Addressing stigma and discrimination through ethical community-based TB policies

Tuberculosis (TB) control is not only an issue for clinical intervention but also considered as one that requires ethics and community-responsive practices to reduce stigma and discrimination. In this research by using mixed methods, we will analyse how stigma affects patient's engagement with tuberculosis services and assesses whether policies that are applied in communities uphold principles of dignity, autonomy, and confidentiality. Quantitative survey data from 120 TB patients included four domains of stigma: self-stigma, perceived stigma, enacted discrimination and structural discrimination, exposure to home-based care, peer support and privacy safeguards. Semi-structured interviews with patients, caregivers, and community health workers enriched the analysis by recording lived experiences and ethical conflicts in the field. Results show that perceived and internalized stigma are more common than overt discrimination, and these psychosocial pressures are linked to delays in care seeking and poor adherence. Seventy-eight percent of the study participants received visits from community health workers (CHWs), and adherence was much higher in this group than in those who did not have contact (82% vs. 65%), highlighting the importance of community support. However, 46% of respondents reported poor consent while sharing information and 40% were doubtful about confidentiality, indicating that routine visits to the community may cause sufferers to be socially scrutinized inadvertently. Rights awareness was poor, with only 22% knowing that they had the right to report discrimination or breaches. Together, the findings highlight the fact that community-based TB control can strengthen and reduce stigma, depending on their implementation. Prioritizing privacy-promoting techniques, reinforcing ethics education for CHWs, and building up and expanding patient rights education may help minimize stigma-induced barriers and improve treatment outcomes, which would contribute to support national and global End TB strategies.