Reducing stigma among vulnerable populations with TB: insights from a community intervention.

<sec><title>BACKGROUND</title>Addressing stigma is essential for effective TB control. This study assessed the impact of behaviour change solutions (BCSs) in reducing TB-stigma among specific vulnerable populations (including migrants, mining/industrial workers, tea garden workers, tribal communities, and urban/metro populations) in Assam, Bihar, Karnataka, and Telangana, India.</sec><sec><title>METHODS</title>Two cross-sectional surveys were conducted under the 'Breaking the Barriers' initiative. A total of 2,153 participants at baseline and 2,146 at endline, including men and women aged 18 and older, reported experiencing stigma in various settings, including health care, home, community, and workplace, which negatively affected their TB care. Changes in stigma levels were assessed by socio-demographic characteristics (e.g., sex, age, education, religion, marital status, and income). The treatment effect of BCSs on stigma encounters was estimated using the nearest neighbourhood method.</sec><sec><title>RESULTS</title>TB-stigma decreased from 43% (95% confidence interval [CI]: 41.0%-45.2%) to 30% (95% CI: 28.2%-32.1%) between baseline and endline surveys (P < 0.001). Significant reductions were observed among the most vulnerable groups, except urban populations in Bihar and Karnataka. Stigma declined across various demographic segments. BCS interventions, such as TB Champion Health Worker (TBCHW) engagement, Jaanch Coupons, and TB Mukt Certificates, had a positive and significant effect on reducing stigma (>10 percentage points).</sec><sec><title>CONCLUSION</title>The findings underscore the importance of community-level interventions through certain BCSs, particularly TBCHW engagement, and distribution of coupons and certificates in mitigating TB-stigma among vulnerable populations. Such insights are crucial to shaping policies and programmes aimed at reducing stigma.</sec>.