Community-based Psychosocial Support Interventions to Reduce Stigma and Improve Mental Health of People with Infectious Diseases: a Scoping Review

Background: Stigma experienced by people with infectious diseases impedes access to care, leading to adverse psychosocial consequences. Community-based interventions could prevent or mitigate these consequences but lack robust evidence. This scoping review aimed to identify and critically appraise community-based psychosocial support interventions to reduce stigma and improve mental health for people affected by stigmatizing infectious diseases including tuberculosis (TB), HIV/AIDS, and leprosy.

Methods: This was a scoping review of literature indexed in PubMed, Web of Science, Elton B. Stephens Company (EBSCO) database, as well as reports in the World Health Organization repository, published from January 2000 to June 2023. We included research articles and reports addressing stigma and mental health disorders among individuals with TB, HIV/AIDS, or leprosy and/or their household members in low- and middle-income and/or high TB burden countries. We extracted information regarding types of psychosocial interventions and their reported impact on health and psychosocial indicators.

Results: Thirty studies were included in this review: 21 (70%) related to HIV/AIDS, seven (23%) leprosy, and two (7%) TB. Of these, eleven were quantitative studies, nine qualitative, and ten mixed-methods. Eleven community-based interventions were reported to reduce infectious disease-related stigma, predominantly internalized and enacted stigma, and improve adherence to medication, quality of life, health-related knowledge, depression symptoms, and psychosocial wellbeing. Most studies involved lay people in the community as supporters of those affected. The predominant reported mechanism of intervention effect was the ability of supporters to enable those affected to feel seen and listened to, to accept their diagnosis, to improve their self-esteem, and to facilitate continuation of their daily lives, and thereby reducing anticipated stigma, self-stigma, and mental illness. Adequate training for lay people was reported to be essential to ensure success of interventions.

Conclusions: This review identified a paucity of high-quality evidence relating to community-based interventions to reduce stigma for infectious diseases. However, such interventions have been reported to reduce stigma and improve mental health among people with HIV/AIDS, leprosy, and TB. Engaging affected communities and peers, through the conception, planning, training, implementation, and evaluation phases, was reported to be essential to optimise intervention uptake, impact, and sustainability.