{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:20:27Z","timestamp":1793334027410,"version":"4.5.0"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T00:00:00Z","timestamp":1725062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Programme Consortium"},{"DOI":"10.13039\/100013986","name":"UK government","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Research Programme Consortium"},{"DOI":"10.13039\/100013986","name":"UK government","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013986","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Gender 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\u2019s ideal and actual step-by-step TB health-seeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a \u2018river\u2019 and each \u2018steppingstone\u2019 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\u2019s 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.<\/jats:p>","DOI":"10.1093\/heapol\/czae087","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T20:56:33Z","timestamp":1724878593000},"page":"1-12","source":"Crossref","is-referenced-by-count":15,"title":["Finding the missing men with tuberculosis: a participatory approach to identify priority interventions in Uganda"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1189-5861","authenticated-orcid":false,"given":"Jasper","family":"Nidoi","sequence":"first","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]},{"name":"Clinical Sciences, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4756-8480","authenticated-orcid":false,"given":"Justin","family":"Pulford","sequence":"additional","affiliation":[{"name":"International Public Health, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-6887","authenticated-orcid":false,"given":"Tom","family":"Wingfield","sequence":"additional","affiliation":[{"name":"Clinical Sciences, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]},{"name":"International Public Health, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]},{"name":"WHO Collaborating Centre in TB and Social Medicine, Department of Global Public Health, Karolinska Institutet , Nobels v\u00e4g 6, Solna, Stockholm 171 77,","place":["Sweden"]},{"name":"Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust , Prescot Street, Liverpool L7 8XP,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5010-3428","authenticated-orcid":false,"given":"Thomson","family":"Rachael","sequence":"additional","affiliation":[{"name":"Clinical Sciences, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3950-3145","authenticated-orcid":false,"given":"Beate","family":"Ringwald","sequence":"additional","affiliation":[{"name":"International Public Health, Liverpool School of Tropical Medicine , Pembroke Place, Liverpool L3 5QA,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4622-191X","authenticated-orcid":false,"given":"Winceslaus","family":"Katagira","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7154-2964","authenticated-orcid":false,"given":"Winters","family":"Muttamba","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]},{"name":"Division of Infection and Global Health, School of Medicine, University of St Andrews , College Gate, St. Andrews KY16 9AJ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milly","family":"Nattimba","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Namuli","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2023-2840","authenticated-orcid":false,"given":"Bruce","family":"Kirenga","sequence":"additional","affiliation":[{"name":"Department of Research and Innovation, Makerere University Lung Institute , New Mulago Hospital Complex, Upper Mulago Hill Road, Kampala P.O. Box 7749,","place":["Uganda"]},{"name":"Department of Internal Medicine, School of Medicine, Makerere University , Upper Mulago Hill Road, Kampala P. O. 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