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

Tuberculosis (TB) stigma continues to impede equitable access to prevention, diagnosis, treatment, and care, undermining efforts to end the epidemic. Despite commitments to eliminate TB stigma in the 2023 United Nations Political Declaration on TB, implementation of evidence-based stigma reduction interventions remains constrained by limited systematic and comparable data. This community-led paper describes findings from 17 national TB stigma assessments conducted using validated stigma measurement scales and guided by the World Health Organization social-ecological model to generate cross-country evidence for action. Across the 17 countries-representing 38% of the estimated global TB burden in 2024-a total of 26,040 individuals participated in the quantitative components. Participants included people with TB (56%, n = 14,685), family members (18%, n = 4,662), community members living in the same areas (16%, n = 4,206), and healthcare workers (10%, n = 2,487). The most frequently reported contexts where people with TB reported stigma inhibited access to services were observed in the community (25%) and self-stigma (23%). These were followed by stigma in health facilities (18%), homes and families (18%), and workplaces (16%). Common drivers included self-isolation among people with TB, concealment of TB status by families, community avoidance behaviours (e.g., reluctance to share food or drink), and healthcare workers' endorsement of forced isolation during treatment. Thirty percent (30%) of healthcare workers reported experiencing stigma, mainly from colleagues. Stigma occurred most often before presentation at health facilities-particularly during symptom recognition, disclosure, and treatment initiation and adherence-and disproportionately affected women and underserved populations. Although most countries reported protective laws and policies-generally embedded in broader health or constitutional frameworks rather than TB-specific legislation-implementation and enforcement were frequently inadequate, particularly regarding workplace protections, privacy, non-discrimination, and safeguards against involuntary isolation. These findings confirm that stigma remains a major barrier to TB care and highlight the need to scale up context-responsive stigma reduction strategies. Priorities include targeting critical settings and stages of the TB care continuum, addressing prevalent stigma drivers, strengthening enforcement of legal protections, prioritizing disproportionately affected populations, and promoting meaningful co-creation and leadership by people affected by TB.