Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa.
BMJ Open. 2022 Apr 5;12(4):e045477. doi: 10.1136/bmjopen-2020-045477.
Tuberculosis (TB) has become an occupational health hazard in South African hospitals where healthcare workers (HCWs) are additionally confronted daily with HIV and its associated stigma, causing a . Early TB diagnosis and treatment are vital, but the uptake of these services through occupational healthcare units (OHUs) is low. The current study hypothesises that (1) the link between HIV and TB and (2) the perceived HIV stigmatisation by colleagues create (3) a double HIV-TB stigma which increases (4) internalised TB stigma and leads to (5) a lower willingness to use OHU services for TB screening and treatment.
A cross-sectional study using the baseline data from the HIV and TB Stigma among Healthcare workers Study (HaTSaH Study).
Six hospitals in the Free State province of South Africa.
820 HCWs of the six selected hospitals.
The study results demonstrate that the co-epidemic (β=0.399 (screening model) and β=0.345 (treatment model)) combined (interaction effect: β=0.133 (screening) and β=0.132 (treatment)) with the persistent stigmatisation of HIV is altering the attitudes towards TB (β=0.345 (screening) and β=0.400 (treatment)), where the stigmatising views of HIV are transferred to TB-illustrating the syndemic impact. Our model demonstrated that this syndemic not only leads to higher levels of internal TB stigma (β=0.421 (screening) and β=0.426 (treatment)), but also to a lower willingness to use the OHU for TB screening (probit coefficient=-0.216) and treatment (probit coefficient=-0.160). Confidentiality consistently emerged as a contextual correlate of OHU use.
Theoretically, our results confirm HIV as a 'syndemic generator' which changes the social meaning of TB in the hospital context. Practically, the study demonstrated that the syndemic of TB and HIV in a highly endemic context with stigma impacts the intended use of occupational TB services.
Pre-results of the trial registered at the South African National Clinical Trials Register, registration ID: DOH-27-1115-5204.
在南非医院，结核病（TB）已成为一种职业健康危害，医护人员（HCWs）每天还面临着艾滋病毒及其相关污名的问题，这导致了……早期结核病诊断和治疗至关重要，但通过职业保健单位（OHUs）获得这些服务的比例较低。目前的研究假设（1）艾滋病毒与结核病之间的联系，以及（2）同事对艾滋病毒的感知污名化，造成了（3）一种双重的艾滋病毒-结核病污名化，这增加了（4）内化的结核病污名化，并导致（5）对使用 OHU 进行结核病筛查和治疗的意愿降低。
使用艾滋病毒和结核病医护人员污名研究（HaTSaH 研究）的基线数据进行的横断面研究。
南非自由州的六所医院。
六所选定医院的 820 名 HCWs。
研究结果表明，共同流行（β=0.399（筛查模型）和β=0.345（治疗模型））与持续的艾滋病毒污名化相结合（交互效应：β=0.133（筛查）和β=0.132（治疗））正在改变对结核病的态度（β=0.345（筛查）和β=0.400（治疗）），其中对艾滋病毒的污名化观点被转移到结核病上——这说明了综合征的影响。我们的模型表明，这种综合征不仅导致更高水平的内化结核病污名化（β=0.421（筛查）和β=0.426（治疗）），而且还导致对 OHU 进行结核病筛查（概率系数=-0.216）和治疗（概率系数=-0.160）的意愿降低。保密性始终作为 OHU 使用的情境相关因素出现。
从理论上讲，我们的结果证实艾滋病毒是一种“综合征生成器”，它改变了医院环境中结核病的社会意义。从实践上讲，该研究表明，在高度流行地区，结核病和艾滋病毒的综合征以及污名化会影响对职业性结核病服务的预期使用。
该试验的预结果在南非国家临床试验注册处注册，注册号：DOH-27-1115-5204。
