In 2015, an estimated 10.4 million individuals developed TB disease globally, of which 62% of cases were men. Recent surveys suggest that case detection is lower and reporting gaps larger for men compared to women. Furthermore, research by our group and others have found that men are less likely to report early TB-related symptoms, get tested, receive their diagnosis, or have successfully treatment outcomes than women. Social norms regarding masculinity can negatively influence men's health behaviors, including retention and progression along the TB care cascade. Given the disproportionate burden of TB disease among men, and the increased risk for poor outcomes compared to women, there is a clear need to develop innovative male-centered interventions to ensure men's progression and retention along the TB care cascade and to stop TB transmission. In response to the urgent need to improve TB outcomes for men, we propose the an innovative mixed-methods study with the following Specific Aims:
Aim 1 : Investigate how men's health care experiences and behaviours associated with retention and progression along the TB care cascade impact their preferences for a male-centered care intervention. Using mixed-methods, we will explore men's health behaviours, their health care experiences, their support networks and their resources at different points along the TB care cascade. Data will be collected from men currently on TB treatment, men that successfully completed TB treatment, men that defaulted from treatment, men's key supporters during TB treatment, and healthcare providers.
Aim 2 : Develop and pilot-test a Discrete Choice Experiment (DCE) for a nuanced understanding of men's preferences for male-centered TB care and treatment support interventions. Utilizing findings from Aim 1, we will develop and pilot a DCE to refine choice set preferences among men that are currently in TB treatment, men that recently completed treatment, and men that defaulted from treatment to inform intervention development. Our study will be conducted in Buffalo City Metropolitan Health District, South Africa, which has high TB incidence. We will be conducting surveys, in-depth interviews, and focus group discussions with men recently diagnosed with TB (n=120), their key supporters (n=12?15), and TB nurses (n=20). We will also develop and administer a DCE questionnaire to men receiving TB care (n=150). Findings will identify the individual, clinic and support network factors that influence men's progression along the TB care cascade and identify preferences for the content and delivery of a future male-centered care intervention to improve treatment outcomes among men.
To improve TB-related outcomes for men, we must understand how to counteract social norms of masculinity that impact health behaviors relevant to retention in and progression along the TB care cascade. To achieve the End TB Strategy target of halving TB incidence by 2025, and a 95% reduction in TB deaths by 2035, treatment and control of TB specifically among men is absolutely imperative. Our results will inform a future NIH R34 grant proposal to develop and pilot a male-centered care intervention to support men during their TB treatment and ultimately improve TB outcomes.