Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Mae Sot General Hospital, Mae Sot, Tak, Thailand.
J Racial Ethn Health Disparities. 2022 Dec;9(6):2495-2507. doi: 10.1007/s40615-021-01185-3. Epub 2021 Nov 22.
The objective of this study was to assess the effect of health insurance and documentation status on tuberculosis (TB)-related stigma and social support before and during Thailand's policy on border closure.
A cross-sectional study was conducted in two TB clinics in Mae Sot district, a border area of Thailand. Myanmar migrants with new TB were interviewed before (between September 2019 and March 2020) and during Thailand's policy (between April 2020 and January 2021). We used multiple linear regression models to assess the association of health insurance and documentation status with stigma and social support before and during the policy on border closure.
Of 229 migrants diagnosed new TB recruited, 117 and 112 were interviewed before and during Thailand's policy on border closure. The relationship of stigma with health insurance and documentation status was modified by the policy. Migrants with health insurance reported significantly lower stigma during the policy compared to those without health insurance, whereas documented migrants had lower stigma before the policy compared to undocumented migrants. No significant association of health insurance and documentation status with social support was observed. Ethnicity, perceived TB severity and education level were also independently associated with TB-related stigma.
The relationships between health insurance, documentation status and TB-related stigma were modified by Thailand's policy on border closure among Myanmar migrants with TB in a border area of Myanmar and Thailand. Promotion of health insurance and well-planned documentation for migrants should be more discussed and strengthened among stakeholders and policymakers.
本研究旨在评估医疗保险和文件状况对泰国边境关闭政策前后与结核病（TB）相关的耻辱感和社会支持的影响。
在泰国美索地区的两家结核病诊所进行了一项横断面研究。在泰国边境关闭政策期间（2020 年 4 月至 2021 年 1 月），对新诊断为结核病的缅甸移民进行了采访。我们使用多元线性回归模型来评估医疗保险和文件状况与政策前后耻辱感和社会支持之间的关联。
在招募的 229 名新诊断为结核病的移民中，有 117 名和 112 名在泰国边境关闭政策之前和期间接受了采访。耻辱感与医疗保险和文件状况的关系受到政策的影响。有医疗保险的移民在政策期间报告的耻辱感明显低于没有医疗保险的移民，而有文件的移民在政策之前报告的耻辱感低于没有文件的移民。医疗保险和文件状况与社会支持之间没有显著关联。族裔、感知结核病严重程度和教育水平也与结核病相关的耻辱感独立相关。
在缅甸和泰国边境地区，泰国边境关闭政策改变了医疗保险、文件状况与结核病相关耻辱感之间的关系。应在利益相关者和政策制定者中更深入地讨论和加强为移民提供医疗保险和妥善的文件工作。
