Bwambale Kelvin, Nakkonde Damalie, Nassanga Gloria, Buregyeya Esther, Zalwango Sarah, Sekandi Juliet N
Makerere University.
Kampala Capital City Authority.
Res Sq. 2025 Sep 1:rs.3.rs-7447805. doi: 10.21203/rs.3.rs-7447805/v1.
Adherence to video directly observed treatment (VDOT) remains inconsistent, with some patients frequently missing video submissions. Stigma associated with tuberculosis (TB) may influence patients' engagement with VDOT, leading to non-adherence. This study examines the effect of baseline TB-related stigma on missed VDOT submissions as a marker of patient engagement throughout treatment among patients with TB.
This study was a secondary analysis of 71 patients with TB from the DOT Selfie Randomized clinical trial (RCT) in Kampala, Uganda (July 2020-October 2021). It focused on the association between baseline TB-related stigma and missed video submissions during six months of VDOT. Stigma was measured using a 13-item tool covering self-, anticipated, and public stigma. Self-stigma is when individuals believe and internalize negative views about TB, causing shame and avoiding care. Public stigma involves harmful attitudes and discrimination from others, leading to isolation. Anticipated stigma is the fear of being judged or treated unfairly if one's TB status becomes known. Four negative binomial regression models adjusted for HIV status, alcohol use, household size, marital status, and TB severity were used to estimate adjusted incidence rate ratios (aIRR) with their 95% confidence intervals (CIs) using STATA 14.2.
The study included 71 patients with TB with a mean age of 33 years (SD = 12), and 36 (51%) were female. TB-related stigma was highly prevalent, with 51% (95% CI: 39-62) experiencing high levels of overall stigma. The prevalence of public stigma was 97% (95% CI: 90-100), self-stigma was 80% (95% CI: 22-45), and anticipated stigma was 68% (95% CI: 55-78). High overall stigma was significantly associated with an increase in the rate of missed VDOT videos (aIRR = 1.9; 95% CI: 1.1-3.5). Similarly, patients who reported anticipated stigma missed twice as many VDOT videos as those without anticipated stigma (aIRR: 2.1; 95% CI: 1.2-3.8). There was no significant association between self and public stigma and missed videos.
TB-related stigma, particularly the anticipated fear of judgment, undermines VDOT adherence monitoring. Interventions such as early screening for stigma, patient counselling, and community education are essential to improving outcomes.
对视频直接观察治疗（VDOT）的依从性仍然不一致，一些患者经常错过视频提交。与结核病（TB）相关的耻辱感可能会影响患者参与VDOT的程度，导致不依从。本研究调查了基线结核病相关耻辱感对错过VDOT提交的影响，以此作为结核病患者整个治疗过程中患者参与度的一个指标。
本研究是对乌干达坎帕拉DOT自拍随机临床试验（RCT）中71例结核病患者的二次分析（2020年7月至2021年10月）。它关注基线结核病相关耻辱感与VDOT六个月期间错过视频提交之间的关联。耻辱感使用一个包含13个条目的工具进行测量，涵盖自我耻辱感、预期耻辱感和公众耻辱感。自我耻辱感是指个体相信并内化对结核病的负面看法，从而产生羞耻感并回避治疗。公众耻辱感涉及他人的有害态度和歧视，导致孤立。预期耻辱感是指担心如果自己的结核病状况被知晓会受到评判或不公平对待。使用四个针对艾滋病毒状况、饮酒情况、家庭规模、婚姻状况和结核病严重程度进行调整的负二项回归模型，使用STATA 14.2估计调整后的发病率比（aIRR）及其95%置信区间（CI）。
该研究纳入了71例结核病患者，平均年龄33岁（标准差=12），36例（51%）为女性。结核病相关耻辱感非常普遍，51%（95%CI：39 - 62）的患者经历了高水平的总体耻辱感。公众耻辱感的患病率为97%（95%CI：90 - 100），自我耻辱感为80%（95%CI：22 - 45），预期耻辱感为68%（95%CI：55 - 78）。高水平的总体耻辱感与错过VDOT视频的发生率增加显著相关（aIRR = 1.9；95%CI：1.1 - 3.5）。同样，报告有预期耻辱感的患者错过VDOT视频的次数是没有预期耻辱感患者的两倍（aIRR：2.1；95%CI：1.2 - 3.8）。自我耻辱感和公众耻辱感与错过视频之间没有显著关联。
结核病相关耻辱感，尤其是预期的被评判恐惧，会破坏VDOT依从性监测。诸如早期耻辱感筛查、患者咨询和社区教育等干预措施对于改善结果至关重要。
