"As a patient I do not belong to the clinic, I belong to the community": co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa.

Autor: Hayward SE; Institute for Infection and Immunity, St George's, University of London, London, UK.; TB Proof, Cape Town, South Africa., Vanqa N; Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa., Makanda G; TB Proof, Cape Town, South Africa., Tisile P; TB Proof, Cape Town, South Africa., Ngwatyu L; TB Proof, Cape Town, South Africa., Foster I; TB Proof, Cape Town, South Africa., Mcinziba AA; Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa., Biewer A; Beth Israel Deaconess Medical Center, Boston, MA USA., Mbuyamba R; TB Proof, Cape Town, South Africa., Galloway M; TB Proof, Cape Town, South Africa., Bunyula S; TB Proof, Cape Town, South Africa., van der Westhuizen HM; TB Proof, Cape Town, South Africa.; Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK., Friedland JS; Institute for Infection and Immunity, St George's, University of London, London, UK., Medina-Marino A; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; Desmond Tutu Health Foundation, Cape Town, South Africa.; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA., Viljoen L; Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa., Schoeman I; TB Proof, Cape Town, South Africa., Hoddinott G; Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.; Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia., Nathavitharana RR; TB Proof, Cape Town, South Africa.; Beth Israel Deaconess Medical Center, Boston, MA USA.; Harvard Medical School, Boston, MA USA.
Jazyk: angličtina
Zdroj: BMC global and public health [BMC Glob Public Health] 2024; Vol. 2 (1), pp. 55. Date of Electronic Publication: 2024 Aug 15.
DOI: 10.1186/s44263-024-00084-z
Abstrakt: Background: Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.
Methods: Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n  = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.
Results: Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.
Conclusions: Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.
Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-024-00084-z.
Competing Interests: Competing interestsThe authors declare no competing interests.
(© The Author(s) 2024.)
Databáze: MEDLINE
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