Tuberculosis-related stigma and associated factors among people with pulmonary tuberculosis predominantly co-infected with HIV in Kampala, Uganda: a cross-sectional study

Rationale: Stigma has a profound effect on the well-being and treatment outcomes of people with tuberculosis (PWTB). Despite its negative effects, TB-related stigma remains underexplored in high-burden TB settings such as Uganda. Objective: To examine the factors associated with tuberculosis (TB)-related stigma among people with drug-susceptible pulmonary TB aged ≥18 years in Kampala, Uganda. Methods: We conducted a cross-sectional study across five primary health facilities. The primary exposure was psychological well-being and was assessed using the World Health Organization (WHO) Five Well-Being Index (WHO-5). Scores ranged from 0 to 20, with ≥15 indicating good psychological well-being, and <15 indicating poor psychological well-being. TB-related stigma was the primary outcome measured using the Van Rie Stigma Scale, ranging from 0 to 48. We applied Generalized Estimating Equations, adjusting for important covariates and clustering by health facility to determine associated factors. Beta coefficients (β) and 95% confidence intervals (CI) were reported. Results: We analyzed data from 818 participants, with normally distributed TB-related stigma scores: 25.3 ± 6.45. Higher TB-related stigma scores were statistically significantly associated with poor psychological well-being (β = 0.86, 95% CI: 0.60–1.13) and being a male (β = 0.77, 95% CI: 0.53–1.00). Individuals aged ≥25 years showed a borderline statistically significant association with TB-related stigma (β = 0.83, 95% CI: 0.11–1.55). Conclusion: This study showed that poor psychological well-being and being male are associated with higher TB-related stigma scores among PWTB in Kampala, Uganda. TB programs should integrate mental health and implement stigma-reduction strategies that address underlying causes.