Implementation of tuberculosis infection control measures at HIV care and treatment sites in sub-Saharan Africa

Reid, Marianne; Saito, Suzue; Nash, Denis; Scardigli, Anna; Casalini, Caterina; Howard, Andrea A.

doi:10.5588/ijtld.12.0033

Cited by 31 publications

(29 citation statements)

References 18 publications

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“…This high burden of disease together with the increasing prevalence of resistant strains highlights the need to maximize infection control measures in settings in which TB transmission is likely occurring [3,4]. Nosocomial outbreaks of TB have been well documented [5-9].…”

Section: Introductionmentioning

confidence: 99%

“…However, despite widespread use worldwide, the impact of this approach on TB exposure, the intensity of the exposure or, most importantly, transmission in settings with high prevalence of HIV and TB remains unclear [3,4,11]. A major determinant of the effectiveness of cohorting is the performance of the triage approach on admission and the recognition of suspect cases during the hospitalization period.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

Zetola

Macesic²,

Shin³

et al. 2014

BMC Infect Dis

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BackgroundNosocomial transmission of pulmonary tuberculosis (PTB) is a problem in resource-limited settings. However, the degree of TB exposure and the intermediate- and long-term morbidity and mortality of hospital-associated TB is unclear. In this study we determined: 1) the nature, patterns and intensity of TB exposure occurring in the context of current TB cohorting practices in medical centre with a high prevalence of TB and HIV; 2) the one-year TB incidence after discharge; and 3) one-year TB-related mortality after hospital discharge.MethodsFactors leading to nosocomial TB exposure were collected daily over a 3-month period. Patients were followed for 1-year after discharge. TB incidence and mortality were calculated and logistic regression was used to determine the factors associated with TB incidence and mortality during follow up.Results1,094 patients were admitted to the medical wards between May 01 and July 31, 2010. HIV was confirmed in 690/1,094 (63.1%) of them. A total of 215/1,094 (19.7%) patients were diagnosed with PTB and 178/1,094 (16.3%) patients died during the course of their hospitalization; 12/178 (6.7%) patients died from TB-related complications. Eventually, 916 (83.7%) patients were discharged and followed for one year after it. Of these, 51 (5.6%) were diagnosed with PTB during the year of follow up (annual TB rate of 3,712 cases per 100,000 person per year). Overall, 57/916 (6.2%) patients died during the follow up period, of whom 26/57 (45.6%) died from confirmed TB. One-year TB incidence rate and TB-associated mortality were associated with the number of days that the patient remained hospitalized, the number of days spent in the cohorting bay (regardless of whether the patient was eventually diagnosed with TB or not), and the number and proximity to TB index cases. There was no difference in the performance of each of these 3 measurements of nosocomial TB exposure for the prediction of one-year TB incidence.ConclusionSubstantial TB exposure, particularly among HIV-infected patients, occurs in nosocomial settings despite implementation of cohorting measures. Nosocomial TB exposure is strongly associated with one-year TB incidence and TB-related mortality. Further studies are needed to identify strategies to reduce such exposure among susceptible patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

Zetola

Macesic²,

Shin³

et al. 2014

BMC Infect Dis

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“…Despite these clear recommendations for TB-IC, studies have consistently demonstrated the absence of TB-IC programmes in health-care facilities in HBCs 2,33 . The lack of implementation and scale up of these preventative measures, with an emphasis on rapidly diagnosing and treating unsuspected TB, are primarily responsible for nosocomial TB transmission 10,34,35 .…”

Section: Challengesmentioning

confidence: 99%

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

Nathavitharana

Bond²,

Dramowski

et al. 2017

La Presse Médicale

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Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired wellbeing in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

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“…In Nigeria, as in many countries with high numbers of cases and limited resources, implementation of TB infection control measures has been inadequate (8). An initiative aimed at increasing health care worker knowledge about TB infection control and implementing measures to reduce nosocomial transmission in Nigeria resulted in substantial improvement in managerial, administrative, environmental, and personal protective measures and in demonstrable country and facility commitment to the initiative during a 6-month implementation period.…”

Section: Discussionmentioning

confidence: 99%

“…Preventing nosocomial TB transmission, aimed at reducing the impact of TB on persons living with HIV, is also a priority for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) (7). However, infection control measures to prevent TB transmission in health care facilities have not been adequately implemented, especially in settings with high incidence of TB and limited resources (8,9).…”

mentioning

confidence: 99%

Building and Strengthening Infection Control Strategies to Prevent Tuberculosis — Nigeria, 2015

Dokubo¹,

Odume²,

Lipke³

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

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Implementation of tuberculosis infection control measures at HIV care and treatment sites in sub-Saharan Africa

Abstract: To protect HIV-infected patients and health care workers, there is an urgent need to scale up IC practices at HIV care and treatment sites, particularly at sites without anti-tuberculosis treatment services.

Cited by 31 publications

References 18 publications

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

Longer hospital stay is associated with higher rates of tuberculosis-related morbidity and mortality within 12 months after discharge in a referral hospital in Sub-Saharan Africa

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

Building and Strengthening Infection Control Strategies to Prevent Tuberculosis — Nigeria, 2015

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