A94-04 Tuberculosis Stigma in Community Activity Spaces: Results From the 2022 Nairobi, Kenya Tuberculosis Prevalence Survey

Introduction Community-based tuberculosis (TB) interventions are needed in high-burden settings. TB stigma is hypothesized to be a barrier to delivery of such interventions. The epidemiology of TB stigma across community activity spaces remains unexplored. Methods We conducted a cluster-based TB prevalence survey in 2022 among adults in nine Nairobi communities. TB stigma was measured using a validated questionnaire, and exploratory factor analysis identified stigma sub-types. Multi-level logistic regression models determined associations between activity spaces and TB stigma. Results Exploratory factor analysis was performed on TB stigma questionnaire results from 5741 individuals. Two factors were identified which explained 73% of the total variance. Factor loading supported a coherent structure with excellent internal consistency corresponding with two stigma sub-types, interpreted as “avoidance” TB stigma (example item: I keep my distance from those with TB) and “rejection” TB stigma (example item: I think those with TB are disgusting). The crude prevalence of avoidance and rejection stigma was higher in schools (41.1% and 38.7%) than in other activity spaces (15.2% and 20.4%) (Figure 1). Among 448 participants who named a social activity space, alcohol associated spaces had the lowest level of avoidance and rejections stigma (14.8% and 9.9%), and community and sports spaces had large discrepancies between TB stigma sub-types. In multilevel models, the odds of avoidance TB stigma were lower among participants reporting activity locations including home (OR 0.67, 95%CI 0.58, 0.77), church (OR 0.73, 95%CI 0.64, 0.84), market (OR 0.77, 95%CI 0.66, 0.90), and work (OR 0.68 95%CI 0.60, 0.78), and was higher in participants reporting school (OR 2.54, 95%CI 2.07, 3.12). The odds of rejection TB stigma were higher among locations including home (OR 1.27, 95%CI 1.08, 1.48), church (OR 1.25, 95%CI 1.08, 1.45), and school (OR 3.37, 95%CI 2.72, 4.17), and lower at work locations (OR 0.75, 95%CI 0.65, 0.87). Among social activity spaces, alcohol-related spaces were associated with lower odds of rejection stigma (OR 0.44, 95%CI 0.213, 0.918), community spaces were associated with higher odds of avoidance stigma (OR 2.55, 95%CI 1.09, 6.00), and playgrounds were associated with lower odds of avoidance stigma (OR 0.37, 95%CI 0.13, 0.99). Conclusion We identified two sub-types of TB stigma that were characterized by avoidance and rejection of people with TB and exhibited distinct distributions across activity spaces. Locations where people spend time strongly correlates with TB stigma and should be considered in stigma reduction and community-based TB interventions. This abstract is funded by: National Institutes of Health/NIAID (NIH grant 5R01AI150815)