Enacted and internalized stigma as predictors of successful treatment outcome among newly diagnosed tuberculosis patients in Gauteng, South Africa

Tuberculosis (TB) is a curable and preventable infectious disease that continues to pose a substantial threat to public health. A significant challenge in treating and managing TB relates to patients’ failure to adhere to TB treatment. Low adherence is often linked to stigma, which has long been recognized as one of the critical factors influencing medication adherence and significantly affects treatment outcomes. Both enacted (external stigma, experiences of unfair treatment from others) and internalized (self-stigma, beliefs in negative messages become part of how you see yourself) stigma are experienced by persons with TB (PWTB). This study examined the predictive ability of both enacted and internalized stigma on TB outcomes. A total of 90 newly diagnosed PWTB patients who were initiated on treatment were enrolled from five clinic facilities in the Ekurhuleni District, South Africa, between February 2022 and March 2023. Self-reported stigma experience was assessed using the 8-item Stigma Scale for Chronic Illnesses (SSCI-8) administered individually at enrollment among newly diagnosed participants. TB treatment outcomes were obtained after 6 months of treatment from the patients’ files, which were completed by a facility-registered nurse. Successful treatment outcomes were defined as patients who were cured or completed treatment. Bivariate logistic regression models were used to analyze the predictive ability of enacted and internalized stigma on TB outcomes. The majority of PWTB (n = 60; 68%) experienced low stigma. A strong, significant correlation was found between enacted and internalized stigma (r = 0.63; p < 0.001). Overall, 76/87 (87%) of PWTB had favorable TB outcomes. From the bivariate logistic regression models, PWTB who had low internalized stigma and low enacted stigma were more than 2.6 times likely to have favorable TB treatment outcomes compared to PWTB with high internalized stigma and high enacted stigma. Both internalized stigma (OR = 2.6; p = 0.007) and enacted stigma (OR = 2.9; p = 0.011) odds ratios observed were significant with favorable TB outcomes. Although the study found low levels of internalized and enacted stigma experienced by TB patients, it remains a significant contributing factor to TB outcomes. Low stigma was associated with favorable TB outcomes among newly diagnosed TB patients. Therefore, understanding stigma in PWTB is crucial for policy development and interventions aimed at improving TB treatment outcomes.