Fighting TB stigma: we need to apply lessons learnt from HIV activism

Daftary, Amrita; Frick, Mike; Venkatesan, Nandita.; Pai, Madhukar

doi:10.1136/bmjgh-2017-000515

Cited by 63 publications

(48 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TB-related stigma was independently associated with non-submission of sputum, consistent with findings from a study in India [22]. Several studies have reported high perception of TB-associated stigma [23][24][25][26][27], and specific actions are needed to counter this [28,29].…”

Section: Discussionsupporting

confidence: 81%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

View full text Add to dashboard Cite

BackgroundGhana'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. MethodsA 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. ResultsA 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). ConclusionThe 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.

show abstract

Section: Discussionsupporting

confidence: 81%

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Our analyses revealed a substantial delay between the onset of TB symptoms and TB care-seeking among high burden countries, highlighting the need to continue to shape knowledge, change attitude, and raise awareness of the community, people at risk of TB, and the health providers. To improve access to TB services and early diagnosis, specific vulnerabilities such as sex disparities in careseeking, being older, and geographic isolation should be recognized and addressed through tailored approaches [180] It is also crucial to improve consciousness of the society regarding TB to battle stigma, and networks [181] of support from within the families, the grassroots, and institutions could create an enabling environment for early care-seeking, treatment adherence and success. In contrast to patient delay, the shorter health system and treatment delay were encouraging.…”

Section: Discussionmentioning

confidence: 99%

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Globally, 30 countries with the highest tuberculosis (TB) burden bears 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 determinants and duration 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. For quantitative studies, we performed narrative synthesis of the covariates that were 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: We included 124 articles from 14 low-and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC) in this review. The pooled median duration of patient, health system, and treatment delay were 28 days (95%CI 20–30), 11.5 days (95%CI 3.9–24.7), and six days (95%CI 1–28.4), respectively. We found that the duration of delays was consistently shorter among UMIC compared to LIC and LMIC. There was consistent evidence that being female and rural residence was associated with longer patient delay. Furthermore, 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. Health system and treatment delay were mediated by organizational and policy factors. 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 detailed the determinants of delayed TB diagnosis and treatment in high burden countries. The gaps identified at different socio-ecological levels 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.

show abstract

“…As the TB and HIV program in the Philippines becomes integrated, there may be a need to craft communication strategies addressing double stigmatization. More importantly, TB patients' consciousness needs to be raised so that they can speak and act collectively against double stigmatization [27].…”

Section: Discussionmentioning

confidence: 99%

Bottlenecks in integrating TB and HIV services in the Philippines: a qualitative implementation research

Sy¹,

Padmawati²,

General³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The Philippines is subdivided into 17 regions, with a devolved health system. It has a high burden of tuberculosis (TB) (554 per 100,000 population), and more than 25% increase in human immunodeficiency virus (HIV) incidence. However, years after the World Health Organization’s (WHO) recommendations on TB/HIV collaborative activities, only 24% of Filipinos with TB know their HIV status. The present study aims to describe implementation bottlenecks that hamper integration of TB and HIV services in the Philippines. Methods Ten focus group discussions with program managers, non-government organizations (NGO), patient organizations, and primary healthcare centers from different levels of the Philippine health system were conducted. Thematic analysis was used to analyze qualitative data. Results Implementation bottlenecks can be categorized into four areas: policy, operational, human resources, and patient-related factors. Mechanisms to cascade TB/HIV knowledge and policies from the national to the municipality level have been identified as barriers to integrated TB/HIV services. Double stigmatization among TB patients was also linked to poor uptake of HIV testing. Conclusion National policies and health promotion efforts need to be revisited to operationalize how information about TB/HIV policies is cascaded to the grassroots. Interventions to address double stigmatization should also be explored.

show abstract

Fighting TB stigma: we need to apply lessons learnt from HIV activism

Cited by 63 publications

References 14 publications

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

Where are patients missed in the tuberculosis diagnostic cascade? A prospective cohort study in Ghana

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Bottlenecks in integrating TB and HIV services in the Philippines: a qualitative implementation research

Contact Info

Product

Resources

About