{"doc_desc":{"title":"Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care:a whole systems approach","idno":"DDI.AHRI.UmoyaOmuhle.Datasets","producers":[{"name":"Africa Health Research Institute","abbreviation":"AHRI","affiliation":"","role":""}]},"study_desc":{"title_statement":{"idno":"AHRI.UmoyaOmuhle.Datasets","title":"Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care:a whole systems approach"},"authoring_entity":[{"name":"Govender, Indira","affiliation":"LSHTM"}],"oth_id":[{"name":"Alison Grant","affiliation":"LSHTM \/ AHRI","email":"","role":"PI"}],"production_statement":{"producers":[{"name":"Africa Health Research Institute","affiliation":"","role":""}],"funding_agencies":[{"name":"Economic and Social research council","abbreviation":"ESRC","role":""}],"grant_no":"ES\/P008011\/1"},"version_statement":{"version":"V1.0.0"},"study_info":{"keywords":[{"keyword":"Tuberculosis; sputum; culture-positive; prevalence; South Africa","vocab":"Africa Health Research Institute","uri":"www.ahri.org"}],"abstract":"Drug-resistant tuberculosis (DR-TB) is a major threat to global public health, causing one in four estimated world-wide deaths attributable to antimicrobial resistance. In South Africa, DR-TB transmission within clinics, particularly to HIV positive people, is well-documented. Most TB transmission happens before people start TB treatment, but DR-TB transmission may continue after treatment is started, raising concern as DR-TB services in South Africa are decentralised from hospitals to primary care clinics. The extent to which exposure in clinics, as compared to other community settings, drives ongoing transmission of DR-TB requires better definition, to mobilise necessary resources to address this problem. Guidelines for clinics concerning infection prevention and control (IPC) measures to reduce DR-TB transmission are widely available. There is ample evidence that recommended measures are not put into practice, but limited understanding of the reasons. A comprehensive approach to understanding barriers to implementation is required to design effective IPC interventions for DR-TB.\nFailure of IPC measures for DR-TB is often attributed to health care workers (HCW) failure to adhere to guidelines. Cognisant that HCW are part of a health system with specific organizational features, we examine how the health system as a whole supports IPC measures. We investigate the biological, environmental, infrastructural, and social dynamics of DR-TB transmission in clinics in two provinces in South Africa (KwaZulu-Natal and Western Cape). Our aim is to provide evidence for effective ways to improve IPC for DR-TB, addressing not only behavioural factors, but also the ways in which clinic space, infrastructure, work and patient flows are managed, and a rights-based occupational health ethos might be cultivated. Our innovative approach brings together a team from several scientific disciplines. Taking a 'whole systems' approach, we will use methods from epidemiology, anthropology, and health systems research to understand the context, practice, and the potential for effective implementation of IPC for DR-TB. We will examine how South African policies on IPC for TB have evolved and been implemented. The epidemiological context will be defined by estimating how much DR-TB transmission happens in clinics compared to other community locations. We will estimate the risk of contact between people with infectious DR-TB and other clients within clinics, and separately estimate, among community members, the frequency of social contacts in clinics as compared to other settings where people meet.\n\nWe will use structured and in-depth qualitative methods to document IPC practice in health clinics: the role of clinic design, organisation of care, work practices, as well as HCW, manager, and patient ideas about risk and responsibility in IPC. In collaboration with key stakeholders, we will use health systems mapping and model-building exercises to visually document the environmental and organizational barriers and enablers to implementing optimal DR-TB IPC.\nSynthesis of all these data will lead to development of a package of health systems interventions to reduce DR-TB\ntransmission in clinics, adapted to the constraints and opportunities of the South African health system. We will use\nmathematical and economic modelling to project the potential impact of interrupting clinic-based transmission on\ncommunity-wide TB incidence, and the consequent economic benefits for health systems and households.\nIn addition to significant academic, policy and programme-relevant outputs, the project will create an interdisciplinary\nplatform for future implementation and evaluation of health systems strategies to improve IPC. It will stimulate \ndiscussion between researchers working on DR-TB and other drug-resistant infections, and foster greater public \nawareness of the importance of systems that minimize the risk of airborne infections in health facilities.\n<<Abstract here>> from paper pre-print\nBackground:\nTuberculosis (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). \nMethods:\nClinic: Randomly-selected adults (=18 years) attending two primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. 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. \nResults:\nClinic: 2,055 patients were enrolled (76.9% female, median age 36 years); 1,479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported =1 TB symptom. Of 20\/2,055 (1.0% [95% CI 0.6-1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10,320 residents were enrolled (68.3% female, median age 38 years); 3,105 (30.3%) tested HIV-positive (87.4% on ART) and 1,091 (10.6%) reported =1 TB symptom. Of 58\/10,320 (0.6% [95% CI 0.4-0.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms. \nIn both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom. \nConclusions:\nIn both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB case finding based on symptom screening in health facilities will miss many people with active disease.","coll_dates":[{"start":"2018-06-25","end":"2019-05-25","cycle":""}],"nation":[{"name":"South Africa","abbreviation":"ZA"}],"geog_coverage":"KwaZulu-Natal","analysis_unit":"Various -  includes clinical results of sputum sample and qualitative and quantitative textual data from interviews","universe":"Adult clinic attendees in KZN South Africa  - sputum sample\nAdult clinic attendees in KZN South Africa - interviews\nAdult clinic attendees in KZN South Africa - heath care utilisation survey","data_kind":"Sputum samples (1035 specimens) clinical data; interviewing of participants-textual data (2055 interviews); health care utilisation survey-textual data participant interviews (90)"},"method":{"data_collection":{"sampling_procedure":"The prevalence survey interviewed 2055 participants, collected sputum specimens from 1035 and then attempted to contact 90 of those participants for the health care utilisation survey."}},"data_access":{"dataset_use":{"cit_req":"Indira, G. (2022). Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care:a whole systems approach [Data set]. Africa Health Research Institute. https:\/\/doi.org\/10.23664\/AHRI.UMOYAOMUHLE.DATASETS","conditions":"The representative of the Receiving Organization agrees to comply with the following conditions:\n\n1. Access to the restricted data will be limited to the Lead Researcher and other members of the research team listed in this request.\n2. Copies of the restricted data or any data created on the basis of the original data will not be copied or made available to anyone other than those mentioned in this Data Access Agreement, unless formally authorized by the Data Archive.\n3. The data will only be processed for the stated statistical and research purpose. They will be used for solely for reporting of aggregated information, and not for investigation of specific individuals or organizations. Data will not in any way be used for any administrative, proprietary or law enforcement purposes. \n4. The Lead Researcher must state if it is their intention to match the restricted microdata with any other micro-dataset. If any matching is to take place, details must be provided of the datasets to be matched and of the reasons for the matching. Any datasets created as a result of matching will be considered to be restricted and must comply with the terms of this Data Access Agreement.\n5. The Lead Researcher undertakes that no attempt will be made to identify any individual person, family, business, enterprise or organization. If such a unique disclosure is made inadvertently, no use will be made of the identity of any person or establishment discovered and full details will be reported to the Data Archive. The identification will not be revealed to any other person not included in the Data Access Agreement.\n6. The Lead Researcher will implement security measures to prevent unauthorized access to licensed microdata acquired from the Data Archive. The microdata must be destroyed upon the completion of this research, unless the Data Archive obtains satisfactory guarantee that the data can be secured and provides written authorization to the Receiving Organization to retain them. Destruction of the microdata will be confirmed in writing by the Lead Researcher to the Data Archive.\n7. Any books, articles, conference papers, theses, dissertations, reports, or other publications that employ data obtained from the Data Archive will cite the source of data in accordance with the citation requirement provided with the dataset.\n8. An electronic copy of all reports and publications based on the requested data will be sent to the Data Archive.\n9. The original collector of the data, the Data Archive, and the relevant funding agencies bear no responsibility for use of the data or for interpretations or inferences based upon such uses.\n10. This agreement will come into force on the date that approval is given for access to the restricted dataset and remain in force until the completion date of the project or an earlier date if the project is completed ahead of time.\n11. If there are any changes to the project specification, security arrangements, personnel or organization detailed in this application form, it is the responsibility of the Lead Researcher to seek the agreement of the Data Archive to these changes. Where there is a change to the employer organization of the Lead Researcher this will involve a new application being made and termination of the original project.\n12. Breaches of the agreement will be taken seriously and the Data Archive will take action against those responsible for the lapse if willful or accidental. Failure to comply with the directions of the Data Archive will be deemed to be a major breach of the agreement and may involve recourse to legal proceedings. The Data Archive will maintain and share with partner data archives a register of those individuals and organizations which are responsible for breaching the terms of the Data Access Agreement and will impose sanctions on release of future data to these parties."}}},"schematype":"survey","tags":[{"tag":"Umoya-Omuhle"}]}