Implementing TB-Stigma reduction interventions in High Burden Countrieshigh burden countries: a perspective on a conceptual framework

Bushra Bibi^1*Mark Goodall²Injety Ranjit^3,4Stephanie Jones⁵Colette Miller⁶

• ¹Office of Research Innovation & Commercialization, Khyber Medical University, Peshawar, Pakistan
• ²Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
• ³Honorary Research Fellow, School of Nursing Midwifery and the Applied Health Research hub (AHRh), University of Central Lancashire, Preston, United Kingdom
• ⁴Doctoral Fellow, Ulverscroft Eye Unit, Institute of Precision Health, University of Leicester, Leicester, United Kingdom
• ⁵Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire, Preston, United Kingdom
• ⁶Stroke Research Team, School of Nursing & Midwifery, University of Central Lancashire,, Preston, Pakistan

Tuberculosis (TB) is a preventable, curable disease but still impacts people in high-burden countries, who face challenges, including stigma, in accessing and engaging with healthcare services. Nuttall et al. (2022) examined the quality of existing TB-stigma intervention studies and created a novel conceptual framework of pathways to TB-stigma reduction. We critically appraised the methods used within Nuttall et al. (2022) and expanded upon their findings in the context of the World Health Organisation (WHO) End TB Strategy. The included studies showed significant heterogeneity in design, aims, populations, type of TB-stigma targeted and took place across diverse countries. Only three of eleven (n) studies were rated as high quality. Nuttall et al. (2022) synthesized study interventions and outcomes into a conceptual framework with pathways to reduce TB-stigma based on targeted populations. The conceptual framework highlights the need for educational, emotional, and psychosocial support for TB patients, Health Care Workers, and Communities, and provides a useful guide of pathways needed in TB-stigma reduction interventions. However, to be effective, stigma reduction interventions must be part of a well-organized, and committed multi-sectoral collaboratives, which extend beyond national and global TB programs, including mental health services, social support systems, and public health programs.