Internalized social stigma and its determinants among drug-sensitive tuberculosis patients in Armenia

BACKGROUND: Internalized social stigma (ISS) is still an issue among tuberculosis (TB) patients, exacerbating their suffering and affecting their treatment compliance. Quantitative studies of TB-related ISS are scarce. This study sought to measure ISS and identify its predictors among primary drug-sensitive TB patients in Armenia. METHODS: All patients throughout Armenia diagnosed with drug-sensitive TB from Apr, 2019 through Feb, 2021 were targeted for baseline and follow-up interviews at the start of their TB treatment and shortly after completing it, respectively. The instrument included domains on patient's social support, TB knowledge, health, and stigma. ISS was measured via a 10-item scale previously used in Armenia, with the total score ranging from 10 to 50. Fitted linear regression models identified predictors of ISS at each assessment. RESULTS: Overall, 401 patients were interviewed at the baseline and 285 at the follow-up. Between the assessments, patient's ISS score decreased from 27.4 to 23.8 (p < 0.01). Factors related to higher stigma at the baseline included age (B = 0.13, p < 0.01), rural residence (B = 1.56, p < 0.05), depression (B = 2.46, p < 0.01), frequent alcohol use (B = 2.67, p < 0.01), and higher stigma in the family (B = 0.55, p < 0.01), while socioeconomic status score was protective against ISS (B = (-0.74), p < 0.01). The fitted model explained 33.4% of the ISS score variance. Age and depression were related to higher ISS score at the follow-up as well, while quality of life score (B = (-5.27), p < 0.01), family support score (B = (-0.53), p < 0.01), and receiving psychological counseling/education (B = (-2.04), p < 0.05) were protective against ISS. CONCLUSIONS: This study found rather high levels of ISS both at the time of TB diagnosis and after the treatment course. It also pointed out several factors that could be targeted to reduce ISS, including educating TB patients and their family members, providing them timely psychological counseling and financial support. KEY MESSAGES: • During TB treatment, ISS decreased significantly. Modifiable factors protective against ISS included more support in the family and family's satisfactory financial status. • After the treatment, ISS score was significantly lower among those patients who received psychological counseling and education on TB at the treatment start compared to those who did not receive it.