The role of the law in reducing tuberculosis transmission in Botswana, South Africa and Zambia.

Andre R Verani,Isaac Zulu,Barbara J Marston,Nathan Kapata,Philip Lederer,Bess Miller,Samson Lanje,Courtney N Emerson,Annatjie C Peters,Ginny Lipke

doi:10.2471/blt.15.156927

Abstract

ObjectiveTo determine whether laws and regulations in Botswana, South Africa and Zambia – three countries with a high tuberculosis and HIV infection burden – address elements of the World Health Organization (WHO) policy on tuberculosis infection control.MethodsAn online desk review of laws and regulations that address six selected elements of the WHO policy on tuberculosis infection control in the three countries was conducted in November 2015 using publicly available domestic legal databases. The six elements covered: (i) national policy and legal framework; (ii) health facility design, construction and use; (iii) tuberculosis disease surveillance among health workers; (iv) patients’ and health workers’ rights; (v) monitoring of infection control measures; and (vi) relevant research.FindingsThe six elements were found to be adequately addressed in the three countries’ laws and regulations. In all three, tuberculosis case-reporting is required, as is tuberculosis surveillance among health workers. Each country’s legal and regulatory framework also addresses the need to respect individuals’ rights and privacy while safeguarding public health. These laws and regulations create a strong foundation for tuberculosis infection control. Although the legal and regulatory frameworks thoroughly address tuberculosis infection control, their dissemination, implementation and enforcement were not assessed, nor was their impact on public health.ConclusionLaws and regulations in Botswana, South Africa and Zambia address all six selected elements of the WHO policy on tuberculosis infection control. However, the lack of data on their implementation is a limitation. Future research should assess the implementation and public health impact of laws and regulations.

Highlights

Tuberculosis is the leading cause of death among human immunodeficiency virus (HIV)-infected people in Africa,[1,2] where 80% of HIV-positive tuberculosis cases and deaths occur.[3]
We employed rules-based indicators to determine whether laws and regulations from three English-speaking countries in southern Africa[18,19,20] address the six elements of the World Health Organization (WHO) policy on tuberculosis infection control listed in Box 2.21 Botswana, South Africa and Zambia were selected because they have a high burden of HIV-associated tuberculosis and high tuberculosis mortality
We found that national laws and regulations in Botswana, South Africa and Zambia address all six selected elements of the WHO policy on tuberculosis infection control (Box 2)

Summary

Introduction

Tuberculosis is the leading cause of death among human immunodeficiency virus (HIV)-infected people in Africa,[1,2] where 80% of HIV-positive tuberculosis cases and deaths occur.[3]. Substantial nosocomial transmission of multidrug-resistant and extensively drug-resistant tuberculosis has been documented in Africa – these forms of the disease are far more costly and difficult to treat.[3,7] the risk of nosocomial transmission can be minimized by a combination of managerial, administrative, environmental and personal protection measures, collectively referred to as tuberculosis infection control.[8,9] Political commitment is critical for tuberculosis infection control and that commitment can be demonstrated by a country’s legislation,[8] which may influence the practice of infection control. If we are to discern the impact of legislation on tuberculosis infection control, or on any other area of public health, we must first have information about the relevant laws – this may require a cross-disciplinary approach involving legal research and policy analysis

Methods

Results

Discussion

Conclusion