02642nas a2200301   4500000000100000008004100001653001100042653001700053653001100070653001700081653000800098653001600106100001100122700001200133700001200145700001300157700002300170700001600193700001500209700001200224700001900236245012100255856003200376300001000408490000700418520190100425022001402326       2017                            d10aStigma10aTuberculosis10aZambia10aSouth Africa10aCRT10avariability1 aBond V1 aFloyd S1 aFenty J1 aSchaap A1 aGodfrey-Faussett P1 aClaassens M1 aShanaube K1 aAyles H1 aHargreaves J R00aSecondary analysis of tuberculosis stigma data from a cluster randomised trial in Zambia and South Africa (ZAMSTAR).  uhttp://tinyurl.com/y6umbztr  a49-590 v213 a<p><strong>SETTING: </strong>Zambian and South African TB and HIV Reduction (ZAMSTAR) cluster-randomised trial (CRT) communities, 2006-2009.</p>

<p><strong>OBJECTIVES: </strong>To develop TB stigma items, and evaluate changes in them in response to a household intervention aimed at reducing TB transmission and prevalence but not tailored to reduce stigma.</p>

<p><strong>DESIGN: </strong>TB stigma was measured at baseline and 18 months later among 1826 recently diagnosed TB patients and 1235 adult members of their households across 24 communities; 12 of 24 communities were randomised to receive the household intervention. We estimated the impact of the household intervention on TB stigma using standard CRT analytical methods.</p>

<p><strong>RESULTS: </strong>Among household members, prevalence of blame and belief in transmission myths fell in both study arms over time: adjusted prevalence ratios (aPRs) comparing the household intervention with the non-household intervention arm were respectively 0.61 (95%CI 0.26-1.44) and 0.77 (95%CI 0.48-1.25) at 18-month follow-up. Among TB patients, at baseline a low percentage experienced social exclusion and poor treatment by health staff and a relatively high percentage reported 'being made fun of', with little change over time. Disclosure of TB status increased over time in both study arms. Internalised stigma was less prevalent in the household arm at both baseline and follow-up, with an aPR of 0.85 (95%CI 0.41-1.76). Variability in stigma levels between countries and across communities was large.</p>

<p><strong>CONCLUSION: </strong>Robust TB stigma items were developed. TB stigma was not significantly reduced by the household intervention, although confidence intervals for estimated intervention effects were wide. We suggest that stigma-specific interventions are required to effectively address TB stigma.</p>
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