Tuberculosis infection prevention and control policies, practices, and the risk of TB infection among healthcare workers

Healthcare workers (HCWs) located in low-and middle-income countries (LMIC) that have a high Tuberculosis (TB) burden, are at increased occupational risk from TB. HCWs can have recurrent and extended exposure to pulmonary TB patients in these countries and often work in settings that lack basic TB infection prevention and control (IPC) measures. Over the last 30 years, multiple international and national guidelines have been released focused on TB IPC in health settings. However, the guidelines have been criticized for not considering the LMIC context. TB IPC involves social, political, and epidemiological factors that require a whole of society approach. To enhance TB IPC in LMIC, this research program aimed to examine the development and implementation of TB IPC guidelines and practices, determine the burden of latent TB infection amongst HCWs and lastly, identify strategies to improve TB IPC in low resource health settings. Following a multi-method approach, five studies were conducted at the international, national, and local levels. The first study analysed national TB IPC guidelines from seven countries with a high burden of TB, to assess consistencies and identify gaps in the recommendations and implementation. The second study critically examined the updated WHO TB IPC guidelines published in 2019 from an LMIC lens to identify gaps. Next, I assessed pulmonary TB patients' length of hospital stay, management and HCWs' exposures to TB patients, and the use of personal protective equipment in two Bangladeshi public tertiary care hospitals. In the fourth study, the prevalence of latent TB infection was estimated using tuberculin skin testing of HCWs from two Bangladeshi hospitals. The final study explored hospital preparedness to implement national TB IPC guidelines through key-informant interviews and focus group discussions. These studies found gaps in the guidelines that warranted more specific IPC recommendations in the context of LMICs. Implementing the guideline recommendations had been challenging due to the social, economic, and local burden of TB, resulting in 42% healthcare-associated TB infection among HCWs. The study also identified health system factors affecting TB IPC implementation. Based on the findings from these five studies, I have suggested relevant and tailored recommendations, identified ways to develop guidelines that will reflect the needs of HCWs and the local context, and highlighted strategies to improve guidelines implementation and evaluation.