The effect of smart pillboxes on TB stigma among adults in a cluster-randomised TB treatment trial.

Background: TB stigma has been shown to result in delayed health-seeking behaviours and treatment initiation. Few studies have quantitatively described stigma during treatment. As part of the TB Mate trial, we summarise TB stigma at treatment start and the effect of the intervention on stigma in follow-up.

Methods: In the TB Mate trial, we conducted a cluster-randomised trial in 18 primary health care facilities from three provinces in South Africa to evaluate the use of alarmed electronic pillboxes in drug-sensitive TB on treatment adherence. We administered a questionnaire, measuring five TB stigma domains, at baseline, 6 months, and 18 months. We conducted a sub-analysis of these stigma data.

Results: Overall, 2,469/2,657 adults with TB enrolled had a baseline stigma questionnaire. At baseline, reporting experience of stigma or internalised stigma was low (≤3%), whereas disclosure of TB status outside of the household was common (42.3%; 1,045/2,469). Prevalence of experiencing stigma remained low at the end of treatment. Disclosure increased at 6 months in the intervention (40%-64%) and standard of care arms (44.7%-56%), though was similar by arm (adjusted prevalence ratio 2.55 [95% confidence interval: 0.50-12.90]).

Conclusion: The overall prevalence of TB stigma, in domains other than disclosure, in our study population was low. There was no evidence that stigma increased with use of an alarmed smart pillbox.