Social Stigma of the New Tuberculosis

描述（由申请人提供）：在世纪的大部分时间里，结核病（TB）呈下降趋势，但自20世纪80年代中期以来，这一趋势发生了逆转，目前全球结核病病例数继续增加。“新”结核病的特点是艾滋病毒/-I-B合并感染和多重耐药结核病。在世界大部分地区，结核病和艾滋病毒的流行密不可分，需要对这两种流行病采取综合办法。在发展中国家，结核病是艾滋病毒/艾滋病感染者最常见的机会性感染，结核病是艾滋病相关死亡的主要原因。人们害怕结核病，因为它经常预示着以前未被怀疑的艾滋病毒感染。与“新”结核病相关的社会耻辱现在与艾滋病毒/艾滋病相关的社会耻辱相结合。更好地了解结核病不断变化的社会方面对于改善疾病控制至关重要。 结核病和艾滋病毒之间的临床、生物学和流行病学相互作用已得到广泛研究，但对结核病在艾滋病毒感染者中的心理社会复杂性或艾滋病毒/艾滋病流行地区社区对结核病的社会反应知之甚少。 在本研究项目中，一个在行为科学、流行病学、社会学、人种学、人类学、传染病和伦理学领域具有临床和操作研究经验的多学科团队建议开发和验证一个结核病耻辱量表，用于在泰国最南部地区（艾滋病毒/艾滋病和结核病双重流行地区）对结核病耻辱进行基于人口的评估。我们将利用新开发的研究工具，更好地了解结核病相关耻辱的关键决定因素。我们将在一组活动性结核病患者中测量结核病患者经历的耻辱水平，并将耻辱评分与结核病控制的两个关键因素-寻求健康的行为和对结核病治疗的依从性相关联。 该项目首次尝试将定性和定量研究结合起来，对艾滋病流行地区的结核病污名进行研究。该项目还将启动两所大学（美国北卡罗来纳州大学和泰国宋卡王子大学）之间的合作，以建设关于一个具有全球重要性的课题的研究能力。

DESCRIPTION (provided by applicant): For most of the 20th century, tuberculosis (TB) was in decline but since the mid 1980s, the trend has reversed and the number of TB cases globally now continues to increase. The "new" TB is characterized by HIV/-I-B co-infection and multiple drug resistant TB. In most parts of the world, TB and HIV epidemics are inextricably linked and call for an integrated approach of this dual epidemic. In developing countries, TB is the most frequent presenting opportunistic infection in people living with HIV/AIDS and TB is the leading cause of AIDS-related deaths. People fear TB, as it frequently heralds previously unsuspected HIV infection. The social stigma associated with the "new" TB is now compounded with the social stigma associated with HIV/AIDS. A better understanding of the changing social aspects of TB will be crucial for improved disease control. Clinical, biological and epidemiological interactions between TB and HIV have been studied extensively, but little is known about the psychosocial complexity of TB in HIV-infected individuals or about the social response of communities to TB in HIV/AIDS endemic areas. In this research project, a multidisciplinary team with clinical and operational research experience in the fields of behavioral science, epidemiology, sociology, ethnography, anthropology, infectious diseases and ethics propose to develop and validate a TB stigma scale for population-based assessment of TB stigma in the most southern part of Thailand, an area with a dual HIV/AIDS and TB epidemic. We will use the newly developed research instrument to obtain a better understanding of the key determinants of TB related stigma. We will measure the level of stigma experienced by TB patients in a cohort of active TB patients and correlate the stigma score to health-seeking behavior and adherence to TB therapy, two crucial elements of TB control. This project is the first attempt to integrate qualitative and quantitative research on stigma of TB in HIV endemic areas. The project will also initiate the collaboration between two universities (University of North Carolina, USA, and Prince of Songkla University, Thailand) to build research capacity on a subject of global importance.