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Early TB diagnosis and treatment are vital, but the uptake of these services through occupational healthcare units (OHUs) is low. The current study hypothesises that (1) the link between HIV and TB and (2) the perceived HIV stigmatisation by colleagues create (3) a double HIV\u2013TB stigma which increases (4) internalised TB stigma and leads to (5) a lower willingness to use OHU services for TB screening and treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional study using the baseline data from the HIV and TB Stigma among Healthcare workers Study (HaTSaH Study).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Six hospitals in the Free State province of South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>820 HCWs of the six selected hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study results demonstrate that the co-epidemic (\u03b2=0.399 (screening model) and \u03b2=0.345 (treatment model)) combined (interaction effect: \u03b2=0.133 (screening) and \u03b2=0.132 (treatment)) with the persistent stigmatisation of HIV is altering the attitudes towards TB (\u03b2=0.345 (screening) and \u03b2=0.400 (treatment)), where the stigmatising views of HIV are transferred to TB\u2014illustrating the syndemic impact. Our model demonstrated that this syndemic not only leads to higher levels of internal TB stigma (\u03b2=0.421 (screening) and \u03b2=0.426 (treatment)), but also to a lower willingness to use the OHU for TB screening (probit coefficient=\u22120.216) and treatment (probit coefficient=\u22120.160). Confidentiality consistently emerged as a contextual correlate of OHU use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Theoretically, our results confirm HIV as a \u2018syndemic generator\u2019 which changes the social meaning of TB in the hospital context. Practically, the study demonstrated that the syndemic of TB and HIV in a highly endemic context with stigma impacts the intended use of occupational TB services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Pre-results of the trial registered at the South African National Clinical Trials Register, registration ID: DOH-27-1115-5204.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-045477","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T12:00:26Z","timestamp":1649160026000},"page":"e045477","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["How the \u2018HIV\/TB co-epidemic\u2013HIV stigma\u2013TB stigma\u2019 syndemic impacts on the use of occupational health services for TB in South African hospitals: a structural equation modelling analysis of the baseline data from the HaTSaH Study (cluster RCT)"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-3829","authenticated-orcid":false,"given":"Edwin","family":"Wouters","sequence":"first","affiliation":[{"name":"Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium"},{"name":"Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Janse","family":"van Rensburg","sequence":"additional","affiliation":[{"name":"Centre for Rural Health, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Engelbrecht","sequence":"additional","affiliation":[{"name":"Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-9525","authenticated-orcid":false,"given":"Veerle","family":"Buffel","sequence":"additional","affiliation":[{"name":"Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Campbell","sequence":"additional","affiliation":[{"name":"Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Sommerland","sequence":"additional","affiliation":[{"name":"Office for National Statistics, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asta","family":"Rau","sequence":"additional","affiliation":[{"name":"Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, Free State, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josefien","family":"van Olmen","sequence":"additional","affiliation":[{"name":"Family and Population Health, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Masquillier","sequence":"additional","affiliation":[{"name":"Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,5]]},"reference":[{"key":"2025121511320408000_12.4.e045477.1","unstructured":"Statistics South Africa . 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