Abstract
Infection prevention and control (IPC) measures to reduce transmission of drug-resistant and drug-sensitive tuberculosis (TB) in health facilities are well described but poorly implemented. The implementation of TB IPC has been assessed primarily through quantitative and structured approaches that treat administrative, environmental, and personal protective measures as discrete entities. We present an on-going project entitled Umoya omuhle (“good air”), conducted in two provinces of South Africa, that adopts an interdisciplinary, ‘whole systems’ approach to problem analysis and intervention development for reducing nosocomial transmission of Mycobacterium tuberculosis (Mtb) through improved IPC. We suggest that TB IPC represents a complex intervention that is delivered within a dynamic context shaped by policy guidelines, health facility space, infrastructure, organisation of care, and management culture. Methods drawn from epidemiology, anthropology, and health policy and systems research enable rich contextual analysis of how nosocomial Mtb transmission occurs, as well as opportunities to address the problem holistically. A ‘whole systems’ approach can identify leverage points within the health facility infrastructure and organisation of care that can inform the design of interventions to reduce the risk of nosocomial Mtb transmission.
Highlights
Limited understanding of why TB infection prevention and control (IPC) measures are poorly implemented Recommendations to improve health care worker (HCW) adherence to guidelines tend to focus on training and supportive resources, yet there is limited understanding of which elements work to enable sustained implementation
We share our experience of applying a whole systems approach to an on-going study of infection prevention and control (IPC) for both drug-sensitive (DS-TB) and drug-resistant tuberculosis (DR-TB) in South Africa
Despite clear guidelines for TB infection prevention and control (IPC) that are relevant to Drug-sensitive tuberculosis (DSTB) and DR-TB, there is only weak evidence to show that implementing TB IPC reduces nosocomial transmission
Summary
We share our experience of applying a whole systems approach to an on-going study of infection prevention and control (IPC) for both drug-sensitive (DS-TB) and drug-resistant tuberculosis (DR-TB) in South Africa. TB remains one of the most critical issues facing global public health and health systems today: the disease is responsible for over one million deaths every year, with DR-TB accounting for 29% of AMR-related deaths [3]. IPC measures to reduce airborne transmission of Mtb in health facilities, such as opening doors and windows, wearing protective respirators, and instituting cough triage, remain poorly implemented [6,7,8]; there are large gaps in understanding the barriers and enablers to implementing these measures in resourceconstrained health systems and within primary health clinics
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