for Implementation Science in Public Health, City University of New York, New York, NY, USA
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Udwadia Z, Furin J. Quality of drug-resistant tuberculosis care: Gaps and solutions. J Clin Tuberc Other Mycobact Dis 2019; 16:100101. [PMID: 31720427 PMCID: PMC6830144 DOI: 10.1016/j.jctube.2019.100101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Drug-resistant forms of tuberculosis (DR-TB) are a significant cause of global morbidity and mortality and the treatment of DR-TB is characterized by long and toxic regimens that result in low rates of cure. There are few formal studies documenting the quality of DR-TB treatment services provided globally, but the limited data that do exist show there is a quality crisis in the field. This paper reviews current issues impacting quality of care in DR-TB, including within the areas of patient-centeredness, safety, effectiveness and equity. Specific issues affecting DR-TB quality of care include: 1) the use of regimens with limited efficacy, significant toxicity, and high pill burden; 2) standardized treatment without drug susceptibility testing; 3) non-quality assured medications and drug stock outs; 4) lack of access to newer and repurposed drugs; 5) high rates of adverse events coupled with minimal monitoring and management; 6) care provided by multiple providers in the private sector; 7) depression, anxiety, and stress; and 8) stigma and discrimination. The paper discusses potential ways to improve quality in each of these areas and concludes that many of these issues arise from the traditional "public health approach" to TB and will only transformed when a human-rights based approach is put into practice.
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Affiliation(s)
| | - Jennifer Furin
- Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Ave., Boston, MA, 02115, USA
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Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique. PLoS One 2019; 14:e0219470. [PMID: 31291352 PMCID: PMC6619801 DOI: 10.1371/journal.pone.0219470] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. Materials and methods Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. Results Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. Discussion TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB.
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Min J, Chung C, Jung SS, Park HK, Lee SS, Lee KM. Understanding illness perception in pulmonary tuberculosis patients: One step towards patient-centered care. PLoS One 2019; 14:e0218106. [PMID: 31188871 PMCID: PMC6561564 DOI: 10.1371/journal.pone.0218106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/27/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Assessing the illness perception of patients with tuberculosis (TB) could improve our understanding of their beliefs about disease and help address problems in their health-seeking behavior. STUDY AIM We assessed illness perception in patients with pulmonary TB in association with patients' demographic, socioeconomic, and clinical features. METHODS Adult patients who were newly diagnosed with pulmonary TB at three tertiary hospitals in South Korea were included from November 2016 and September 2018. Participants' illness perception was assessed using the Brief Illness Perception Questionnaire (BIPQ) at the start of anti-TB treatment. RESULTS In total, 390 patients with pulmonary TB completed this survey. The mean BIPQ score was 31.6 ± 13.2, and that was positively correlated with clinical TB scores. Patients were highly concerned about their illness, but believed in the treatment. Unhealthy eating habits were mentioned as the most prevalent perceived cause. Coughing for more than one month and alarming symptoms were significantly associated with BIPQ scores ≥ 33. Non-adherent patients had significantly higher BIPQ scores. CONCLUSIONS Assessing the illness perceptions of those with severe TB-related symptoms and signs may help to identify TB patients with vulnerable to poor treatment outcomes.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sung Soo Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ki Man Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
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Mazumdar S, Satyanarayana S, Pai M. Self-reported tuberculosis in India: evidence from NFHS-4. BMJ Glob Health 2019; 4:e001371. [PMID: 31263580 PMCID: PMC6570983 DOI: 10.1136/bmjgh-2018-001371] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/28/2019] [Accepted: 04/27/2019] [Indexed: 11/03/2022] Open
Abstract
This paper reports self-reported levels and socioeconomic patterns in the distribution of tuberculosis (TB) cases in India, based on information collected under the National Family Health Survey-Round 4 (NFHS-4, 2014-2015). Based on a nationally representative sample of over 600 000 households comprising of about 2.9 million individuals, we estimate a self-reported point prevalence of 304 TB cases per 100 000 population, with a higher burden evident among households with poorer wealth status and among individuals with low educational levels. About 55% of the reported TB cases sought treatment from public services, with higher public service use observed in West Bengal, Kerala and Tamil Nadu. However, more than a third of the patients from poorest groups sought treatment from private sources. Results indicate a significant proportion of the general population, including those with completed school-level education continue to have incomplete knowledge on the routes of the spread of TB infection. Social stigma, such as reluctance to disclose about a family member being infected with the disease to others, also remains high. Imminent need for appropriate policy mechanisms for involving the private sector and raising consciousness through suitable advocacy measures is re-emphasised.
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Affiliation(s)
- Sumit Mazumdar
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against TB and Lung Disease, Paris, France
| | - Madhukar Pai
- McGill International TB Center, McGill University, Montreal, Quebec, Canada
- Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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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: 17] [Impact Index Per Article: 2.8] [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.
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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
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Clark J, Barnes A, Gardiner C. Reframing Global Palliative Care Advocacy for the Sustainable Development Goal Era: A Qualitative Study of the Views of International Palliative Care Experts. J Pain Symptom Manage 2018; 56:363-370. [PMID: 29953941 DOI: 10.1016/j.jpainsymman.2018.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT The World Health Assembly Palliative Care Resolution in 2014 and the inclusion of palliative care within the sustainable development goals raised optimism that palliative care would no longer be a peripheral aspect of global health. However, no funding, accountability measures, or indicators for palliative care development accompanied these policy developments. This risks health actors continuing to prioritize the attainment of better known target-driven aspects of health care. OBJECTIVES To explore the attitudes of international palliative care experts regarding how the future development of palliative care can be accelerated. METHODS About 16 international palliative care experts were interviewed for their epistemic expertise. Participants were interviewed face to face or via Skype. Interviews were recorded, transcribed nonverbatim, and analyzed using a thematic approach (NVivo). RESULTS Participants strongly supported the rollout of national palliative care policies around the world for two reasons: to ensure palliative care attracts national funding streams and to attract global funding for palliative care. The absence of a global indicator for palliative care development was considered a severe impediment to the inclusion of palliative care within global efforts toward universal health care. Advocacy partnerships, using human rights approaches with economic frames, were considered the most effective methods of influencing policymakers. CONCLUSION Palliative care represents a value proposition that is not currently being maximized by advocacy. Advocates should consider palliative care developmentally, focusing on key asks for development and consider how palliative care can contribute to other international development priorities, in particular poverty reduction.
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Affiliation(s)
- Joseph Clark
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom.
| | - Amy Barnes
- Section of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Clare Gardiner
- The School of Nursing & Midwifery, University of Sheffield, Sheffield, United Kingdom
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Brooks-Pollock E, Jacobson KR. Rethinking tuberculosis control by targeting previously treated individuals. LANCET GLOBAL HEALTH 2018; 6:e361-e362. [PMID: 29472017 DOI: 10.1016/s2214-109x(18)30068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Ellen Brooks-Pollock
- Bristol Veterinary School, University of Bristol, BS40 5DU, UK; Population Health Sciences, Bristol Medical School, University of Bristol, UK.
| | - Karen R Jacobson
- Section of Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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