Exposed, but Not Protected: More Is Needed to Prevent Drug-Resistant Tuberculosis in Healthcare Workers and Students

Abstract

"Occupational MDR-TB" … "XDR-TB" … "Treatment-induced hearing loss": 3 life-changing messages imparted over the phone. Three personal accounts are shared highlighting the false belief held by many healthcare workers (HCWs) and students in low-resource settings-that they are immune to tuberculosis despite high levels of occupational tuberculosis exposure. This misconception reflects a lack of awareness of tuberculosis transmission and disease risk, compounded by the absence of accurate occupational tuberculosis estimates. As the global problem of drug-resistant (DR) tuberculosis evolves, HCWs are increasingly infected and suffer considerable morbidity and mortality from occupational DR tuberculosis disease. Similarly, healthcare students are emerging as a vulnerable and unprotected group. There is an urgent need for improved detection, vaccines, preventive therapy, treatment, and support for affected HCWs and those they care for, as well as destigmatization of all forms of tuberculosis. Finally, efforts to protect HCWs and prevent DR tuberculosis transmission by universal implementation of tuberculosis infection control measures should be prioritized.

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

“…Outcomes for treatment of drug-resistant TB in HCWs are poor, with high rates of treatment failure, mortality and therapy related morbidity 12,13 . Although healthcare workers know the rationale for treatment and need for adherence, many have commented that they had little understanding of the true demands of TB and its treatment regimens and the effect that the disease and the antibiotics have on the body until they became patients themselves 45 . Consultations are often pressed for time, leaving little or no time for compassionate conversations that delve into the patient’s emotional state or ability to cope with treatment 27 .…”

“…Social support networks may be limited. Side effects such as peripheral neuropathy, ototoxicity and vision loss may be career-ending for HCWs 27,45,46 . Although HCWs may have better access to healthcare facilities than other patients, they may encounter greater stigma and be reluctant to engage in care 47 .…”

“…One approach designed to engage HCWs to become agents of change has focused on sharing relatable stories of HCWs affected by tuberculosis to destigmatize occupational TB and dispel the notion that HCWs are “TB Proof”, highlighting the shared risk in healthcare facilities 45 . HCWs can also advocate for testing and treatment for LTBI, which has been a neglected issue in HBCs but is now the subject of greater attention.…”

“…Unfortunately students, CHWs and volunteers with the same exposures typically do not receive the same legal protection despite suffering the same devastating consequences 45 . Legal frameworks must be strengthened to ensure that TB-IC measures are implemented, monitored and evaluated as recommended and to provide care and compensation to all HCWs including trainees and volunteers who are affected by occupational TB.…”

Taking forward the World TB Day 2016 theme ‘Unite to End Tuberculosis’ for the WHO Africa Region

“…28 (5) The expansion of Africa-based grassroots community initiatives: (a) The ENGAGE-TB approach, where the five founder countries (the Democratic Republic of the Congo, Ethiopia, Kenya, South Africa, and the United Republic of Tanzania) have been joined by Burkina Faso, Cô te d'Ivoire, Malawi, Namibia, and Zimbabwe. 29 (b) Increasing activities of community TB groups like TB Proof, 30 which was founded in 2012 by African health care workers and students after suffering multiple personal experiences with MDR-TB, 31,32 and increased the commitment of 90 non-governmental and other civil society organizations from 35 African countries to the WHO End TB Strategy. 33 (6) The United States Agency for International Development (USAID) ''Challenge TB Award'' to fight TB, a 5-year cooperative agreement to implement the USAID global TB strategy.…”