title: Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.
abstract: 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 well-being 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 (LTBI) 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.
authors.affiliation: TB Proof, Cape Town, South Africa; Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA 02215, USA. Electronic address: rnathavi@bidmc.harvard.edu.
authors.forename: Ruvandhi R
authors.initials: RR
authors.lastname: Nathavitharana
authors.affiliation: TB Proof, Cape Town, South Africa.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bond
authors.affiliation: TB Proof, Cape Town, South Africa; Paediatric Infectious Diseases, Stellenbosch University, Department of Paediatrics and Child Health, Cape Town, South Africa.
authors.forename: Angela
authors.initials: A
authors.lastname: Dramowski
authors.affiliation: TB Proof, Cape Town, South Africa; East London Hospital Complex, East London, South Africa.
authors.forename: Koot
authors.initials: K
authors.lastname: Kotze
authors.affiliation: TB Proof, Cape Town, South Africa; Massachusetts General Hospital, Division of Infectious Diseases, , Boston, MA 02215, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Lederer
authors.affiliation: Nelson Mandela Metropolitan University, Dietetics Division, , Port Elizabeth, South Africa.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Oxley
authors.affiliation: TB Proof, Cape Town, South Africa; London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Clinical Research Department, London, UK.
authors.forename: Jurgens A
authors.initials: JA
authors.lastname: Peters
authors.affiliation: TB Proof, Cape Town, South Africa.
authors.forename: Chanel
authors.initials: C
authors.lastname: Rossouw
authors.affiliation: TB Proof, Cape Town, South Africa; East London Hospital Complex, East London, South Africa.
authors.forename: Helene-Mari
authors.initials: HM
authors.lastname: van der Westhuizen
authors.affiliation: TB Proof, Cape Town, South Africa; Stellenbosch University, Division of Community Health, Faculty of Medicine and Health Sciences, , Cape Town, South Africa.
authors.forename: Bart
authors.initials: B
authors.lastname: Willems
authors.affiliation: TB Proof, Cape Town, South Africa; Clinical Research Center, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
authors.forename: Tiong Xun
authors.initials: TX
authors.lastname: Ting
authors.affiliation: TB Proof, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925 Observatory, South Africa.
authors.forename: Arne
authors.initials: A
authors.lastname: von Delft
authors.affiliation: TB Proof, Cape Town, South Africa.
authors.forename: Dalene
authors.initials: D
authors.lastname: von Delft
authors.affiliation: Institute of Public Health, Porto University, EpiUnit, Portugal; Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
authors.forename: Raquel
authors.initials: R
authors.lastname: Duarte
authors.affiliation: Brigham and Women's Hospital, Division of Global Health and Social Medicine, 02115 Boston, MA, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Nardell
authors.affiliation: TB Proof, Cape Town, South Africa; University College London, and NIHR Biomedical Research Centre, University College London Hospital, Division of Infection and Immunity, London, UK.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
mesh_terms: D003254:Consumer Advocacy; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D006282:Health Personnel / Q000193:education; D006806:Human Rights; D006801:Humans; D017053:Infection Control / Q000331:legislation & jurisprudence / Q000458:organization & administration; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D059232:Laboratory Personnel; D055985:Latent Tuberculosis / Q000453:epidemiology; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016273:Occupational Exposure; D009786:Occupational Health Services / Q000458:organization & administration; D062707:Return to Work; D012307:Risk Factors; D013337:Students, Medical; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission