title: Tuberculosis and latent tuberculosis infection among healthcare workers in Kisumu, Kenya.
abstract: OBJECTIVE
  To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a healthcare setting in western Kenya.
  
  
  METHODS
  We conducted a cross-sectional survey among healthcare workers in western Kenya in 2013. They were recruited from dispensaries, health centres and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among healthcare workers compared to school workers; and among healthcare workers only, we assessed work-related risk factors for latent TB infection.
  
  
  RESULTS
  We enrolled 1005 healthcare workers and 411 school workers. Approximately 60% of both groups were female. A total of 22% of 958 healthcare workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among healthcare workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among healthcare workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among healthcare workers than school workers (95% confidence interval 1.2-2.0). Healthcare workers at all three facility types had similar prevalence of latent TB infection (P = 0.72), but increasing years of employment was associated with increased odds of LTBI (P < 0.01).
  
  
  CONCLUSIONS
  Healthcare workers at facilities in western Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. Implementation of WHO-recommended TB infection control measures are urgently needed in health facilities to protect healthcare workers.
authors.affiliation: Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya.
authors.forename: Janet
authors.initials: J
authors.lastname: Agaya
authors.affiliation: Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.|Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Chimeremma D
authors.initials: CD
authors.lastname: Nnadi
authors.affiliation: U.S. Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Joseph
authors.initials: J
authors.lastname: Odhiambo
authors.affiliation: Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya.
authors.forename: Charles
authors.initials: C
authors.lastname: Obonyo
authors.affiliation: Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya.
authors.forename: Vincent
authors.initials: V
authors.lastname: Obiero
authors.affiliation: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Lipke
authors.affiliation: Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya.
authors.forename: Elisha
authors.initials: E
authors.lastname: Okeyo
authors.affiliation: U.S. Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cain
authors.affiliation: Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Oeltmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006282:Health Personnel; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D055985:Latent Tuberculosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000382:microbiology; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012574:Schools; D057566:Self Report; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult
keywords: HIV; infection control; latent tuberculosis; nosocomial infection; tuberculosis; western Kenya