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Tuberculosis (TB) remains one of the leading infectious disease causes of death at a global level, only surpassed in 2020-21 by COVID-19. Airborne infection prevention and control (IPC) measures in health facilities play an important role to reduce the spread of TB and make health care facilities safer for patients and health workers. My overall aim with the programme of research was to explore health worker and patient experiences of using TB IPC measures in healthcare facilities from an interdisciplinary perspective. I conducted a systematic review and qualitative evidence synthesis to better understand the existing academic literature on TB IPC implementation and develop implementation considerations that could support TB IPC guideline implementation. I found that health workers often focussed their TB IPC efforts on patients who are known with TB and are already on treatment, who only pose a small risk of infection. Existing research also highlighted stigma as an important impediment to TB IPC implementation, with sparse evidence about how this could be mitigated. I responded to these evidence gaps by including this as focus areas for my fieldwork. I looked at how a district hospital refined where it focussed it TB IPC efforts and aimed to explore ways in which the stigma associated with TB IPC measures could be better understood and potentially mitigated. Using the rural Eastern Cape in South Africa as setting for in-person data collection, I draw on in-depth individual interviews with 18 health workers and 15 patients conducted between 2019 and 2020 as well as fieldnotes and document reviews. During 2021 I conducted 11 remote follow-up interviews during the COVID-19 pandemic. My analysis makes an original contribution to understanding the complexity involved in using TB IPC measures in health facilities through exploring a positive deviant organisational case study. My main findings are that TB IPC use can be understood as a process of organisational sensemaking, where what was ‘necessary’ and ‘effective’ TB IPC are contested and negotiated between health workers. In my study context, I found that TB IPC measures both reflected and contributed to the stigma that patients with TB experience. I recommend viewing TB IPC implementation in health facilities through the perspective of the broader cultural setting and adapting IPC campaigns based on contextual factors such as local explanatory models of illnesses. Using a pragmatist philosophical approach, I focus on how these findings could be used to support TB IPC implementation and relate to the clinical context. The position I develop in this thesis is to view TB IPC implementation as an example of a social practice: with reciprocal interactions between broader societal social structures, norms in healthcare organisations, health worker and patient knowledge, beliefs and values, and the social meanings and material properties of TB IPC technologies. Viewing TB IPC implementation as a social practice offers new ways of understanding why TB IPC has been difficult to implement and presents novel possibilities for an interdisciplinary approach to support TB IPC implementation.

Summary\ud Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles

The science around the use of masks by the general public to impede COVID-19 transmission is advancing rapidly. Policymakers need guidance on how masks should be used by the general population to combat the COVID-19 pandemic. In this narrative review, we develop an analytical framework to examine mask usage, considering and synthesizing the relevant literature to inform multiple areas: population impact; transmission characteristics; source control; PPE; sociological considerations; and implementation considerations. A primary route of transmission of COVID-19 is via respiratory droplets, and is known to be transmissible from presymptomatic and asymptomatic individuals. Reducing disease spread requires two things: first, limit contacts of infected individuals via physical distancing and other measures, and second, reduce the transmission probability per contact. The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts. Public mask wearing is most effective at reducing spread of the virus when compliance is high. The decreased transmissibility could substantially reduce the death toll and economic impact while the cost of the intervention is low. Given the current shortages of medical masks we recommend the adoption of public cloth mask wearing, as an effective form of source control, in conjunction with existing hygiene, distancing, and contact tracing strategies. Because many respiratory droplets become smaller due to evaporation, we recommend increasing focus on a previously overlooked aspect of mask usage: mask-wearing by infectious people ("source control") with benefits at the population-level, rather than mask-wearing by susceptible people, such as health-care workers, with focus on individual outcomes. We recommend that public officials and governments strongly encourage the use of widespread face masks in public, including the use of appropriate regulation.