TB stigma index study on the cards
WHILE TB is a bacterial infection that can be cured with antibiotics, there are still a lot of patients who have not been diagnosed and patients who have discontinued treatment before being cured, sometimes because of the stigma attached to TB as one of the most common opportunistic infections for those living with HIV.
So Zimbabwe will this year carry out a tuberculosis stigma index study as well as a survey to identify the location and number of people affected by TB and the level of stigma and discrimination they are subjected to.
The survey, which will be undertaken by the Jointed Hands Welfare Organisation through the Challenge Facility for Civil Society, will seek to come up with and estimate of the key and vulnerable population size to understand the vulnerabilities associated with TB in the country.
JHWO executive director Dr Donald Tobaiwa said some of the key populations to be included in the study were children, cross border traders, mobile populations, and prisoners among others
“In our strategic plan, we continue to mention children, mobile populations, we talk about cross-borders (being affected by TB), but then we want to get to know their numbers.
“If sex workers are a key and vulnerable population to TB, we want to know the magnitude, how many are there and where are they so that when we then are focusing on interventions, people that have resources then can focus on where they are.
“If it’s prisoners, we then get to know the magnitude of TB within the prison population. Then we then can affirm to say, in terms of our key and vulnerable population study for TB, this is where we are.”
He said the TB stigma assessment would be done in a similar fashion as the HIV stigma index which had already been carried out in the country.
The most recent study showed that the country’s HIV stigma and discrimination index rose from 65,5 percent in 2014 to 69,7 in 2022, indicating a possible hindrance in the continued success of the HIV response.
The TB stigma index would similarly indicate how stigma and discrimination affects the prevention and treatment efforts.
Dr Tobaiwa said the country had carried out a community rights and gender assessment across 10 districts, which had various components including TB stigma.
“So we intend to do a deep dive TB stigma index to understand the extent in which TB stigma manifests in different people. Is it structural, is it self-stigma or is it perceived stigma?
“We would need to get to understand all those dynamics. So that when we then engage, we know how to tailor our messages, we know how to tailor our interventions.”
He said JHWO was currently finalising the funding aspects after which they would seek clearance from the Medical Research Council of Zimbabwe. Once approval has been granted, data collection would then begin.
“These studies are critical because we will get to target our interventions where they are needed. We then put resources towards the most affected communities.
“Once we then know where the burden is, it’s easy to eradicate TB. Because remember, we still have lots of people with TB that we have to find, so these studies redirect us to where those missing people are,” said Dr Tobaiwa.
Stop TB Partnership Zimbabwe chairman Mr Ronald Rungoyi said discrimination remains one of the major reasons why TB patients default treatment and end up dying.
Mr Rungoyi, who is also a drug resistant TB survivor said it was imperative to address both self-stigma and the stigma that patients meet at health facilities.
“I experienced stigma at the health institution not anywhere else. The community knew me as a TB patient and my friends would come and sit with me and provide moral support. But at the health institution, I faced a lot of discrimination and stigma from the health workers.
“That is why it is important to have institutions, especially DRTB and TB institutions manned by someone who is experienced,” he said.
Stigma index studies are expected to address some of these challenges and inform policies and strategies to end TB.
Zimbabwe is among the countries with a high burden of TB in the world. Although the country has been moved from the top 30 countries with a high burden of TB, it still remains among the top 30 countries with a high burden of drug-resistant TB as well as patients with combined TB and HIV.
Acting deputy director AIDS and TB programmes in the Ministry of Health and Child Care Dr Fungai Kavenga said Government was currently running with two strategic goals to reduce the incidence of TB by 80 percent and mortality by 80 percent from the 2015 figures. This should happen by 2030.
“In 2015, 40 people per 100 000 died from TB, in 2022 we had 14 per 100 000 so we managed to reduce TB deaths. Our target is to reduce deaths to below eight per 100 000.