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Alele FO, Franklin RC, Emeto TI, Leggat P. Occupational tuberculosis in healthcare workers in sub-Saharan Africa: A systematic review. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:95-108. [PMID: 29702035 DOI: 10.1080/19338244.2018.1461600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/01/2018] [Indexed: 06/08/2023]
Abstract
This article investigates the incidence, prevalence and factors associated with occupational tuberculosis (TB) in healthcare workers (HCWs) in sub-Saharan Africa (SSA). Studies were extracted from MEDLINE, PsycINFO, CINAHL, Cochrane Library, and SCOPUS databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from inception to the 2nd of June 2017. Twenty-one studies met the inclusion criteria. The median prevalence of latent TB infection in HCWS was 62% (IQR 22%) and the median incidence of TB disease was 3871/100,000 (IQR 9314/100,000). The risk factors associated with LTBI or active TB disease were workplace, history of contact with TB patients, and longer duration of employment. The findings of this review demonstrate that the risk of acquiring TB among HCWs in SSA is high. This may impact on the recruitment, longevity and retention of HCWs.
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Affiliation(s)
- Faith O Alele
- a Public Health and Tropical Medicine , College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville QLD , Australia
| | - Richard C Franklin
- a Public Health and Tropical Medicine , College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville QLD , Australia
| | - Theophilus I Emeto
- a Public Health and Tropical Medicine , College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville QLD , Australia
| | - Peter Leggat
- a Public Health and Tropical Medicine , College of Public Health, Medical and Veterinary Sciences, James Cook University , Townsville QLD , Australia
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Malotle MM, Spiegel JM, Yassi A, Ngubeni D, O'Hara LM, Adu PA, Bryce EA, Mlangeni N, Gemell GSM, Zungu M. Occupational tuberculosis in South Africa: are health care workers adequately protected? Public Health Action 2017; 7:258-267. [PMID: 29584794 DOI: 10.5588/pha.17.0070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A provincial tertiary hospital in Gauteng province, South Africa, with a high burden of tuberculosis (TB) patients and high risk of TB exposure among health care workers (HCWs). Objective: To determine HCWs' adherence to recommended TB infection prevention and control practices, TB training and access to health services and HCW TB rates. Design: Interviews with 285 HCWs using a structured questionnaire as part of a large, international mixed-methods study. Results: Despite 10 HCWs (including seven support HCWs) acquiring clinical TB during their period of employment, 62.8% of interviewees were unaware of the hospital's TB management protocol. Receipt of training was low (34.5% of all HCWs and <5% of support HCWs trained on TB transmission; 27.5% of nurses trained on respirator use), as was use of respiratory protection (44.5% of HCWs trained on managing TB patients). Support HCWs were over 36 times more likely to use respiratory protection if trained; nurses who were trained were approximately 40 times more likely to use respirators if they were readily available. Conclusion: Improved coordination and uptake of TB infection prevention training is urgently needed, especially for non-clinical HCWs in settings of regular exposure to TB patients. Adequate supplies of appropriate respiratory protection must be made available.
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Affiliation(s)
- M M Malotle
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
| | - J M Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Ngubeni
- Employee Health and Wellness, Gauteng Provincial Department of Health, Johannesburg, South Africa
| | - L M O'Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - P A Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - E A Bryce
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Mlangeni
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
| | - G S M Gemell
- Employee Health and Wellness, Gauteng Provincial Department of Health, Johannesburg, South Africa
| | - M Zungu
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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O'Hara LM, Yassi A, Zungu M, Malotle M, Bryce EA, Barker SJ, Darwin L, Mark FitzGerald J. The neglected burden of tuberculosis disease among health workers: a decade-long cohort study in South Africa. BMC Infect Dis 2017; 17:547. [PMID: 28784107 PMCID: PMC5547542 DOI: 10.1186/s12879-017-2659-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Health workers (HWs) in resource-limited settings are at high-risk of exposure to tuberculosis (TB) at work. The aim of this study was to estimate the rate of TB disease among HWs in the Free State Province of South Africa between 2002 and 2012 and to compare demographic and clinical characteristics between HWs and the general population with TB. This study also explores the effect of occupational variables on risk of TB among HWs. Methods Probabilistic record linkage was utilized to identify HWs who were also registered as TB patients. This historical prospective cohort study calculated incidence rate ratios (IRR) for TB disease among HWs in Free State from 2002 to 2012. Generalized linear mixed-effects regression was used to model the association between sex, race, facility type, occupation, duration of employment, and the rate of TB. Results There were 2677 cases of TB diagnosed among HWs from 2002 to 2012 and 1280 cases were expected. The overall TB incidence rate in HWs during the study period was 1496·32 per 100,000 compared to an incidence rate of 719·37 per 100,000 in the general population during the same time period. IRR ranged from 1·14 in 2012 to 3·12 in 2005. HWs who were male, black, coloured and employed less than 20 years had higher risk of TB. Facility type and occupation were not associated with increased risk of TB when adjusted for other covariates. Conclusion HWs in South Africa have higher rates of TB than the general population. Improved infection prevention and control measures are necessary in all high-burden TB healthcare settings. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2659-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lyndsay M O'Hara
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Molebogeng Malotle
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Elizabeth A Bryce
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Stephen J Barker
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lincoln Darwin
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - J Mark FitzGerald
- Division of Respiratory Medicine, University of British Columbia, Vancouver, Canada
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Grobler L, Mehtar S, Dheda K, Adams S, Babatunde S, van der Walt M, Osman M. The epidemiology of tuberculosis in health care workers in South Africa: a systematic review. BMC Health Serv Res 2016; 16:416. [PMID: 27544429 PMCID: PMC4992336 DOI: 10.1186/s12913-016-1601-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In South Africa, workplace acquired tuberculosis (TB) is a significant occupational problem among health care workers. In order to manage the problem effectively it is important to know the burden of TB in health care workers. This systematic review describes the epidemiology of TB in South African health care workers. METHODS A comprehensive search of electronic databases [MEDLINE, EMBASE, Web of Science (Social Sciences Citation Index/Science Citation Index), Cochrane Library (including CENTRAL register of Controlled Trials), CINAHL and WHO International Clinical Trials Registry Platform (ICTRP)] was conducted up to April 2015 for studies reporting on any aspect of TB epidemiology in health care workers in South Africa. RESULTS Of the 16 studies included in the review, ten studies reported on incidence of active TB disease in health care workers, two report on the prevalence of active TB disease, two report on the incidence of latent TB infection, three report on the prevalence of latent TB infection and four studies report on the number of TB cases in health care workers in various health care facilities in South Africa. Five studies provide information on risk factors for TB in health care workers. All of the included studies were conducted in publicly funded health care facilities; predominately located in KwaZulu-Natal and Western Cape provinces. The majority of the studies reflect a higher incidence and prevalence of active TB disease in health care workers, including drug-resistant TB, compared to the surrounding community or general population. CONCLUSIONS There is relatively little research on the epidemiology of TB in health care workers in South Africa, despite the importance of the issue. To determine the true extent of the TB epidemic in health care workers, regular screening for TB disease should be conducted on all health care workers in all health care facilities, but future research is required to investigate the optimal approach to TB screening in health care workers in South Africa. The evidence base shows a high burden of both active and latent TB in health care workers in South Africa necessitating an urgent need to improve existing TB infection, prevention and control measures in South African health care facilities.
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Affiliation(s)
- Liesl Grobler
- Center for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa
| | - Shaheen Mehtar
- Unit of Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and University of Cape Town Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shahieda Adams
- Centre for Occupational and Environmental Health Research, University of Cape Town, Cape Town, South Africa
| | | | - Martie van der Walt
- Tuberculosis Research Platform, South African Medical Research Council, Pretoria, South Africa
| | - Muhammad Osman
- Cape Town City Health Department, Cape Town, South Africa
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Pan SC, Chen YC, Wang JY, Sheng WH, Lin HH, Fang CT, Chang SC. Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan. PLoS One 2015; 10:e0145047. [PMID: 26679188 PMCID: PMC4683009 DOI: 10.1371/journal.pone.0145047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/29/2015] [Indexed: 11/26/2022] Open
Abstract
Background Proportional mortality ratio data indicate that healthcare workers (HCWs) have an elevated tuberculosis (TB) mortality. Whether this is caused by an increased TB incidence, a worse TB treatment outcome, or a combination of effects, remains unclear. To elucidate the hazard components of occupational TB, we assessed TB incidence and TB treatment outcome among HCWs in Taiwan. Methods We compared the incidence of active TB among HCWs at a major medical center in Taiwan with that of Taiwan general population in 2004–2012. We also compared the TB treatment outcome of HCWs with that of age/sex-matched non-HCW patients treated at the same hospital, as well as that of nationally registered TB patients. Results The standardized TB incidence ratio of the HCWs was 1.9 (95% confidence interval [CI]: 1.2–2.9), compared with the general population. HCWs with pulmonary TB (n = 30) were less likely to have underlying diseases, delay in diagnosis, delay in treatment, or side effects of treatment, compared with age/sex-matched non-HCW TB patients (n = 120) (all Ps<0.05). The TB treatment outcome of HCWs was significantly better than that of non-HCW patients (TB-related mortality: 0.0% vs. 5.8%, P = 0.008, Mantel-Haenszel test). The standardized TB-related mortality rate was 1.08% [95% CI: 0.96% - 1.20%] for all of the nationally registered TB patients in Taiwan. Conclusions HCWs are at increased risk of active TB, compared with general population. To mitigate this occupational hazard, more efforts need to be directed towards the prevention of nosocomial TB transmission. Healthy worker effect, more rapid diagnosis, and less delay in treatment contribute to a lower TB-related mortality in HCWs.
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Affiliation(s)
- Sung-Ching Pan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jann-Yuan Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail: (CTF); (HHL)
| | - Chi-Tai Fang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (CTF); (HHL)
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University College of Medicine, Taipei, Taiwan
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Adams S, Ehrlich R, Baatjies R, van Zyl-Smit RN, Said-Hartley Q, Dawson R, Dheda K. Incidence of occupational latent tuberculosis infection in South African healthcare workers. Eur Respir J 2015; 45:1364-73. [PMID: 25700382 DOI: 10.1183/09031936.00138414] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/09/2014] [Indexed: 11/05/2022]
Abstract
The test-specific incidence of latent tuberculosis infection (LTBI) in healthcare workers from sub-Saharan Africa is unknown. 505 healthcare workers from South Africa were screened at baseline, and after 12 months, with a questionnaire, the tuberculin skin test (TST), and two T-cell assays (T-SPOT.TB and QuantiFERON-TB Gold-In-Tube). Test-specific conversion rates were calculated. The prevalence of presumed LTBI at baseline was 84, 69 and 62% using the TST, QuantiFERON-TB Gold-In-Tube and T-SPOT.TB, respectively. The annual test-specific conversion rate, depending on the cut-off point used, was as follows: TST 38%; QuantiFERON-TB Gold-In-Tube 13-22%; and T-SPOT.TB 18-22%. Annual reversion rates were 4, 7 and 16%, respectively. The annual TST conversion rate was significantly higher than that derived from published local community-based data (IRR 3.53, 95% CI 1.81-6.88). Factors associated with conversion (any test) included healthcare sector of employment, counselling of tuberculosis patients, and a baseline positive TST (for T-SPOT.TB). The annual rate of tuberculosis infection in South African healthcare workers was very high, irrespective of the testing method used, and may be explained by occupational exposure, as the rate was considerably higher than non-healthcare workers from the same community. Collectively, these data support the need for implementation of tuberculosis-specific infection control measures in Africa.
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Affiliation(s)
- Shahieda Adams
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rodney Ehrlich
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Roslynn Baatjies
- Dept of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Rodney Dawson
- Centre for TB Research Innovation, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
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Claassens MM, van Schalkwyk C, du Toit E, Roest E, Lombard CJ, Enarson DA, Beyers N, Borgdorff MW. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa. PLoS One 2013; 8:e76272. [PMID: 24098461 PMCID: PMC3788748 DOI: 10.1371/journal.pone.0076272] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. METHODS One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. RESULTS The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). CONCLUSION The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.
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Affiliation(s)
- Mareli M. Claassens
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands
| | - Cari van Schalkwyk
- The South African Department of Science and Technology / National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Elizabeth du Toit
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Eline Roest
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Carl J. Lombard
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- Biostatistics Unit, Medical Research Council, Parow, South Africa
| | - Donald A. Enarson
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
- The International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nulda Beyers
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Parow, South Africa
| | - Martien W. Borgdorff
- Department of Clinical Epidemiology, Biostatistics and Bio-informatics, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- Daphne Ling
- Respiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, QC H2X 2P4, Canada
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Jarand J, Shean K, O'Donnell M, Loveday M, Kvasnovsky C, Van der Walt M, Adams S, Willcox P, O'Grady J, Zumla A, Dheda K. Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa. Trop Med Int Health 2010; 15:1179-84. [PMID: 20831672 DOI: 10.1111/j.1365-3156.2010.02590.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
SUMMARY OBJECTIVE To determine the clinical profile and outcomes of health care workers (HCWs) with extensively drug resistant tuberculosis (XDR-TB) in the Eastern and Western Cape Provinces of South Africa. METHOD Retrospective case record review of 334 patients with XDR-TB reported during the period 1996-2008 from Western and Eastern Cape Province, Cape Town, South Africa. Case records of HCWs with XDR-TB were analysed for clinical and microbiological features, and treatment outcomes. RESULTS From 334 case records of patients with XDR-TB, 10 HCWs were identified. Eight of ten were HIV-uninfected, and four of 10 had died of XDR-TB despite treatment. All 10 HCWs had received an average of 2.4 courses of TB treatment before being diagnosed as XDR-TB. CONCLUSIONS In the Eastern and Western Cape provinces of South Africa XDR-TB affects HCWs, is diagnosed rather late, does not appear to be related to HIV status and carries a high mortality. There is an urgent need for the South African government to implement WHO infection control recommendations and make available rapid drug susceptibility testing for HCWs with suspected multidrug-resistant (MDR)/XDR-TB. Further studies to establish the actual risk and sources of infection (nosocomial or community) are required.
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Affiliation(s)
- Julie Jarand
- Lung Infection and Immunity Unit, Department of Medicine, University of Cape Town, South Africa
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Uebel KE, Nash J, Avalos A. Caring for the caregivers: models of HIV/AIDS care and treatment provision for health care workers in Southern Africa. J Infect Dis 2008; 196 Suppl 3:S500-4. [PMID: 18181701 DOI: 10.1086/521113] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Rollout of antiretroviral therapy (ART) has been successfully initiated in many countries, but concerns have been raised about the ability to meet treatment needs in areas where there is a high prevalence of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) and where there are severe deficits in human-resource capacity. Many health care workers in resource-poor areas are experiencing burnout, struggling with external and internal stigma, failing to access HIV testing and treatment early, and subsequently becoming sick and dying of AIDS. Although the human-resource deficit is a well-recognized problem, little has been written about the programs that have been established to provide treatment for HIV-infected health care workers. In the present article, we describe staff care programs at McCord Hospital in Durban, South Africa; Mseleni Hospital in northern KwaZulu-Natal, South Africa; and the Tshedisa Institute in Gaborone, Botswana. These programs provide convenient, confidential, and holistic care for HIV-infected health care workers and health care workers affected by caring for HIV-infected patients. All 3 programs have noted that, among health care workers, there is increasing acceptance of counseling, testing, and treatment. We propose that there is an urgent need for the development of HIV/AIDS care and treatment programs for health care workers that remove barriers to access, provide confidentiality in testing, are conveniently located, and are integrated with tuberculosis programs and other treatment services.
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Joshi R, Reingold AL, Menzies D, Pai M. Tuberculosis among health-care workers in low- and middle-income countries: a systematic review. PLoS Med 2006; 3:e494. [PMID: 17194191 PMCID: PMC1716189 DOI: 10.1371/journal.pmed.0030494] [Citation(s) in RCA: 330] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 10/11/2006] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The risk of transmission of Mycobacterium tuberculosis from patients to health-care workers (HCWs) is a neglected problem in many low- and middle-income countries (LMICs). Most health-care facilities in these countries lack resources to prevent nosocomial transmission of tuberculosis (TB). METHODS AND FINDINGS We conducted a systematic review to summarize the evidence on the incidence and prevalence of latent TB infection (LTBI) and disease among HCWs in LMICs, and to evaluate the impact of various preventive strategies that have been attempted. To identify relevant studies, we searched electronic databases and journals, and contacted experts in the field. We identified 42 articles, consisting of 51 studies, and extracted data on incidence, prevalence, and risk factors for LTBI and disease among HCWs. The prevalence of LTBI among HCWs was, on average, 54% (range 33% to 79%). Estimates of the annual risk of LTBI ranged from 0.5% to 14.3%, and the annual incidence of TB disease in HCWs ranged from 69 to 5,780 per 100,000. The attributable risk for TB disease in HCWs, compared to the risk in the general population, ranged from 25 to 5,361 per 100,000 per year. A higher risk of acquiring TB disease was associated with certain work locations (inpatient TB facility, laboratory, internal medicine, and emergency facilities) and occupational categories (radiology technicians, patient attendants, nurses, ward attendants, paramedics, and clinical officers). CONCLUSIONS In summary, our review demonstrates that TB is a significant occupational problem among HCWs in LMICs. Available evidence reinforces the need to design and implement simple, effective, and affordable TB infection-control programs in health-care facilities in these countries.
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Affiliation(s)
- Rajnish Joshi
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Arthur L Reingold
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, Canada
| | - Madhukar Pai
- Montreal Chest Institute, McGill University, Montreal, Canada
- * To whom correspondence should be addressed. E-mail:
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Reid A, Scano F, Getahun H, Williams B, Dye C, Nunn P, De Cock KM, Hankins C, Miller B, Castro KG, Raviglione MC. Towards universal access to HIV prevention, treatment, care, and support: the role of tuberculosis/HIV collaboration. THE LANCET. INFECTIOUS DISEASES 2006; 6:483-95. [PMID: 16870527 DOI: 10.1016/s1473-3099(06)70549-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tuberculosis is the oldest of the world's current pandemics and causes 8.9 million new cases and 1.7 million deaths annually. The disease is among the most common causes of morbidity and mortality in people living with HIV. However, tuberculosis is more than just part of the global HIV problem; well-resourced tuberculosis programmes are an important part of the solution to scaling-up towards universal access to comprehensive HIV prevention, diagnosis, care, and support. This article reviews the impact of the interactions between tuberculosis and HIV in resource-limited settings; outlines the recommended programmatic and clinical responses to the dual epidemics, highlighting the role of tuberculosis/HIV collaboration in increasing access to prevention, diagnostic, and treatment services; and reviews progress in the global response to the epidemic of HIV-related tuberculosis.
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Nunn P, Williams B, Floyd K, Dye C, Elzinga G, Raviglione M. Tuberculosis control in the era of HIV. Nat Rev Immunol 2005; 5:819-26. [PMID: 16200083 DOI: 10.1038/nri1704] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Without HIV, the tuberculosis (TB) epidemic would now be in decline almost everywhere. However, instead of looking forward to the demise of TB, countries that are badly affected by HIV are struggling against a rising tide of HIV-infected patients with TB. As a consequence, global TB control policies have had to be revised and control of TB now demands increased investment. This paper assesses what is being done to address the issue and what remains to be done.
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Affiliation(s)
- Paul Nunn
- Stop TB Department, World Health Organization, Via Appia 27, CH-1211, Geneva 12, Switzerland.
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Abstract
Recent experiences with severe acute respiratory syndrome and the US smallpox vaccination program have demonstrated the vulnerability of healthcare workers to occupationally acquired infectious diseases. However, despite acknowledgment of risk, the occupational death rate for healthcare workers is unknown. In contrast, the death rate for other professions with occupational risk, such as police officer or firefighter, has been well defined. With available information from federal sources and calculating the additional number of deaths from infection by using data on prevalence and natural history, we estimate the annual death rate for healthcare workers from occupational events, including infection, is 17-57 per 1 million workers. However, a much more accurate estimate of risk is needed. Such information could inform future interventions, as was seen with the introduction of safer needle products. This information would also heighten public awareness of this often minimized but essential aspect of patient care.
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Affiliation(s)
- Kent A Sepkowitz
- Memorial-Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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15
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Tuberculosis and Co-infection with the Human Immunodeficiency Virus. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Abstract
Tuberculosis is currently an enormous global health problem. In industrialized countries in Western Europe and North America, tuberculosis case rates are low and an increasing proportion of cases now occur in foreign-born individuals and in marginalized populations, including the homeless, prisoners, drug users, and persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS). In contrast, the burden of tuberculosis in sub-Saharan Africa continues to grow, largely fueled by the HIV pandemic and poor public health infrastructure. Use of the World Health Organization's (WHO) directly observed therapy, short course (DOTS) strategy has been successful in improving outcomes and preventing the emergence of acquired drug resistance in several African countries; however, case rates are increasing throughout most of the region. It is clear that control of tuberculosis in Africa is closely linked to control of HIV and AIDS. Substantial external donor support and innovative approaches to enhance interactions between HIV/AIDS prevention and treatment efforts and tuberculosis control programs will be needed to improve the current tuberculosis situation in Africa. The purpose of this review is to provide a synopsis of recent developments in these areas and to serve as a reference source for interested readers.
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Affiliation(s)
- J L Johnson
- Department of Medicine, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-4984, USA.
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