TB-CAPS: a mixed methods study to implement a peer-led, community-based psychosocial support package for Indonesians affected by tuberculosis stigma

结核病（TB）是一种主要的传染病杀手，消灭结核病是全球公共卫生的一个关键战略优先事项。然而，实现世界卫生组织（WHO）到2050年消灭结核病的目标具有挑战性。其中一个关键障碍是对结核病患者的污名化（TB-污名化）。在某些文化中，结核病被认为是对家庭的“诅咒”，并与贫困、艾滋病毒/艾滋病或其他不当行为有关。这些往往导致社会名誉扫地，孤立和“羞耻，自我拒绝和自我厌恶”的感觉。当有结核病症状的人预期或经历这种污名化行为时，他们可能会避免寻求治疗。这导致延误诊断和治疗，使他们病情严重，并感染家庭和邻里的其他人。结核病耻辱感也会对他们的治疗依从性和心理健康产生负面影响，例如由于歧视行为和内疚感而产生的抑郁症。它还具有社会经济后果，如收入和失业，这可能会增加精神疾病的风险。尽管耻辱的后果，我们缺乏证据的最佳策略，以有效地解决结核病的耻辱。TB-CAPS研究旨在设计，实施和评估心理社会支持干预措施，以减少结核病的耻辱。将共同设计支助方案，并通过一个由同侪领导的、以社区为基础的一揽子干预措施提供支助。在TB-CAPS中，干预将分几个步骤进行。首先，我们将回顾文献，以确定以社区为基础的心理社会支持干预措施，旨在减少疾病相关的耻辱在不同的国家。我们将综合范围审查结果，以创建一个长列表，其中包括咨询、互助小组、结核病教育、戏剧/讲故事、家访和基于智能手机的应用程序。通过一项德尔菲研究和一个参与式研讨会，我们将反复形成一个最终名单，在研讨会上，我们邀请结核病患者、他们的家庭和社区卫生志愿者与利益相关者和专家一起共同设计干预措施。我们还将为社区医疗志愿者制作培训模块和学习材料，以确保标准化的干预措施。在TB-CAPS期间，研究地点内的结核病患者、他们的家庭和社区卫生志愿者不仅将共同设计减少结核病污名的干预措施，而且将成为目标接受人群。我们将在印度尼西亚的两个省实施干预措施。将通过两个主要机制对干预措施进行评估。首先，我们将邀请接受干预措施的人和关键利益相关者参加焦点小组讨论和关键知情人访谈，以评估干预措施的可行性、可接受性、公平性和可扩展性。其次，我们将确定干预后结核病污名和抑郁症状的减少。在最后的参与式研讨会上，我们将邀请所有利益相关者就干预措施的完善和大规模干预措施的进展达成集体决定。所有评价将作为全国实施方案的政策简报、开放获取培训手册和协议以及国际科学出版物进行报告，以供更广泛地复制和实施。这项研究及其结果将与实现可持续发展目标3/10的努力保持一致，并巩固与印度尼西亚、英国和世卫组织结核病民间社会工作队的伙伴关系。

Tuberculosis (TB) is a leading infectious disease killer, and ending TB is a key strategic priority in global public health. However, achieving the World Health Organization's (WHO) goal of ending TB by 2050 is challenging. One of the critical barriers is the stigma towards people with TB (TB-Stigma). In some cultures, TB is considered a 'curse' on family and is associated with poverty, HIV/AIDS, or other misconduct behaviour. These often lead to social discrediting, isolation, and feelings of "shame, self-rejection, and self-loathing". When people with symptoms of TB anticipate or experience such stigmatising behaviour, they may avoid seeking care. It results in delayed diagnosis and treatment, making them seriously ill and infecting others in the family and neighbourhood. TB-stigma also can negatively impact their treatment compliance and mental health, such as depression because of discriminating behaviour and feeling guilty. It also has socioeconomic consequences, such as income and job loss, which can increase the risk of mental illness. Despite the consequences of stigma, we have lacked evidence on the optimal strategies to address TB-stigma effectively. TB-CAPS study aims to design, implement, and evaluate psychosocial support interventions to reduce TB-stigma. The support will be co-designed and provided through a peer-led, community-based intervention package. In TB-CAPS, the intervention will be developed in several steps. First, we will review the literature to identify community-based psychosocial support interventions designed to reduce disease-related stigma in various countries. We will synthesise the scoping review findings to create a long list of potential community-based psychosocial support packages, including counselling, mutual support groups, TB education, drama/storytelling, home visits, and smartphone-based applications. The list will be iteratively shaped to a shortlist through a Delphi study and a participatory workshop, in which we invite people with TB, their households, and community health volunteers to co-design the intervention, together with stakeholders and experts. We will also produce the training module and learning materials for community healthcare volunteers to ensure a standardised intervention. During TB-CAPS, people with TB, their households, and community health volunteers within the study sites will not only co-design a TB-stigma reduction intervention but be the target recipient population. We will implement the intervention in two provinces of Indonesia. The intervention will be evaluated through two main mechanisms. First, we will invite people receiving the interventions and critical stakeholders into focus group discussions and key informant interviews to assess the intervention's feasibility, acceptability, equity, and scalability. Second, we will determine the reduction of TB-stigma and depression symptoms after the intervention. At the closing participatory workshop, we will invite all stakeholders to reach a collective decision on intervention refinement and the progression of the large-scale intervention. All evaluations will be reported as a policy brief for a nationwide implementation program, open access training manual and protocol for wider replication and implementation, and international scientific publications. This study and its findings will align with the efforts to achieve SDGs 3/10 target and consolidated partnerships with the Indonesian, UK, and WHO's TB Civil Society Task Force.