Settings, characteristics, and experiences of stigma among people with tuberculosis in Kenya: National survey results

Tuberculosis (TB) related stigma remains a significant barrier to TB care and treatment adherence in Kenya. Despite progress in TB control, stigma continues to affect individuals diagnosed with TB and their families, leading to delayed healthcare-seeking behaviors, social exclusion, and economic consequences. This study examines the prevalence and dimensions of TB-related stigma among people infected and affected by TB in Kenya. A cross-sectional study was conducted in November 2023. Data were collected from people with TB (PWTB) in 180 health facilities across 11 counties in Kenya. Recruitment started on 11/05/2023 and ended on 11/05/2024. A multistage stratified sampling method was employed to ensure regional representation. Stigma levels were assessed using a structured stigma index, and logistic outputs was used to analyze factors associated with stigma. A total of 357 PWTB were included in the analysis. Most (67%) were men and the median age was 35 years. The study found high levels of community stigma (68%), family stigma (52%), healthcare system stigma (51%) and self-stigma (49%). Further, multivariable logistic regression indicated that participants with secondary or higher education had significantly higher odds of reporting stigma compared with those with primary education or less (Adjusted OR = 9.30, 95% CI: 2.01-57.3, p = 0.008), while female participants had significantly higher odds of reporting stigma compared with males (Adjusted OR = 4.02, 95% CI: 1.14-15.6, p = 0.035). TB-related stigma in Kenya is prevalent across multiple dimensions, with community, family level, healthcare system and self-stigma particularly prominent. Female sex and higher educational attainment were independently associated with reporting stigma. These findings highlight the need for targeted community-based stigma reduction strategies, integration of psychosocial support within TB care, and gender-responsive strategies.