Mapping risk and protective factors in tuberculosis-related stigma: a scoping review

Vieira, Mariana; Barbosa, Pedro; Ramos, João Pedro; Castro, Marta; Torres, Dulce; Duarte, Raquel

http://hdl.handle.net/10400.18/10922

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Despite global efforts to end tuberculosis (TB), slow declines in incidence and mortality rates persist, partly due to entrenched social and structural challenges. TB-related stigma is a critical barrier to effective TB prevention and treatment. However, existing frameworks often overlook broader structural and intersectional influences, underscoring the need for a comprehensive analysis of the social and structural factors influencing TB-related stigma. We aimed to (1) identify risk and protective factors influencing TB-related stigma and (2) examine how cultural, social, and economic determinants shape stigma experiences among people with TB. A systematic search was conducted across PubMed, SCOPUS, Web of Science, APA PsycInfo, and Sociology Source Ultimate. Studies were included if they (a) involved human participants, (b) were published in the last decade, and (c) reported stigma experiences influenced by social, economic, or environmental determinants. A total of 43 studies were included. Key determinants associated with higher TB-related stigma included lower educational attainment, rural residency, low income, gender, and specific mental health conditions. Cultural perceptions of TB, healthcare system interactions, and the dual stigma associated with HIV co-infection significantly exacerbated TB-related stigma experiences. Factors such as social support, patient-provider communication, and prior TB experience emerged as protective against stigma. Findings underscore TB-related stigma's complex intersection with social and structural determinants, highlighting gaps research, especially concerning standardised conceptual definitions and measurements. Addressing stigma is essential for improving TB care-seeking behaviours and health outcomes, particularly in low-resource settings where TB-related social isolation and discrimination are prevalent.

Highlights: - TB stigma remains a significant barrier to effective prevention and care. - Social and economic determinants shape TB stigma experiences globally. - TB stigma appears to increase mental health risks, including stress and depression. - Healthcare stigma appears to cause delays in diagnosis and reduces treatment adherence. - Targeted interventions must address stigma at individual, community, and policy levels.