Tuberculosis related stigma attached to the adherence of Directly Observed Treatment Short Course (DOTS) in West Bengal, India.

Background: Stigma is a major barrier to the successful completion of the Directly Observed Treatment Short Course (DOTS). People put on DOTS have to face repeated exposure to stigma as per the requirement of the treatment. Thus stigma can shape the extent of access and adherence to treatment. But there is very little information available in Indian context explaining the extent of association between the stigma perceived among the patients and adherence to their DOTS therapy.

Aim: To explore the level of stigma perceived by the persons with TB and its influence on the adherence to DOTS treatment.

Methods: A cross sectional epidemiological study was conducted among 145 DOTS defaulters from three randomly selected districts in West Bengal. Respondents were approached at their households. Information was collected using a pretested questionnaire. Adherence to DOTS was grouped as early default (continued DOTS from 0 to 30 days) and late default (continued DOTS > 30). Stigma score was assessed using 11 item questions. Stigma score was grouped as low level (0-23) and high level (24-44). Analysis was done using Chi-square and multivariate logistic regression models to identify factors to influence adherence to DOTS. SPSS 23.0 version statistical software was used for analysis.

Results: Mean stigma score for the state was 23.0. Total 51 (40.69%) persons were within the low stigma group and 94 persons (59.31%) were within high stigma score group. District wise mean score was 19.8, 22.8 and 24.5 respectively for Birbhum, Jalpaiguri and North 24 Parganas. In North 24 Parganas, the high stigma score group accounted for 85.5% compared to 35.9% in Birbhum. Among the low stigma group, late default was 52.1% compared to 66.7% in high stigma group (p = 0.054). People with lower stigma level were 8.59 times more likely to have late default than the people with higher stigma level (p = 0.001).

Conclusion: Perceived stigma among the patients was identified as an important predictor for the adherence to DOTS therapy. Stigma reduction strategy should be designed to improve adherence to DOTS therapy. Present study recommends in-depth qualitative research to get more insight on the extent and shape of stigma and the way it influences the adherence. Apart from the stigma of the patients, influence of community stigma is a gray area for further research.