Tuberculosis related stigma attached to the adherence of Directly Observed Treatment Short Course (DOTS) in West Bengal, India.

BACKGROUND: Stigma is a major barrier to the successful completion of the Directly Observed Treatment Short Course (DOTS). People put on DOTS have to face repeated exposure to stigma as per the requirement of the treatment. Thus stigma can shape the extent of access and adherence to treatment. But there is very little information available in Indian context explaining the extent of association between the stigma perceived among the patients and adherence to their DOTS therapy. AIM: To explore the level of stigma perceived by the persons with TB and its influence on the adherence to DOTS treatment. METHODS: A cross sectional epidemiological study was conducted among 145 DOTS defaulters from three randomly selected districts in West Bengal. Respondents were approached at their households. Information was collected using a pretested questionnaire. Adherence to DOTS was grouped as early default (continued DOTS from 0 to 30 days) and late default (continued DOTS > 30). Stigma score was assessed using 11 item questions. Stigma score was grouped as low level (0-23) and high level (24-44). Analysis was done using Chi-square and multivariate logistic regression models to identify factors to influence adherence to DOTS. SPSS 23.0 version statistical software was used for analysis. RESULTS: Mean stigma score for the state was 23.0. Total 51 (40.69%) persons were within the low stigma group and 94 persons (59.31%) were within high stigma score group. District wise mean score was 19.8, 22.8 and 24.5 respectively for Birbhum, Jalpaiguri and North 24 Parganas. In North 24 Parganas, the high stigma score group accounted for 85.5% compared to 35.9% in Birbhum. Among the low stigma group, late default was 52.1% compared to 66.7% in high stigma group (p = 0.054). People with lower stigma level were 8.59 times more likely to have late default than the people with higher stigma level (p = 0.001). CONCLUSION: Perceived stigma among the patients was identified as an important predictor for the adherence to DOTS therapy. Stigma reduction strategy should be designed to improve adherence to DOTS therapy. Present study recommends in-depth qualitative research to get more insight on the extent and shape of stigma and the way it influences the adherence. Apart from the stigma of the patients, influence of community stigma is a gray area for further research.

Tuberculosis related stigma and its effect on the delay for sputum examination under the Revised National Tuberculosis Control Program in India.

BACKGROUND: One major barrier to achieve goal of tuberculosis (TB) control program globally, is the stigma attached to the disease. Perceived stigma can delay sputum test in time. Delay will lead to spread of infection in the community. There is no scientific information available in India exactly looking into the association between delay in sputum examination and stigma. AIM: We conducted a study in rural West Bengal among persons with cough for 2 weeks or more to assess their level of stigma, its influence on delay for sputum test and identify factors those shape the level of stigma. METHODS: A community based cross sectional survey was conducted from February to June 2015 in West Bengal, India. We interviewed 135 persons of 15-60 years. Data were collected using a pretested structured questionnaire. Chi-square and logistic regression analysis were done using SPSS 23.0 statistical software. RESULTS: Among the 'lower stigma' group (score 4-24), 'delay' (14-25 days) is found among 46.2% respondents and 'much delay' (26-120 days) among 53.8%. Among the 'higher stigma' (score 25-36) group, 'delay' is found among 20.5% respondents and 'much delay' among 79.5%. Persons with lower stigma are 0.17 times likely to delay than persons with higher stigma [adjusted odds ratio (AOR): 0.17 (0.044-0.668), p=0.011)]. Important influencers of stigma are caste [AOR: 5.90 (1.66-20.90), p=0.006], number of family members [AOR: 3.46 (1.08-11.06), p=0.009] and residence in urban or rural [AOR: 3.97 (1.03-15.27), p=0.045]. CONCLUSION: Revised National Tuberculosis Control Program in India should de-stigmatize the community giving priorities to lower castes, big families and rural areas.