02580nas a2200265   4500000000100000008004100001653001300042653001100055653001200066653001000078653002200088653000800110653002400118653001900142653001100161100001800172700001500190700001900205245011500224856003200339300000900371490000700380520191300387022001402300       2017                            d10aTanzania10aStigma10aNamibia10aKenya10aInfection Control10aHIV10aHealth care workers10aDiscrimination10aAfrica1 aStraetemans M1 aBakker M I1 aMitchell E M H00aCorrelates of observing and willingness to report stigma towards HIV clients by (TB) health workers in Africa.  uhttp://tinyurl.com/yd34utkc  a6-180 v213 a<p><strong>SETTING: </strong>Health care facilities in Kenya, Tanzania and Namibia.</p>

<p><strong>OBJECTIVE: </strong>To study the factors associated with the observation of and willingness to report stigmatising behaviour towards persons living with the human immunodeficiency virus (HIV) among health care workers (HCWs).</p>

<p><strong>DESIGN: </strong>Mixed-effect logistic regression analyses of 9516 HCW interviews, including those of 4062 (43%) TB workers carried out as part of the Service Provision Assessments (SPAs) between 2006 and 2010.</p>

<p><strong>RESULT: </strong>Discrimination (i.e., enacted stigma) was observed by respectively 1042 (60%), 384 (40%) and 907 (69%) TB workers in Kenya, Namibia and Tanzania, similar to the trend observed among all HCWs. Observations of discrimination were clustered at facility level in Kenya, and mapping of facility-level discrimination suggested geographic clustering. HCWs were more likely to observe discrimination in facilities without regular supportive supervision (adjusted OR [aOR] 2.33, 95%CI 1.09-4.96). No HCW characteristics were found to predict intention to report. Training in patients' rights and in confidentiality predisposed HCWs to recognise discrimination (aOR 2.51, 95%CI 1.19-5.28) and the willingness to report it (aOR 2.23, 95%CI 1.11-4.47). Exposure to training in TB infection control (IC) was associated with greater willingness to report discrimination (aOR 2.13, 95%CI 1.03-4.39).</p>

<p><strong>CONCLUSION: </strong>Supervision and exposure to training in patient's rights and confidentiality improved HCWs' understanding and advocacy of dignified and respectful TB-HIV care. All HCWs are equally likely to be allies, agents of change and amplifiers of an anti-stigma message, and broad engagement is required. Innovative approaches to reduce discrimination-while ensuring proper IC-should be explored.</p>
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