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Dormechele W, Bonsu EO, Boadi C, Adams MO, Hlormenu BA, Addo SK, Bossman BB, Addo IY. Determinants of intention to conceal tuberculosis status among family members: an analysis of seven Sub-Saharan African countries. BMC Infect Dis 2024; 24:175. [PMID: 38331730 PMCID: PMC10854020 DOI: 10.1186/s12879-024-09064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/27/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a significant public health burden in Sub-Saharan Africa (SSA), accounting for about 25% of global TB cases. In several communities, TB diagnosis, treatment, and control have become a critical challenge, largely due to the intention to conceal TB status among family members. It is therefore crucial to understand the factors associated with the intentions to conceal TB status among family members in SSA. METHODS This quantitative study utilised data from the most recent Demographic and Health Surveys (DHS). The objective was to examine the factors associated with the intention to conceal the TB status of family members. The sample consisted of 58,849 individuals aged 10 years or older from seven SSA countries. Binary logistic regression was employed to assess the associations between TB status concealment and various socio-demographic and economic variables. RESULTS The overall prevalence of TB status concealment intentions for the seven countries was 28.0% (95% CI: 27.6-28.4). Malawi and Eswatini accounted for the highest (47.3%) and lowest (3.0%) prevalence of TB concealment intentions respectively. TB status concealment intentions decreased with increasing age (p < 0.001). Living in rural areas was associated with lower odds of intending to conceal the TB of family members compared to living in urban areas (aOR = 0.92; p = 0.008). Higher education levels were associated with lower odds of TB status concealment intentions (aOR = 0.50; p < 0.001) compared to lower education levels. As participants wealth index increased, the odds of TB status concealment intentions decreased (aOR = 0.83; p < 0.001). Country of residence also showed significant associations with individuals in Ghana (aOR = 4.51; p < 0.001), Lesotho (aOR = 2.08; p < 0.001), Malawi (aOR = 4.10; p < 0.001), Namibia (aOR = 4.40; p < 0.001), and Sao-Tome and Principe (aOR = 5.56; p < 0.001) showing higher odds of TB status concealment intentions compared to Eswatini. CONCLUSIONS The findings conclude that several social determinants of health, including age, urbanicity, education, and wealth contribute to TB status concealment intentions for family members. Considering these factors is important for designing targeted interventions to improve TB control in the sample. In light of the unavailability of cultural variables in the dataset, future research can leverage qualitative approaches to conduct a more comprehensive exploration of the cultural factors linked to TB status concealment intentions in the population.
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Affiliation(s)
| | - Emmanuel Osei Bonsu
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Boadi
- Department of Operations and Management Information Systems, University of Ghana, Accra, Ghana
| | | | | | | | | | - Isaac Yeboah Addo
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.
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Nagarajan K, Muniyandi M, Sellappan S, Karunanidhi S, Senthilkumar K, Palani B, Jeyabal L, Krishnan R. A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai. PLoS One 2023; 18:e0280812. [PMID: 36701386 PMCID: PMC9879515 DOI: 10.1371/journal.pone.0280812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/08/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. METHODS This prospective observational study was conducted in Chennai Corporation treatment units during 2019-2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. RESULTS A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44-58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150-180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46-55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%). CONCLUSION Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients.
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Affiliation(s)
- Karikalan Nagarajan
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Malaisamy Muniyandi
- Department of Health Economics, ICMR–National Institute for Research in Tuberculosis, Chennai, India
- * E-mail:
| | - Senthil Sellappan
- ICMR-Regional Medical Research Centre, Port Blair, Andaman and the Nicobar Islands, India
| | - Srimathi Karunanidhi
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Keerthana Senthilkumar
- Department of Social and Behavioral Research, ICMR-National Institute for Research in Tuberculosis, Chennai, India
| | - Bharathidasan Palani
- Department of Statistics, ICMR–National Institute for Research in Tuberculosis, Chennai, India
| | - Lavanya Jeyabal
- District TB Office, National TB Elimination Programme, Chennai, India
| | - Rajendran Krishnan
- Department of Statistics (Epidemiology Unit), ICMR–National Institute for Research in Tuberculosis, Chennai, India
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Rodríguez-Márquez I, Tello-Hoyos KY, Torres-Pereda P, Guzmán-Salazar BL, Pérez F, Polanco-Pasaje JE. Tuberculosis screening indicators in indigenous population in Colombia: a mixed methods research. CAD SAUDE PUBLICA 2022; 38:e00008621. [PMID: 35293536 DOI: 10.1590/0102-311x00008621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/01/2021] [Indexed: 11/22/2022] Open
Abstract
This study aims to evaluate, via a mixed methods study, the implementation of the screening process for pulmonary tuberculosis (PTB) within indigenous population of the Department of Cauca, Colombia, during the 2016-2018 period. Indicators assessing the PTB screening process were elaborated and estimated. Subsequently, an evaluation of the indicators were performed based on a sampling process from health care providers of the municipalities with the highest and lowest PTB incidence and from key agents' perspective. Screening indicators were estimated and thematic analysis was performed based on the interviews conducted with key agents. Finally, a triangulation of quantitative and qualitative findings was performed. From the total population expected to have respiratory symptomatics (n = 16,711), the health care providers were able to identify 42.3% of them. Out of the individuals identified as respiratory symptomatics (n = 7,064), they were able to examine 93.2% (n = 6,585) with at least one acid-fast bacilli smear test. The reported positivity index from acid-fast bacilli smear test was 1.87%. The explanations from key agents revolved around the possibility of an overestimated targeted amount of respiratory symptomatics; insufficient personnel for the search of symptomatic individuals; high costs for the search in areas of difficult access; the need to request permissions from indigenous authorities; culturally ingrained stigma; use of traditional medicine and self-medication; and patient's personal beliefs. This study revealed barriers in the implementation of the screening process for PTB within the indigenous population from the Department of Cauca, mainly in the identifying process of the respiratory symptomatics.
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Affiliation(s)
| | | | | | | | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington DC, U.S.A
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Redwood L, Fox GJ, Nguyen TA, Bernarys S, Mason P, Vu VA, Nguyen VN, Mitchell EMH. Good citizens, perfect patients, and family reputation: Stigma and prolonged isolation in people with drug-resistant tuberculosis in Vietnam. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000681. [PMID: 36962771 PMCID: PMC10021913 DOI: 10.1371/journal.pgph.0000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
Stigma and isolation are common in people with tuberculosis (TB). Social isolation contributes to reduced health outcomes and TB treatment adherence. Stigma and the drivers of isolation in people with Drug-Resistant (DR)-TB may include modifiable advice and practices of family and Health Care Workers (HCW). This study aimed to understand the drivers of isolation and stigma from the perspective of people with DR-TB in Vietnam. A greater understanding of stigma and isolation is important to identify and balance patients' needs and disease transmission risk. In-depth interviews were conducted with 12 people with DR-TB and seven HCWs who care for people with DR-TB in two provinces in Vietnam. Interviews were audio-recorded, transcribed verbatim and translated to English. Data collection and analysis were conducted simultaneously. The data were then analysed using a thematic framework approach. Stigma and extended isolation were common experiences among people with DR-TB. To mitigate stigma, people with DR-TB used the local term 'lao lực' to describe their condition to others which is believed to be a less infectious and less stigmatising type of TB. This study identified that although HCW informed people with DR-TB of when they were no longer infectious and isolation was no longer required, their infection control advice was not always consistent. Despite knowing they were no longer infectious, most people with DR-TB continued to self-isolate to minimise the perceived repercussions of societal stigma, to protect their 'thể diện' (honour, prestige, reputation), and eliminate all risk of transmitting DR-TB to their family. This study identified three interconnected drivers of self-isolation in Vietnam, including fear of infecting others, fear of stigmatization, and to protect family reputation. TB control programmes need to better understand the social aspects of DR-TB to enable them to better support patients. Educating HCW to provide evidence-based infection control advice is vital.
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Affiliation(s)
- Lisa Redwood
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Sarah Bernarys
- The University of Sydney, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Mason
- Taronga Conservation Society Australia, Sydney, Australia
- The University of Sydney, School of Education and Social Work, The University of Sydney, Camperdown New South Wales, Australia
| | - Van Anh Vu
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | | | - Ellen M H Mitchell
- Department of Public Health, Tropical Infectious Disease Group, Institute for Tropical Medicine, Antwerp, Belgium
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Bergman A, Farley JE, Agarwalla V, Relf M. Reframing Intersectional Stigma for a South African Context Integrating Tuberculosis, HIV and Poverty Stigmas. J Assoc Nurses AIDS Care 2022; 33:22-32. [PMID: 34939985 DOI: 10.1097/jnc.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Intersectionality is closely intertwined with Black feminism within the context of the United States. As a result, intersectionality is often overlooked in non-Western contexts where racial homogeneity may reduce some of the impact of race on marginalization. This article will look at intersectional stigma from the South African context using the tuberculosis/HIV (TB/HIV) treatment environment in South Africa to exemplify intersectionality's versatility as an analytic method outside of the United States. We will use colonial history and contemporary research to reframe intersectionality considering a new set of stigmatized identities, including HIV stigma, TB stigma, and poverty stigma, to create a situation-specific framework adapted from a model by Bulent Turan and colleagues.
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Affiliation(s)
- Alanna Bergman
- Alanna Bergman, MSN, AGNP-BC, AAHIVS, is a PhD Student, Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Jason E. Farley, PhD, MPH, ANP-BC, AACRN, FAAN, FAANP, is a Professor at Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA. Vidisha Agarwalla, MA, is a Social Design Associate, Johns Hopkins University in the PROMOTE Center, Baltimore, Maryland, USA. Michael Relf, PhD, RN, AACRN, ACNS-BC, CNE, ANEF, FAAN, is the Associate Dean, Global and Community Health Affairs, Duke University, School of Nursing, Durham, North Carolina, USA
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Grande SW, Adams LV, Maseko TSB, Talbot EA, deGijsel D, Mikal J, Simelane ZZ, Achili A, Mkhontfo M, Haumba SM. The social implications of participant choice on adherence to Isonaizid Preventive Therapy (IPT): A follow-up study to high completion rates in Eswatini. PLoS One 2020; 15:e0232841. [PMID: 32469990 PMCID: PMC7259658 DOI: 10.1371/journal.pone.0232841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eswatini (formerly Swaziland) has one of the highest rates of TB and HIV co-disease in the world. Despite national efforts to improve service delivery and prevent TB and HIV transmission, rates remain high. A recent prospective, observational study of integrated, patient-selected IPT delivery showed extraordinary improvements in IPT adherence, running counter to previous assumptions. This prompted the need to understand contextual and unseen study factors that contributed to high rates of adherence. OBJECTIVE To investigate high rates of IPT adherence rates among people living with HIV who participated in an observational study comparing modes of IPT delivery. METHODS Community-based participatory research guided the development of in-person administration of semi-structured questionnaires. Observational and field note data were analyzed. Qualitative data were analyzed using content analysis. RESULTS We interviewed 150 participants and analyzed responses from the 136 who remembered being given a choice of their IPT delivery method. Fifty-seven percent were female and the median age was 42. Nearly 67% of participants chose to receive facility-based IPT. High rates of self-reported IPT treatment adherence were linked to four key concepts: 1) adherence was positively impacted by community education; 2) disclosure of status served to empower participant completion; 3) mode of delivery perceptions positively impacted adherence; and 4) choice of treatment delivery seen as helpful but not essential for treatment completion. DISCUSSION Achieving higher rates of IPT adherence in Eswatini and similar rural areas requires community-engaged education and outreach in coordination with care delivery systems.
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Affiliation(s)
- S. W. Grande
- The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - L. V. Adams
- The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | | | - E. A. Talbot
- The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - D. deGijsel
- The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - J. Mikal
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | | | - A. Achili
- University Research Co. LLC (URC), Mbabane, Eswatini
| | - M. Mkhontfo
- University Research Co. LLC (URC), Mbabane, Eswatini
| | - S. M. Haumba
- University Research Co. LLC (URC), Mbabane, Eswatini
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