Finding the missing men with tuberculosis: a participatory approach to identify priority interventions in Uganda

Area of Science:

• Public Health
• Global Health
• Gender Studies

Background:

• Gender disparities significantly influence tuberculosis (TB) exposure and vulnerability, with men exhibiting higher prevalence of TB disease and missed diagnoses, contributing substantially to new infections.
• Understanding these gender-specific dynamics is crucial for developing effective TB control strategies, particularly in high-burden settings.

Purpose of the Study:

• To identify gender-specific interventions for systematic tuberculosis (TB) screening among men in Uganda using participatory research methods.
• To delineate and compare men's ideal versus actual TB health-seeking pathways to uncover barriers to care.

Main Methods:

• Formative research involving 70 TB stakeholders (healthcare workers, TB survivors, policymakers, researchers) across four Ugandan hospitals.
• Utilized the 'stepping stones' method to identify barriers and solutions within men's TB health-seeking pathways.
• Co-analysis meeting with 17 participants to synthesize insights and reach consensus on proposed interventions.

Main Results:

• Men's actual TB care pathway diverged from the ideal due to systemic barriers: delayed health seeking, inconvenient facility hours, and long waiting times conflicting with work schedules.
• Proposed interventions include male-specific and integrated TB services prioritizing X-ray screening for men with cough, healthcare worker training, TB champion engagement, and private practitioner involvement.

Conclusions:

• A participatory co-design approach fostered consensus among diverse health actors on context-specific, person-centered TB interventions for men in Uganda.
• The identified package of interventions will be evaluated for acceptability, effectiveness, and cost-effectiveness in an upcoming pilot study.