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5. Estimating waiting times, patient flow, and waiting room occupancy density as part of tuberculosis infection prevention and control research in South African primary health care clinics

Author

Karat, Aaron S., primary, McCreesh, Nicky, additional, Baisley, Kathy, additional, Govender, Indira, additional, Kallon, Idriss I., additional, Kielmann, Karina, additional, MacGregor, Hayley, additional, Vassall, Anna, additional, Yates, Tom A., additional, and Grant, Alison D., additional

Published
2022
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7. Correction to: Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Author

Govender, Indira, primary, Karat, Aaron S, additional, Olivier, Stephen, additional, Baisley, Kathy, additional, Beckwith, Peter, additional, Dayi, Njabulo, additional, Dreyer, Jaco, additional, Gareta, Dickman, additional, Gunda, Resign, additional, Kielmann, Karina, additional, Koole, Olivier, additional, Mhlongo, Ngcebo, additional, Modise, Tshwaraganang, additional, Moodley, Sashen, additional, Mpofana, Xolile, additional, Ndung’u, Thumbi, additional, Pillay, Deenan, additional, Siedner, Mark J, additional, Smit, Theresa, additional, Surujdeen, Ashmika, additional, Wong, Emily B, additional, and Grant, Alison D, additional

Published
2022
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8. Estimating the contribution of transmission in primary healthcare clinics to community-wide TB disease incidence, and the impact of infection prevention and control interventions, in KwaZulu-Natal, South Africa

Author

McCreesh, Nicky, primary, Karat, Aaron S, additional, Govender, Indira, additional, Baisley, Kathy, additional, Diaconu, Karin, additional, Yates, Tom A, additional, Houben, Rein MGJ, additional, Kielmann, Karina, additional, Grant, Alison D, additional, and White, Richard, additional

Published
2022
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10. Waiting times, patient flow, and occupancy density in South African primary health care clinics: implications for infection prevention and control

Author

Karat, Aaron S, McCreesh, Nicky, Baisley, Kathy, Govender, Indira, Kallon, Idriss I, Kielmann, Karina, MacGregor, Hayley, Vassall, Anna, Yates, Tom A, and Grant, Alison D

Abstract

BackgroundTransmission of respiratory pathogens, such as Mycobacterium tuberculosis and severe acute respiratory syndrome coronavirus 2, is more likely during close, prolonged contact and when sharing a poorly ventilated space. In clinics in KwaZulu-Natal (KZN) and Western Cape (WC), South Africa, we estimated clinic visit duration, time spent indoors and outdoors, and occupancy density of waiting rooms.MethodsWe used unique barcodes to track attendees’ movements in 11 clinics in two provinces, multiple imputation to estimate missing arrival and departure times, and mixed-effects linear regression to examine associations with visit duration.Results2,903 attendees were included. Median visit duration was 2 hours 36 minutes (interquartile range [IQR] 01:36–3:43). Longer mean visit times were associated with being female (13.5 minutes longer than males; pOverall, attendees spent more of their time indoors (median 95.6% [IQR 46–100]) than outdoors (2.5% [IQR 0–35]). Attendees at clinics with outdoor waiting areas spent a greater proportion (median 13.7% [IQR 1– 75]) of their time outdoors.In two clinics in KZN (no appointment system), occupancy densities of ∼2.0 persons/m2 were observed in smaller waiting rooms during busy periods. In one clinic in WC (appointment system), occupancy density did not exceed 1.0 persons/m2 despite higher overall attendance.ConclusionsLonger waiting times were associated with early arrival, being female, and attending with a young child. Attendees generally waited where they were asked to. Regular estimation of occupancy density (as patient flow proxy) may help staff assess for risk of infection transmission and guide intervention to reduce time spent in risky spaces.

Published
2021

11. Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa

Author

Govender, Indira, primary, Karat, Aaron S, additional, Olivier, Stephen, additional, Baisley, Kathy, additional, Beckwith, Peter, additional, Dayi, Njabulo, additional, Dreyer, Jaco, additional, Gareta, Dickman, additional, Gunda, Resign, additional, Kielmann, Karina, additional, Koole, Olivier, additional, Mhlongo, Ngcebo, additional, Modise, Tshwaraganang, additional, Moodley, Sashen, additional, Mpofana, Xolile, additional, Ndung’u, Thumbi, additional, Pillay, Deenan, additional, Siedner, Mark J, additional, Smit, Theresa, additional, Surujdeen, Ashmika, additional, Wong, Emily B, additional, and Grant, Alison D, additional

Published
2021
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12. 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

Author

McCreesh, Nicky, primary, Karat, Aaron S, additional, Baisley, Kathy, additional, Diaconu, Karin, additional, Bozzani, Fiammetta, additional, Govender, Indira, additional, Beckwith, Peter, additional, Yates, Tom A, additional, Deol, Arminder K, additional, Houben, Rein M G J, additional, Kielmann, Karina, additional, White, Richard G, additional, and Grant, Alison D, additional

Published
2021
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13. Estimating the contribution of transmission in primary healthcare clinics to community-wide TB disease incidence, and the impact of infection prevention and control interventions, in KwaZulu-Natal, South Africa

Author

McCreesh, Nicky, primary, Karat, Aaron S, additional, Govender, Indira, additional, Baisley, Kathy, additional, Diaconu, Karin, additional, Yates, Tom A, additional, Houben, Rein MGJ, additional, Kielmann, Karina, additional, Grant, Alison D, additional, and White, Richard G, additional

Published
2021
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15. Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa.

Author

Govender, Indira, Karat, Aaron S, Olivier, Stephen, Baisley, Kathy, Beckwith, Peter, Dayi, Njabulo, Dreyer, Jaco, Gareta, Dickman, Gunda, Resign, Kielmann, Karina, Koole, Olivier, Mhlongo, Ngcebo, Modise, Tshwaraganang, Moodley, Sashen, Mpofana, Xolile, Ndung'u, Thumbi, Pillay, Deenan, Siedner, Mark J, Smit, Theresa, and Surujdeen, Ashmika

Subjects
*TUBERCULOSIS epidemiology, *TUBERCULOSIS diagnosis, *HIV infections, *CHEST X rays, *SPUTUM, *SELF-evaluation, *INTERVIEWING, *HEALTH status indicators, *ACQUISITION of data, *MOBILE hospitals, *MEDICAL screening, *PRIMARY health care, *HIGHLY active antiretroviral therapy, *MYCOBACTERIUM tuberculosis, *TUBERCULOSIS, *DISEASE prevalence, *MEDICAL records, *DESCRIPTIVE statistics, *STATISTICAL sampling, *MICROBIAL sensitivity tests, *RURAL population, *SYMPTOMS
Abstract

Background Tuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA). Methods Clinic: Randomly selected adults (≥18 years) attending 2 primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum. Results Clinic: 2055 patients were enrolled (76.9% female; median age, 36 years); 1479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2055 (1.0% [95% CI,.6–1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10 320 residents were enrolled (68.3% female; median age, 38 years); 3105 (30.3%) tested HIV-positive (87.4% on ART) and 1091 (10.6%) reported ≥1 TB symptom. Of 58/10 320 (0.6% [95% CI,.4–.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms. In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom. Conclusions In both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings. [ABSTRACT FROM AUTHOR]

Published
2022
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16. Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review

Author

Karat, Aaron S, primary, Gregg, Meghann, additional, Barton, Hannah E, additional, Calderon, Maria, additional, Ellis, Jayne, additional, Falconer, Jane, additional, Govender, Indira, additional, Harris, Rebecca C, additional, Tlali, Mpho, additional, Moore, David A J, additional, and Fielding, Katherine L, additional

Published
2020
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17. Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey

Author

Hwang, Bella, primary, Shroufi, Amir, additional, Gils, Tinne, additional, Steele, Sarah Jane, additional, Grimsrud, Anna, additional, Boulle, Andrew, additional, Yawa, Anele, additional, Stevenson, Sasha, additional, Jankelowitz, Lauren, additional, Versteeg-Mojanaga, Marije, additional, Govender, Indira, additional, Stephens, John, additional, Hill, Julia, additional, Duncan, Kristal, additional, and van Cutsem, Gilles, additional

Published
2019
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18. Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review.

Author

Karat, Aaron S, Gregg, Meghann, Barton, Hannah E, Calderon, Maria, Ellis, Jayne, Falconer, Jane, Govender, Indira, Harris, Rebecca C, Tlali, Mpho, Moore, David A J, and Fielding, Katherine L

Subjects
INFECTION prevention, TUBERCULOSIS treatment, CROSS infection prevention, PREVENTION of infectious disease transmission, PREVENTION of communicable diseases, INDUSTRIAL hygiene, ISOLATION (Hospital care), PATIENT-professional relations, MYCOBACTERIUM tuberculosis, MEDICAL triage, SYSTEMATIC reviews
Abstract

Evidence is limited for infection prevention and control (IPC) measures reducing Mycobacterium tuberculosis (MTB) transmission in health facilities. This systematic review, 1 of 7 commissioned by the World Health Organization to inform the 2019 update of global tuberculosis (TB) IPC guidelines, asked: do triage and/or isolation and/or effective treatment of TB disease reduce MTB transmission in healthcare settings? Of 25 included articles, 19 reported latent TB infection (LTBI) incidence in healthcare workers (HCWs; absolute risk reductions 1%–21%); 5 reported TB disease incidence in HCWs (no/slight [high TB burden] or moderate [low burden] reduction) and 2 in human immunodeficiency virus-positive in-patients (6%–29% reduction). In total, 23/25 studies implemented multiple IPC measures; effects of individual measures could not be disaggregated. Packages of IPC measures appeared to reduce MTB transmission, but evidence for effectiveness of triage, isolation, or effective treatment, alone or in combination, was indirect and low quality. Harmonizing study designs and reporting frameworks will permit formal data syntheses and facilitate policy making. [ABSTRACT FROM AUTHOR]

Published
2021
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19. Supervised oral HIV self-testing is accurate in rural KwaZulu Natal, South Africa

Author

Martínez Pérez, Guillermo, Steele, Sarah J., Govender, Indira, Arellano, Gemma, Mkwamba, Alec, Hadebe, Menzi, and Cutsem, Gilles van

Abstract

Objectives: To achieve UNAIDS 90-90-90 targets, alternatives to conventional HIV testing models are necessary in South Africa to increase population awareness of their HIV status. One of the alternatives is oral mucosal transudates-based HIV self-testing (OralST). This study describes implementation of counsellor-introduced supervised OralST in a high HIV prevalent rural area. Methods: Cross-sectional study conducted in two government-run primary healthcare clinics and three Médecins Sans Frontières-run fixed-testing sites in uMlalazi municipality, KwaZulu-Natal. Lay counsellors sampled and recruited eligible participants, sought informed consent and demonstrated the use of the OraQuick(™) OralST. The participants used the OraQuick(™) in front of the counsellor and underwent a blood-based Determine(™) and a Unigold(™) rapid diagnostic test as gold standard for comparison. Primary outcomes were user error rates, inter-rater agreement, sensitivity, specificity and predictive values. Results: A total of 2198 participants used the OraQuick(™) , of which 1005 were recruited at the primary healthcare clinics. Of the total, 1457 (66.3%) were women. Only two participants had to repeat their OraQuick(™) . Inter-rater agreement was 99.8% (Kappa 0.9925). Sensitivity for the OralST was 98.7% (95% CI 96.8-99.6), and specificity was 100% (95% CI 99.8-100). Conclusion: This study demonstrates high inter-rater agreement, and high accuracy of supervised OralST. OralST has the potential to increase uptake of HIV testing and could be offered at clinics and community testing sites in rural South Africa. Further research is necessary on the potential of unsupervised OralST to increase HIV status awareness and linkage to care.

Published
2016

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