Background
HIV and TB stigma may undermine TB care and outcomes. We investigated HIV and TB stigma and reported influences of TB stigma on care access among individuals with pulmonary TB in Eldoret, Kenya, and Mbarara, Uganda.
Methods
The Tuberculosis Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS is a global prospective study of people aged ≥15 with pulmonary TB, with and without HIV. East Africa sites conducted stigma questionnaires (adapted from Van Rie and the Stop TB stigma assessment) 1 month into TB treatment, March 21-September 12, 2023. We described responses for stigma domains (felt HIV, community HIV, and TB) and influence of TB stigma on care access. HIV stigma scales employed third-person phrasing for use regardless of HIV status. Standardized domain scores (mean score among all items) ranged 0-4 (0=strong disagreement, 2=no opinion, 4=strong agreement with stigma statements). We assessed stigma scores for associations with sociodemographic/clinical variables in multivariable regression analysis.
Results
Among 177 participants—118 (67%) male, median age 33 years (IQR 25 to 44), 58 (33%) with HIV, and 36 (20%) with recurrent TB—standardized scores for felt HIV stigma were higher than for community HIV stigma and TB stigma (Table). For TB stigma, respondents agreed with, “I am afraid to tell those outside my family I have TB” (54%); “I choose carefully who I tell about having TB” (77%); and “I keep my distance from others to avoid spreading TB” (80%). Among 85 (49%) who endorsed felt TB stigma, none reported it inhibited TB care access. Among 26 (15%) who experienced TB stigma, few reported that experienced TB stigma in the community (15%), at work (8%), in the hospitals/clinics (0), or at home (0) inhibited TB care access. In multivariable analyses, felt HIV stigma was associated with younger age (p=0.004), HIV co-infection (p=0.019), and rural residence (p=0.049). Community HIV stigma was associated with younger age (p=0.001), rural residence (p=0.023), and HIV co-infection (p=0.057). There were no significant predictors of TB stigma, except for HIV status in univariate analyses (Table).
Conclusions
Individuals with TB in East Africa endorsed substantial felt HIV stigma, particularly among younger individuals, those in rural areas, and those living with HIV. TB stigma was comparatively lower, with little self-reported impact on TB care access. Further work is needed to evaluate stigma impacts on TB care outcomes and wellbeing.
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