Association of tuberculosis active case finding with knowledge, attitudes, stigma and health-seeking behaviour among patients in Eswatini

Background. Tuberculosis (TB) poses a significant global public health challenge, with >10 million new infections reported annually, making it one of the top 10 causes of death worldwide. Eswatini has one of the world’s highest TB incidence rates, with an estimated rate of 398 cases per 100 000 population in 2019, as reported by the World Health Organization. In Eswatini, despite the implementation of TB active case finding (ACF) interventions aimed at improving TB case detection and reducing community transmission, there is limited empirical evidence on their association with improved knowledge, attitudes and health-seeking behaviour. This study seeks to address this gap to inform future advocacy, communication and social mobilisation strategies for enhanced TB control and prevention. Objective. To assess the association of TB ACF and improved knowledge, attitudes, perceptions of stigma and discrimination and health- seeking behaviours among individuals diagnosed with TB. Methods. The study employed a cross-sectional design from April to May 2023 to review Eswatini TB patients from treatment registers at 14 selected TB basic management units. The TB treatment register was used to determine the entry point of TB patients into care. Those exposed to the ACF programme were located by the TB champions (community volunteers engaged to conduct TB ACF) (n=208), while the unexposed were drawn from outpatients (n=204). The scores for overall knowledge, attitude and health-seeking behaviour were transformed into binary categories based on the calculated median scores. Descriptive statistics were used to summarise participant characteristics, and a multinomial logistic regression model was applied to determine significant risk factors. Results. A total of 412 TB patients (mean (standard deviation) age 42.21 (4.9) years) were included in the study, and 260 (63%) displayed knowledge about TB. Among the patients, 268 (65%) reported that they had not felt stigmatised, 147 (36%) had sought care early (within 2 weeks) and 297 (72%) exhibited good health-seeking behaviour. Exposure to ACF was associated with higher odds of TB knowledge (adjusted odds ratio (aOR) 6.85; 95% confidence interval (CI) 4.21 - 11.14; p<0.001) and higher odds of seeking care within 2 weeks of symptom onset (aOR 6.84; 95% CI 4.06 - 11.52; p<0.001). Conclusion. Generally, patients found through ACF were associated with greater knowledge about TB and favourable health-seeking behaviour. However, there remained a notable proportion of TB patients without adequate knowledge and with suboptimal health-seeking behaviour, who may pose a considerable risk for TB transmission.