“The way I am being treated matters more to me than the TB itself”: experiences of stigma in healthcare settings among people with drug-resistant tuberculosis in Lagos, Nigeria: a qualitative study

Healthcare-associated stigma is a critical but under-explored barrier to effective drug-resistant tuberculosis (DR-TB) care. Perceived negative attitudes and behaviours by healthcare workers (HCWs) may undermine treatment adherence, psychological well-being, and trust in the health system among people with DR-TB (PwDR-TB). This study explored PwDR-TB’s experiences of stigma within healthcare settings in Lagos, Nigeria, and its implications for care engagement. We held five focus group discussions with 53 PwDR-TB at five purposively selected DR-TB outpatient clinics in Lagos. Participants were adults who had been on treatment for at least 3 months. We audio-recorded discussions, transcribed them verbatim, and analysed them using reflexive thematic analysis guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Link and Phelan’s stigma framework informed interpretation of the findings. Four themes emerged. First, the healthcare setting exposed participants to a diagnosis they could otherwise conceal; visible practices such as HCWs’ mask use marked them as diseased, and several who wanted to report mistreatment did not know how, responding instead by concealing their diagnosis further. Second, some participants weighed the humiliation experienced in care against the benefit of free treatment; one sought costly private care as a result, with reported adverse clinical consequences. Third, these experiences were associated with reluctance to attend appointments and, in one account, contemplation of discontinuing treatment. Fourth, HCWs’ infection-prevention counselling, including some advice with limited transmission-based rationale, extended into the home; family responses ranged from resistance to compliance. Participants described stigma as more severe within healthcare settings than in the community, given their inability to conceal their diagnosis from HCWs and HCWs’ authority over their care. These experiences reflect labelling, stereotyping, separation, status loss, and discrimination within healthcare environments. Healthcare-associated stigma is a significant barrier to patient-centred DR-TB care in Nigeria; some patients weigh mistreatment against the benefit of free treatment. Interventions are needed at multiple levels, including HCW training on respectful, evidence-based care, accessible mechanisms for reporting mistreatment, and psychosocial support. Addressing stigma may improve treatment retention, dignity, and DR-TB outcomes in high-burden settings.