Assessing tuberculosis stigma: a pooled multi-country descriptive analysis of 17 high-burden countries using a...

Area of Science:

• Public Health
• Social Sciences
• Epidemiology

Background:

• Tuberculosis (TB) stigma impedes equitable access to prevention, diagnosis, treatment, and care, undermining global efforts to end the epidemic.
• Despite commitments to eliminate TB stigma, implementation of evidence-based interventions is limited by a lack of systematic, comparable data.

Purpose of the Study:

• To generate cross-country evidence for action by describing findings from 17 national TB stigma assessments.
• To identify contexts, drivers, and consequences of TB stigma across diverse populations and settings.

Main Methods:

• Conducted 17 national TB stigma assessments using validated stigma measurement scales.
• Guided by the World Health Organization social-ecological model.
• Collected quantitative data from 26,040 participants, including people with TB, family members, community members, and healthcare workers across 17 countries.

Main Results:

• The most frequent contexts for stigma inhibiting access to services were the community (25%) and self-stigma (23%).
• Common drivers included self-isolation, concealment of TB status, community avoidance, and healthcare workers endorsing forced isolation.
• Stigma disproportionately affected women and underserved populations, often occurring before health facility presentation and impacting treatment initiation and adherence.

Conclusions:

• TB stigma remains a major barrier to TB care, necessitating scaled-up, context-responsive reduction strategies.
• Priorities include targeting critical care stages, addressing stigma drivers, enforcing legal protections, and empowering people affected by TB.