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


METHODS
An 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.


RESULTS
The 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.


CONCLUSIONS
Laws 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.
Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-39, GA 30329, United States of America (USA).
Andre R
AR
Verani
Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-39, GA 30329, United States of America (USA).
Courtney N
CN
Emerson
Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-39, GA 30329, United States of America (USA).
Philip
P
Lederer
Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-39, GA 30329, United States of America (USA).
Ginny
G
Lipke
National Tuberculosis and Leprosy Control Programme, Ministry of Health, Lusaka, Zambia .
Nathan
N
Kapata
United States Centers for Disease Control and Prevention, Gaborone, Botswana .
Samson
S
Lanje
Jhpiego South Africa, MDR TB Partnership, Pretoria, South Africa .
Annatjie C
AC
Peters
Division of Global HIV and TB, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Mailbox E-39, GA 30329, United States of America (USA).
Isaac
I
Zulu
Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA.
Barbara J
BJ
Marston
Independent Global Public Health Consultant, Atlanta, USA .
Bess
B
Miller
D000353:Africa, Southern / Q000453:epidemiology; D006291:Health Policy; D006801:Humans; D011634:Public Health / Q000331:legislation & jurisprudence*; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*