Knowledge, Attitudes, Practices, and the Post-Cure Stigma Paradox: Determinants of Van Rie Stigma Scores Among MDR-TB Patients in Vietnam

Background Tuberculosis-related stigma remains a substantial psychosocial burden among patients with multidrug-resistant tuberculosis, particularly in resource-constrained settings where prolonged treatment, social vulnerability, and barriers to care may further compromise well-being and engagement with health services. Stigma may adversely affect patients’ treatment experience, healthcare-seeking behavior, and continuity of care. This study aimed to assess perceived stigma and examine its association with tuberculosis-related knowledge, attitudes, and practices among patients with multidrug-resistant tuberculosis in Vietnam. Methods We conducted a cross-sectional study among 528 patients with multidrug-resistant tuberculosis in Vietnam. Perceived stigma was assessed using the Van Rie tuberculosis stigma scale. Knowledge, attitude, and practice scores were derived from structured questionnaire items. Spearman correlation analysis was used to assess bivariate associations between stigma and the knowledge, attitude, and practice domains. Multivariable linear regression was performed to identify factors independently associated with stigma. Results The mean age of participants was 42.61 years (standard deviation, 13.62), and 68.8% were male. The mean stigma score was 23.68 (standard deviation, 4.30), with a median of 24.0 and an interquartile range of 21.0-27.0, indicating a considerable burden of perceived stigma. In bivariate analysis, stigma was inversely correlated with knowledge score (rho = -0.095, p = 0.030), attitude score (rho = -0.270, p < 0.001), and total knowledge-attitude-practice score (rho = -0.192, p < 0.001), while the correlation with practice score was not statistically significant (rho = 0.081, p = 0.064). In multivariable analysis, a higher attitude score remained independently associated with lower stigma (beta = -0.229, 95% confidence interval: -0.306 to -0.153, p < 0.001), whereas knowledge and practice scores were not independently associated with stigma. Being on treatment was also associated with lower stigma (beta = -1.966, 95% confidence interval: -2.716 to -1.216, p < 0.001). Conclusions Patients with multidrug-resistant tuberculosis in Vietnam experienced a considerable burden of perceived stigma. More favorable tuberculosis-related attitudes were independently associated with lower stigma, underscoring the importance of integrating stigma reduction, psychosocial support, and patient-centered educational interventions into multidrug-resistant tuberculosis care. Such approaches may help improve treatment experience and strengthen sustained engagement in care, particularly in settings facing persistent social and health-system challenges.