Finding the missing men with tuberculosis: a participatory approach to identify priority interventions in Uganda

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dc.contributor.authorNidoi, Jasper
dc.contributor.authorPulford, Justin
dc.contributor.authorWingfield, Tom
dc.contributor.authorRachael, Thomson
dc.contributor.authorRingwald, Beate
dc.contributor.authorKatagira, Winceslaus
dc.contributor.authorMuttamba, Winters
dc.contributor.authorNattimba, Milly
dc.contributor.authorNamuli, Zahra
dc.contributor.authorKirenga, Bruce
dc.date.accessioned2025-01-15T08:59:29Z
dc.date.available2025-01-15T08:59:29Z
dc.date.issued2025-01
dc.description.abstractGender impacts exposure and vulnerability to tuberculosis (TB) evidenced by a higher prevalence of both TB disease and missed TB diagnoses among men, who significantly contribute to new TB infections. We present the formative research phase of a study, which used participatory methods to identify gender-specific interventions for systematic screening of TB among men in Uganda. Health facility-level data were collected at four Ugandan general hospitals (Kawolo, Gombe, Mityana and Nakaseke) among 70 TB stakeholders, including healthcare workers, TB survivors, policymakers and researchers. Using health-seeking pathways, they delineated and compared men’s ideal and actual step-by-step TB healthseeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a ‘river’ and each ‘steppingstone’ as a solution, was employed to identify interventions which would help link men with TB symptoms to care. These insights were then synthesized in a co-analysis meeting with 17 participants, including representatives from each health facility to develop a consensus on proposed interventions. Data across locations revealed the actual TB care pathway diverted from the ideal pathway due to health system, community, health worker and individual-level barriers such as delayed health seeking, unfavourable facility operating hours and long waiting times that conflicted with men’s work schedules. Stakeholders proposed to address these barriers through the introduction of male-specific services; integrated TB services that prioritize X-ray screening for men with cough; healthcare worker training modules on integrated male-friendly services; training and supporting TB champions to deliver health education to people seeking care; and engagement of private practitioners to screen for TB. In conclusion, our participatory co-design approach facilitated dialogue, learning and consensus between different health actors on context-specific, person-centred TB interventions for men in Uganda. The acceptability, effectiveness and cost effectiveness of the package will now be evaluated in a pilot study. Keywords: Tuberculosis, participatory research, gender, healthcare-seeking behaviour
dc.identifier.citationNidoi, Jasper, Justin Pulford, Tom Wingfield, et al. 'Finding the Missing Men with Tuberculosis: A Participatory Approach to Identify Priority Interventions in Uganda', Health Policy and Planning, vol. 40/no. 1, (2025), pp. 1.
dc.identifier.issnISSN 1460-2237
dc.identifier.issnEISSN 1460-2237
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/9771
dc.language.isoen
dc.publisherOxford University Press
dc.titleFinding the missing men with tuberculosis: a participatory approach to identify priority interventions in Uganda
dc.typeArticle
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