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dc.rights.licenseCreative Commons Attribution 4.0 Unported (CC BY 4.0) license
dc.contributor.authorMcCreesh, Nickyen
dc.contributor.authorKarat, Aaron S.en
dc.contributor.authorBaisley, Kathyen
dc.contributor.authorDiaconu, Karinen
dc.contributor.authorBozzani, Fiammettaen
dc.contributor.authorGovender, Indiraen
dc.contributor.authorBeckwith, Peteren
dc.contributor.authorYates, Tom A.en
dc.contributor.authorDeol, Arminder K.en
dc.contributor.authorHouben, Rein M. G. J.en
dc.contributor.authorKielmann, Karinaen
dc.contributor.authorWhite, Richard G.en
dc.contributor.authorGrant, Alison D.en
dc.identifier.citationMcCreesh, N., Karat, A.S., Baisley, K., Diaconu, K., Bozzani, F., Govender, I., Beckwith, P., Yates, T. A., Deol, A.K., Houben, R.M.G.J., Kielmann, K., White, R. G. and Grant, A.D. (2021) ‘Modelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africa’, BMJ Global Health, 6(10), article no. e007124.en
dc.descriptionAaron S Karat - ORCID: 0000-0001-9643-664X
dc.descriptionKarin Diaconu - ORCID: 0000-0002-5810-9725
dc.descriptionKarina Kielmann - ORCID: 0000-0001-5519-1658
dc.description.abstractBackground Elevated rates of tuberculosis in health care workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high burden settings. In the context of a project taking a whole systems approach to tuberculosis infection prevention and control (IPC), we aimed to evaluate the potential impact of conventional and novel IPC measures on Mtb transmission to patients and other clinic attendees.en
dc.description.abstractMethods An individual-based model of patient movements through clinics, ventilation in waiting areas, and Mtb transmission was developed, and parameterised using empirical data from eight clinics in two provinces in South Africa. Seven interventions – co-developed with health professionals and policymakers - were simulated: 1. queue management systems with outdoor waiting areas, 2. ultraviolet germicidal irradiation systems (UVGI), 3. appointment systems, 4. opening windows and doors, 5. surgical mask wearing by clinic attendees, 6. simple clinic retrofits, and 7. increased coverage of long antiretroviral therapy prescriptions and community medicine collection points through the CCMDD service.
dc.description.abstractResults In the model, 1. outdoor waiting areas reduced the transmission to clinic attendees by 83% (interquartile range [IQR] 76-88%), 2. UVGI by 77% (IQR 64-85%), 3. appointment systems by 62% (IQR 45-75%), 4. opening windows and doors by 55% (IQR 25-72%), 5. masks by 47% (IQR 42-50%), 6. clinic retrofits by 45% (IQR 16-64%), and 7. increasing the coverage of CCMDD by 22% (IQR 12-32%).
dc.description.abstractConclusions The majority of the interventions achieved median reductions in the rate of transmission to clinic attendees of at least 45%, meaning that a range of highly effective intervention options are available, that can be tailored to the local context. Measures that are not traditionally considered to be IPC interventions, such as appointment systems, may be as effective as more traditional IPC measures, such as mask wearing.
dc.description.sponsorshipThe support of the Economic and Social Research Council (IK) is gratefully acknowledged. The project is partly funded by the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders including support from the GCRF. Grant reference: ES/P008011/1. NM is additionally funded the Wellcome Trust (218261/Z/19/Z). RGW is funded by the Wellcome Trust (218261/Z/19/Z), NIH (1R01AI147321-01), EDTCP (RIA208D-2505B), UK MRC (CCF17-7779 via SET Bloomsbury), ESRC (ES/P008011/1), BMGF (OPP1084276, OPP1135288 & INV-001754), and the WHO (2020/985800-0). TAY is funded via an NIHR Academic Clinical Fellowship. RMGHJ is funded by ERC (action number 757699)en
dc.relation.ispartofBMJ Global Healthen
dc.subjectInfection Prevention And Controlen
dc.subjectMathematical Modelen
dc.subjectPrimary Healthcareen
dc.subjectOccupational Healthen
dc.subjectHealth Systemsen
dc.titleModelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africaen
rioxxterms.typeJournal Article/Reviewen
qmu.authorKarat, Aaron S.en
qmu.authorDiaconu, Karinen
qmu.authorKielmann, Karinaen
qmu.centreInstitute for Global Health and Developmenten

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