Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: a whole systems approach
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Infectious and Tropical Diseases
Abstract
Drug-resistant tuberculosis (DR-TB) is a major threat to global public health, causing one in four estimated worldwide 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.
Failure 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.
We 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.
Synthesis of all these data will lead to development of a package of health systems interventions to reduce DR-TB transmission in clinics, adapted to the constraints and opportunities of the South African health system. We will use mathematical and economic modelling to project the potential impact of interrupting clinic-based transmission on community-wide TB incidence, and the consequent economic benefits for health systems and households.
In addition to significant academic, policy and programme-relevant outputs, the project will create an interdisciplinary platform for future implementation and evaluation of health systems strategies to improve IPC. It will stimulate discussion between researchers working on DR-TB and other drug-resistant infections, and foster greater public awareness of the importance of systems that minimize the risk of airborne infections in health facilities.
Failure 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.
We 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.
Synthesis of all these data will lead to development of a package of health systems interventions to reduce DR-TB transmission in clinics, adapted to the constraints and opportunities of the South African health system. We will use mathematical and economic modelling to project the potential impact of interrupting clinic-based transmission on community-wide TB incidence, and the consequent economic benefits for health systems and households.
In addition to significant academic, policy and programme-relevant outputs, the project will create an interdisciplinary platform for future implementation and evaluation of health systems strategies to improve IPC. It will stimulate discussion between researchers working on DR-TB and other drug-resistant infections, and foster greater public awareness of the importance of systems that minimize the risk of airborne infections in health facilities.
Planned Impact
This research aims to contribute to: 1) the development of evidence-based policies for the more effective reduction of nosocomial transmission of DR-TB in health facilities in high burden settings; and 2) a paradigm shift towards IPC measures for DR-TB in health facilities that are grounded in a whole systems approach. In order to achieve this impact, there are four key groups that are intended beneficiaries of this research.
Who will benefit, and how? Academic groups directly concerned with DR-TB infection and infection prevention and control (IPC) will benefit from the generation of new data around nosocomial DR-TB transmission in high burden settings and effective measures to implement IPC interventions; they may use the data for further analyses or to parameterise mathematical models. For academic researchers interested in the social, environmental, and economic implications of IPC, the research adopts a whole systems approach to address current knowledge gaps around context, processes, and pathways to strengthening the health system for improved IPC. This data is intended to directly inform the development of IPC intervention design and elements (see 'Academic Beneficiaries' for more details).
Policy makers and public health programme managers are another group of beneficiaries. They will be engaged as stakeholders from the outset of the project to ensure that data generated by the primary research and the mathematical modelling will strengthen the evidence base around IPC interventions, and help policy makers to trace the policy-to-practice process, and prioritise investments.
We see the project as empowering health care workers to become effective agents of change and to foster a culture of local stewardship and effective use of information to prevent nosocomial transmission of DR-TB in health facilities and communities. The ethnographic research within the clinic itself can have transformative potential by using methods that are in-depth and centred on real-life experiences of health facility staff - as well as providing 'food for thought' through reflexive critical discussion around what works, and what doesn't work in IPC. Through our public engagement strategy, we also intend to strengthen the capacity of communities to become partners in the health system, and to hold government accountable for implementing effective IPC strategies. Interim outputs developed for different research stages, for example, the policy briefing, visual documentation, and case-based narratives may themselves have a direct impact as health promotion materials in raising awareness and motivating positive practices in DR-TB management in facilities and communities.
In addition to its impact on scholarship, policy, and practice, the project will stimulate further dialogue between TB and AMR researchers, while creating a strong international and interdisciplinary platform for future implementation and evaluation of health systems strategies to improve IPC for DR-TB.
Who will benefit, and how? Academic groups directly concerned with DR-TB infection and infection prevention and control (IPC) will benefit from the generation of new data around nosocomial DR-TB transmission in high burden settings and effective measures to implement IPC interventions; they may use the data for further analyses or to parameterise mathematical models. For academic researchers interested in the social, environmental, and economic implications of IPC, the research adopts a whole systems approach to address current knowledge gaps around context, processes, and pathways to strengthening the health system for improved IPC. This data is intended to directly inform the development of IPC intervention design and elements (see 'Academic Beneficiaries' for more details).
Policy makers and public health programme managers are another group of beneficiaries. They will be engaged as stakeholders from the outset of the project to ensure that data generated by the primary research and the mathematical modelling will strengthen the evidence base around IPC interventions, and help policy makers to trace the policy-to-practice process, and prioritise investments.
We see the project as empowering health care workers to become effective agents of change and to foster a culture of local stewardship and effective use of information to prevent nosocomial transmission of DR-TB in health facilities and communities. The ethnographic research within the clinic itself can have transformative potential by using methods that are in-depth and centred on real-life experiences of health facility staff - as well as providing 'food for thought' through reflexive critical discussion around what works, and what doesn't work in IPC. Through our public engagement strategy, we also intend to strengthen the capacity of communities to become partners in the health system, and to hold government accountable for implementing effective IPC strategies. Interim outputs developed for different research stages, for example, the policy briefing, visual documentation, and case-based narratives may themselves have a direct impact as health promotion materials in raising awareness and motivating positive practices in DR-TB management in facilities and communities.
In addition to its impact on scholarship, policy, and practice, the project will stimulate further dialogue between TB and AMR researchers, while creating a strong international and interdisciplinary platform for future implementation and evaluation of health systems strategies to improve IPC for DR-TB.
Organisations
- London School of Hygiene & Tropical Medicine (Lead Research Organisation)
- Department of Health and Social Care (Co-funder)
- London School of Economics and Political Science (University of London) (Collaboration)
- University College London (Collaboration)
- Africa Health Research Institute (Collaboration)
Publications
Arakelyan S
(2022)
Beyond checklists: Using clinic ethnography to assess the enabling environment for tuberculosis infection prevention control in South Africa.
in PLOS global public health
Beckwith PG
(2022)
Direct estimates of absolute ventilation and estimated Mycobacterium tuberculosis transmission risk in clinics in South Africa.
in PLOS global public health
Benest J
(2022)
Mathematical Modelling for Optimal Vaccine Dose Finding: Maximising Efficacy and Minimising Toxicity.
in Vaccines
Bonell A
(2020)
Does sunlight drive seasonality of TB in Vietnam? A retrospective environmental ecological study of tuberculosis seasonality in Vietnam from 2010 to 2015.
in BMC infectious diseases
Bozzani FM
(2022)
Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa.
in Health policy and planning
Dodd PJ
(2023)
Improving the quality of the Global Burden of Disease tuberculosis estimates from the Institute for Health Metrics and Evaluation.
in International journal of epidemiology
Garcia-Basteiro A
(2022)
End-point definition and trial design to advance tuberculosis vaccine development
in European Respiratory Review
Govender I
(2022)
Correction to: Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa.
in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Govender I
(2022)
Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa.
in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Horton KC
(2022)
Population benefits of addressing programmatic and social determinants of gender disparities in tuberculosis in Viet Nam: A modelling study.
in PLOS global public health
Jayawardana S
(2022)
Feasibility of novel adult tuberculosis vaccination in South Africa: a cost-effectiveness and budget impact analysis
in npj Vaccines
Kallon II
(2021)
Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa: A Qualitative Study.
in International journal of environmental research and public health
Karat AS
(2021)
Evidence for the Use of Triage, Respiratory Isolation, and Effective Treatment to Reduce the Transmission of Mycobacterium Tuberculosis in Healthcare Settings: A Systematic Review.
in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Kielmann K
(2020)
Tuberculosis infection prevention and control: why we need a whole systems approach.
in Infectious diseases of poverty
McCreesh N
(2020)
Tuberculosis from transmission in clinics in high HIV settings may be far higher than contact data suggest.
in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
McCreesh N
(2020)
Impact of social distancing regulations and epidemic risk perception on social contact and SARS-CoV-2 transmission potential in rural South Africa: analysis of repeated cross-sectional surveys.
in medRxiv : the preprint server for health sciences
McCreesh N
(2022)
Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens.
in Emerging infectious diseases
McQuaid CF
(2021)
Ongoing challenges to understanding multidrug- and rifampicin-resistant tuberculosis in children versus adults.
in The European respiratory journal
McQuaid CF
(2020)
The risk of multidrug- or rifampicin-resistance in males versus females with tuberculosis.
in The European respiratory journal
McQuaid CF
(2020)
The potential impact of COVID-19-related disruption on tuberculosis burden.
in The European respiratory journal
McQuaid CF
(2021)
The impact of COVID-19 on TB: a review of the data.
in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
Nelson KN
(2023)
Measuring indirect transmission-reducing effects in tuberculosis vaccine efficacy trials: why and how?
in The Lancet. Microbe
Nimmo C
(2020)
Dynamics of within-host Mycobacterium tuberculosis diversity and heteroresistance during treatment.
in EBioMedicine
Nimmo C
(2020)
Bedaquiline resistance in drug-resistant tuberculosis HIV co-infected patients.
in The European respiratory journal
Nimmo C
(2024)
Detection of a historic reservoir of bedaquiline/clofazimine resistance-associated variants in Mycobacterium tuberculosis
in Genome Medicine
Perera S
(2022)
Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa.
in Health policy and planning
Portnoy A
(2023)
The potential impact of novel tuberculosis vaccines on health equity and financial protection in low-income and middle-income countries.
in BMJ global health
Scarponi D
(2023)
Demonstrating multi-country calibration of a tuberculosis model using new history matching and emulation package - hmer
in Epidemics
Scarponi D
(2023)
Is neglect of self-clearance biasing TB vaccine impact estimates?
in BMJ global health
Shaikh N
(2021)
Impact of COVID-19 Disruptions on Global BCG Coverage and Paediatric TB Mortality: A Modelling Study
in Vaccines
Description | Policy makers reported that TB infection prevention control in South African primary healthcare clinics was "everybody's business and nobody's business". There are widely-held misconceptions concerning that the main risk of TB transmission is from people receiving TB care, whereas the highest risk is in fact from people with undiagnosed TB in general waiting areas. There are multiple obstacles to implementation of TB infection prevention and control measures in primary health care clinics. Among adults attending primary healthcare clinics in KwaZulu-Natal, South Africa, 1% had TB in their sputum. This compared with 0.6% of people in the surrounding community. In both settings, most of people with TB in their sputum did not report classic symptoms of TB. Since symptoms are currently used to identify people who are infectious, many people are being missed. Ventilation in clinics is often poor, particularly in smaller rooms. This could be improved by opening windows and doors, or retrofits. However, there are tensions between improving airflow and thermal comfort. There are large variations in crowding in clinics during the course of the day. Staff find it hard to prevent bottlenecks occurring, and to implement infection prevention control measures. Crowding could be reduced by better queue management and appointment systems. Policy makers and practitioners prioritised seven interventions to reduce TB transmission in clinics. Mathematical modelling suggested that installing UV lights and better queue management would have the highest impact. These interventions could reduce all new TB episodes in rural South Africa over the next decade by 3-8%. All interventions were highly cost-effective. |
Exploitation Route | The award is still active, and there are further outputs still in progress. However these results may have implications for policy on how to find people with TB earlier, and on interventions to reduce TB transmission in clinics. |
Sectors | Healthcare |
URL | https://www.lshtm.ac.uk/research/centres-projects-groups/uo#updates |
Description | Policy maker and practitioner participants in the group model building workshops (in 2019) asked for advice on how to use this technique in their work. The group model building and system dynamics modelling techniques have been used in other research projects. In January 2023, we met with architects developing the templates for new primary healthcare clinic buildings in South Africa and gave input into their designs concerning infection prevention and control. When implemented, these improved designs could reduce the risk of transmission of TB and other airborne infections (including SARS-CoV-2) in all newly-constructed primary healthcare facilities in South Africa. In September 2023 as a result of a webinar to the South Africa TB Think Tank, one of our team was asked to join the TB prevention task team to advice on implementation of TB infection control interventions. |
First Year Of Impact | 2020 |
Sector | Healthcare |
Impact Types | Economic Policy & public services |
Description | Advice to architects designing primary healthcare clinics in South Africa |
Geographic Reach | National |
Policy Influence Type | Contribution to new or improved professional practice |
Description | Exemplars in Primary Health Care |
Amount | $1,568,534 (USD) |
Funding ID | INV-021815 |
Organisation | Bill and Melinda Gates Foundation |
Sector | Charity/Non Profit |
Country | United States |
Start | 11/2020 |
End | 04/2023 |
Description | Modelling the impact on ventilation rates and thermal comfort of pragmatic adaptations to the structure of primary healthcare clinics in South Africa, to inform interventions to reduce Mycobacterium tuberculosis infection in healthcare workers |
Amount | £20,000 (GBP) |
Organisation | The Colt Foundation |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 04/2021 |
End | 06/2023 |
Description | Using system dynamics modelling for collaborative, evidence-based design of interventions to reduce tuberculosis transmission in South African health facilities |
Amount | £199,997 (GBP) |
Funding ID | CCF17-7779 |
Organisation | Bloomsbury Colleges |
Sector | Academic/University |
Country | United Kingdom |
Start | 04/2019 |
End | 10/2020 |
Title | Code and data for the paper Improving estimates of social contact patterns for the airborne transmission of respiratory pathogens |
Description | Code for the paper Improving estimates of social contact patterns for the airborne transmission of respiratory pathogens |
Type Of Material | Computer model/algorithm |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | not discernable yet |
URL | http://github.com/NickyMcC/CasualAgeMixing |
Title | Code determining absolute ventilation in non-steady state |
Description | Approach 1 and Approach 2 code for determining absolute ventilation in non-steady states |
Type Of Material | Computer model/algorithm |
Year Produced | 2019 |
Provided To Others? | Yes |
Impact | none discernable |
URL | https://github.com/ArminderD/ventilation |
Title | Cost model for TB treatment services |
Description | Cost model with all unit costs of interventions and TB treatment services, which were used in the cost-effectiveness analysis |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | none discernable yet |
URL | https://academic.oup.com/heapol/article/37/3/369/6482834?login=true |
Title | Data sets from paper Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: a whole systems approach |
Description | 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 |
Type Of Material | Database/Collection of data |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | not discernable yet |
URL | https://data.ahri.org/index.php/catalog/1026 |
Title | Model code and example input files for a within clinics mathematical model of patient movement through clinics, including ventilation rates, and infection risk. |
Description | Within clinics model Model code and example input files for the paper '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' |
Type Of Material | Computer model/algorithm |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | none discernable yet |
URL | https://github.com/NickyMcC/WithinClinics |
Title | Social contact information from PIPSA residents in uMkhanyakude before and during the Covid-19 pandemic - data from the Umoya Omuhle and Covid Social Contacts studies |
Description | Social contact behaviour dataset from KwaZulu-Natal from the paper "Impact of the Covid-19 epidemic and related social distancing regulations on social contact and SARS-CoV-2 transmission potential in rural South Africa: analysis of repeated cross-sectional survey." Social contact behaviour dataset from KwaZulu-Natal. Can be used to understand patterns of social contact relevant for the transmission of infectious diseases, and to parameterise mathematical models. |
Type Of Material | Database/Collection of data |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | none yet |
URL | https://data.ahri.org/index.php/catalog/1018 |
Title | Social contact model of TB in congregate settings |
Description | Model code for paper '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' |
Type Of Material | Computer model/algorithm |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | impacts not yet clear |
URL | https://github.com/NickyMcC/ClinicTransmissionModel |
Description | Collaboration on building design to improve thermal comfort |
Organisation | University College London |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | As as result of the Umoya omuhle project, we collaborated with architects and building designers to model adaptations to primary health care clinics to maximise ventilation while maintaining thermal comfort. We contributed data and our experience of the practicalities of implementing IPC interventions. |
Collaborator Contribution | Partners brought expertise in building design and in simulation modelling of building adaptations. |
Impact | A report has been submitted to the funder and a publication is in progress. This work formed part of our presentation to the South Africa TB Think Tank in September 2023 and contributed to Dr Tom Yates being asked to join the TB prevention task team. |
Start Year | 2020 |
Description | Collaboration with Vukuzazi project |
Organisation | Africa Health Research Institute |
Country | South Africa |
Sector | Charity/Non Profit |
PI Contribution | Data from the Umoya omuhle clinic TB prevalence survey |
Collaborator Contribution | Data from the Vukuzazi community TB survey |
Impact | doi: 10.1093/cid/ciab970 |
Start Year | 2020 |
Description | Using system dynamics modelling for collaborative, evidence-based design of interventions to reduce tuberculosis transmission in South African health facilities |
Organisation | London School of Economics and Political Science (University of London) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Developing and testing an approach that engages stakeholders in the development of SDM 'causal loop' models depicting system-wide factors influencing TB and DR-TB transmission in primary health clinics in South Africa. The first SDM workshop was completed in early August 2019; workshop turnout was high (9 policy-makers and 15 practitioners) and participation was enthusiastic. |
Collaborator Contribution | Reviewed the literature and synthesised evidence around how SDM systems modelling that may affect evidence use for informing health policy and related decision making. To explore and document current and 'routine' approaches to health policy-related debate and decision-making at provincial and national level. LSE are providing conceptual input to evidence-use and research uptake. |
Impact | SDM 1 August 2019 workshop - interviews with 11 policymakers and practitioners in August 2019 The first SDM workshop was completed in early August 2019; workshop turnout was high (9 policy-makers and 15 practitioners) and participation was enthusiastic 3 follow up drop in calls have been conducted with the workshop participants (Sep 2019, Nov 2019 and Feb 2020) The follow up SDM workshop was held in October 2020, on line because of the COVID pandemic. This is a multidisciplinary collaboration involving anthropologists, epidemiologists, mathematical modellers, economists, health systems researchers and other social scientists. |
Start Year | 2019 |
Description | AHRI - Department of Health research feedback meeting |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | At an event at the Africa Health Research Institute for senior managers and clinic representatives from the local health district, our results were showcased. After our presentation, the District Director of the uMkhanyakude Health District Office requested to be sent our presentation, commenting that our results would help her to persuade clinic staff to implement TB infection prevention and control measures. |
Year(s) Of Engagement Activity | 2023 |
Description | AHRI community advisory board presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Presentation of the study to the AHRI community advisory board |
Year(s) Of Engagement Activity | 2017 |
Description | Africa Health Research Institute meeting with KwaZulu-Natal Department of Health |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | This was a meeting between the Africa Health Research Institute and the provincial Department of Health, where we presented preliminary findings of our clinic prevalence survey. . There was discussion of the implications of our findings for TB services. |
Year(s) Of Engagement Activity | 2019 |
Description | Blog on mask wearing |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | Blog on masks for infection control, published as mask wearing became UK law. 932 views. |
Year(s) Of Engagement Activity | 2020 |
URL | https://www.lshtm.ac.uk/research/centres-projects-groups/uo#updates |
Description | Briefing session on the UO TB infographic with the South Africa National AIDS council |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Briefing session on the TB infographic by LSHTM co-investigator with Dr Thembisile Xulu of the South African National AIDS Council and her colleagues along with staff from the South African National Department of Health. |
Year(s) Of Engagement Activity | 2022 |
Description | Controlling the spread of disease with the help of social science - podcast |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Podcast in which team members talk about the importance of social science insights in disease control. 2600 views as of March 2021. |
Year(s) Of Engagement Activity | 2020 |
URL | https://anchor.fm/lshtm/episodes/S1E32-Controlling-the-spread-of-disease-with-the-help-of-social-sci... |
Description | Expert workshop on tuberculosis transmission in South African primary healthcare facilities. Perspectives of practice stakeholders |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | The workshop's objective was to gather the perspectives of a range of practitioners involved in TB care and public health in South Africa concerning the drivers of TB and drug-resistant TB transmission in health facilities in order to understand challenges to policy implementation, and explore novel, feasible and sustainable solutions to this problem. The workshop facilitated participatory model-building exercises to generate ideas for interventions. The exercise was designed to that the experts' unique voices, experiences and recommendations were included in the development of interventions. The group loved the interactive model building exercise and reported they would use it in their own work contexts. Some asked for further advice on how to use the method. There was active engagement in the model building process and an interest to continue to be involved in the development of the intervention in forthcoming meetings. |
Year(s) Of Engagement Activity | 2019 |
Description | Feedback of research results to participating clinics in South Africa |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Researcher visited 12 clinics - 6 in KwaZulu-Natal and 6 in Western Cape province, South Africa to feedback results of the project to clinic staff. Gave presentation followed by a workshop. Distributed a report from a workshop and a summary of the project results. Both available on our Umoya omuhle website. Noted lots of positive changes concerning infectious prevention and control - eg outdoor waiting areas, mask wearing, motivated by COVID; staff reported that participation in our project had facilitated these changes.. Questions posed about thermal comfort and how to manage this in the hot weather. Questions about difficulties in identifying people with TB |
Year(s) Of Engagement Activity | 2021 |
Description | Feedback to project reference group |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Discussed results with our project reference group who included representatives from the South African Department of Health and academia. Pietermaritzburg TB Director at KwaZulu-Natal Department of Health at KZN Department of Health. KZN Department of Health's TB Programme Manager. Public Health Medicine specialist running the Occupational Medicine Service at King Dinuzulu Hospital in KwaZulu-Natal. Professor of Medicine University of Cape Town |
Year(s) Of Engagement Activity | 2021 |
Description | Feedback to system dynamics modelling participants - 7 October 2020 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Feedback to South African policy makers and practitioners, following from the previous workshop in which they prioritised IPC interventions. We reported back on the results of modelling these interventions. |
Year(s) Of Engagement Activity | 2020 |
Description | Formal meetings with policy makers to discuss project research findings |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | UO researcher met with the following people in South Africa: KwaZulu-Natal (KZN) Department of Health (DoH) Regional Training Centre Manager, KZN DoH in Pietermaritzburg; Ritshidze at Umlazi Community Health Clinic - provided handout with our results Western Cape architects and engineers - 4 people for an hour. Discussed challenges they face working in the system. National DoH staff- (Deputy Director, Primary Care, National DoH) in Pretoria. In addition to study findings researcher relayed impressions current status of infection prevention and control at the clinics - feedback could potentially influence policy and action. Senior Health Technical Advisor, National DoH in Johannesburg to discuss project findings Reported project findings to workshop attendees including Cape Town Metro DoH representative at Stellenbosch University; Public Health Practitioner (Western Cape Government) Right to Care; the Aurum Institute; CSIR; NICD |
Year(s) Of Engagement Activity | 2021 |
Description | Group model building workshop to gather the perspectives of policymakers in South Africa concerning the drivers of TB and drug-resistant TB transmission in health facilities |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | We held a workshop for South African provincial and national policy makers to do a group model building exercise concerning TB transmission in primary healthcare facilities. This will inform our subsequent prioritisation of interventions for TB (and drug-resistant TB) infection prevention and control which we will subsequently use in system dynamics, mathematical and economic modelling. This will lead to recommendations for policy in South Africa and elsewhere. We held three follow-up calls with participants to get further input as the models are refined. This activity also raises awareness of our research among policy makers. |
Year(s) Of Engagement Activity | 2019 |
Description | In epidemics, our health facilities can become hotspots. Here's what to do about it. 25 June 2020 |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | An op ed written for a South African health journalism website about the parallels between infection control for COVID-19 and for tuberculosis, and what lessons we can learn from experience researching infection control for TB. As a result of this, Dr Indira Govender was asked to do an interview on the SA TV channel Newzroom about the parallels between COVID-19 and TB infection control. |
Year(s) Of Engagement Activity | 2020 |
URL | https://bhekisisa.org/opinion/2020-06-25-covid19-lessons-from-tb-infection-control-south-africa/ |
Description | KZN DoH research day - Dec 2021 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Two project researchers fed back our results to the South African provincial Department of Health (virtual meeting). The meeting was attended by NGOs including CAPRISA, SAMRC, Enhancing Care Foundation, HSRC, AHRI, DoH, University of KwaZulu-Natal. The meeting resuled in interaction with the Deputy Director General in the provincial DoH. He gave the closing address and appreciated the speed he had received materials from the project. The meeting led to interaction with Deputy Director of Research & Knowledge Management and and Director of the same unit. They requested the project summary for clinics and the link to the publications page, as well as a copy of the patient flow workshop report. |
Year(s) Of Engagement Activity | 2021 |
Description | Meeting in York on Building Design |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Talk on "Clinic design, patient flow and the organisation of care: responding to tuberculosis transmission in primary care facilities in South Africa". The discussion focused on design for microbial control for the twenty first century. This project presentation was the only one to focus on a non-high income context, and also focused the discussion on LMIC contexts. |
Year(s) Of Engagement Activity | 2022 |
Description | PI gave talk to South African mines occupational health conference on TB and occupational health |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Talk to South African mines occupational health conference on TB and occupational health. Attended by occupational health staff plus mine doctors plus union representatives. |
Year(s) Of Engagement Activity | 2021 |
URL | https://mhsc.org.za/ |
Description | Participatory workshop on patient flow and waiting times |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | To bring together experts in measurement and modification of waiting time, physical space, person movement, primary health care policy, primary health clinic operations, and infection prevention & control to share knowledge and perspectives around measuring and modifying patient flow in South African primary health clinics and to develop methods to assess and improve flow in these settings. Objectives were 1. to facilitate discussion for exchange of ideas and create a 'reference group' for future similar discussions/publications. 2. to design rapid assessment tool/s to assess waiting times, flow, and crowding in South African primary health clinics (PHCs) 3. to devise simple short- and long-term strategies to reduce crowding/improve flow in PHCs Participants were very interested in the methods used in our project and requested further follow up meetings to hear more about the project as it evolves, and to contribute their views on the emerging findings. |
Year(s) Of Engagement Activity | 2019 |
Description | Presentation at KwaZulu-Natal TB Advisory Group meeting |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | Presentation of results of clinic TB prevalence survey to the provincial TB advisory group, comprising staff from the Kwa-Zulu-Natal Department of Health, TB programme managers and clinical staff from the province, and researchers. Participants were very interested in the results which seeks to identify how much transmission occurs in health care facilities and to identify interventions to reduce this. The meeting ensures that research is used to inform policy and practice. |
Year(s) Of Engagement Activity | 2019 |
Description | Presentation to South Africa TB Think Tank working group on TB prevention |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | Presentation on issues affecting implementation of TB infection prevention and control guidelines in South African primary healthcare facilities. |
Year(s) Of Engagement Activity | 2020 |
Description | Presentation to Western Cape Management team, 26 October 2020 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | Invited presentation about the project to the Western Cape management team, comprising city of Cape Town health managers. They were particularly interested in our modelling of the effect of appointment systems and queue management. |
Year(s) Of Engagement Activity | 2020 |
Description | Presentation to the KwaZulu-Natal Department of Health |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | Presentation of early results from our clinic TB prevalence survey to senior staff from the KwaZulu-Natal Department of Health. |
Year(s) Of Engagement Activity | 2018 |
Description | Presentation: Preventing TB and DRTB transmission in primary healthcare clinics in South Africa - ESRC |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Study participants or study members |
Results and Impact | Workshops to consolidate learning from across UKRI-funded Antimicrobial Resistance (AMR) projects to synthesise and highlight high-level findings of global relevance from these research investments. To enable grant holders to compare key findings and to engage high-level stakeholders, in order to maximise impact for policy and practice. |
Year(s) Of Engagement Activity | 2021 |
Description | Public health responses symposium: combatting infectious disease and AMR - Bloomsbury SET |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Other audiences |
Results and Impact | Invited presentation: "Using system dynamics modelling for collaborative, evidence-based design of interventions to reduce tuberculosis transmission in South African health facilities". Interest from and links made with the group at LSE running the LEAD project (Dr Cristin Fergus & Prof Tim Allen), Dr Nina Zhu (Imperial and PHE) who does system dynamics modelling work, and with Kevin Queenan (does food sustainability work in South Africa and is looking to use similar methods). |
Year(s) Of Engagement Activity | 2020 |
URL | https://www.eventbrite.co.uk/e/public-health-responses-symposium-combatting-infectious-disease-amr-b... |
Description | Radio interview - South Africa Community radio station (Rise FM) to talk about TB IPC, TB transmission and COVID |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Researcher from the Umoya omuhle team participated in a community radio station interview - Rise FM - in Somkhele, KwaZulu-Natal to talk about TB and transmission on Monday the 1st of November 2021. The opportunity to speak on local radio provided a valuable opportunity to convey important public health messages to community members that live and work in the surrounding area where the Umoya omuhle research was conducted. |
Year(s) Of Engagement Activity | 2021 |
Description | SA-TB presentation; Preventing TB transmission in PHCs, and implications for COVID |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | TB and COVID 2021 virtual conference. SA-TB hosted a virtual conference to to promote engagement and interaction of stakeholders from government, the private sector, academia, NGOs, and advocacy groups. Event used to demonstrate progress, new drugs and diagnostics in TB, new treatment approaches for COVID. PI of project presented findings from our work. Audience engaged. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.tbconference.co.za/Presentations/ |
Description | South Africa TB Think Tank webinar |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | We gave a webinar summarising the results of the project to the South Africa TB Think Tank (https://tbthinktank.org/), a national network of TB experts who advise the NDoH on evidence-based TB prevention and control policy and programmes. As a consequence of this webinar, one of our team was asked to join the TB prevention task team of the Think Tank to provide advice on TB infection control interventions. |
Year(s) Of Engagement Activity | 2023 |
URL | https://tbthinktank.org/webinar-series-videos/ |
Description | Stakeholder meeting |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | A meeting for key policymakers (representing the South African National Department of Health and the two provincial departments of health where the research will be undertaken) and researchers to discuss our research plans, and get their advice and input. This drew out attention to aspects of infection control policy that we were not aware of. We also sought advice on where to undertake the research. |
Year(s) Of Engagement Activity | 2017 |
URL | https://www.ahri.org/kick-off-meeting-innovative-project-tackle-tb-kzn-western-cape/ |
Description | TV interview: Indira Govender, 26 June 2020 |
Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | Interview on the South African channel Newzroom with Dr Indira Govender talking about infection prevention and control: lessons for coronavirus from TB. Newzroom is estimated to reach 12% of the South African newswatching audience. |
Year(s) Of Engagement Activity | 2020 |
URL | https://youtu.be/NsFFb6W0kc4 |
Description | Talk at TB2018 (AIDS2018) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Project described as part of an invited talk on TB /HIV service integration at the TB2018 conference. |
Year(s) Of Engagement Activity | 2018 |
URL | http://www.tb2018.org/Portals/7/File/tb2/TB_2018__Programme.pdf?ver=2018-06-11-180832-347 |
Description | UO health systems webinar |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | International virtual 'round table' highlighting critical issues around the whole systems approach employed in the Umoya omuhle project, including methods, prioritisation of evidence, and the trade-offs involved in intervention design. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.lshtm.ac.uk/research/centres-projects-groups/uo#events |
Description | Webinar: preliminary findings from the Umoya omuhle project |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Webinar presenting the preliminary findings of the project, primarily directed at an audience of South African policymakers and practitioners with responsibility for TB/DRTB and TB infection prevention and control programmes. We received many messages giving positive feedback and seeking further information, particularly about cost-effectiveness of the interventions. As a result of this presentation we were asked to make a similar presentation to the Western Cape management team, South Africa. |
Year(s) Of Engagement Activity | 2020 |
Description | Webinar: updated findings from the Umoya omuhle project 3 March 2021 |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Webinar presenting updated findings from Umoya omuhle, including cost effectiveness of interventions. Aimed at both a South African and an international audience. Attendees from South African Department of Health (national, provincial and local), South African treasury, WHO, CDC, international TB researchers, NGOs, advocacy groups. Positive feedback from attendees. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.lshtm.ac.uk/research/centres-projects-groups/uo#updates |
Description | Workshop on antibiotic resistance-related intervention impact evaluation 18 March 2020 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Presentation about using system dynamics modelling as part of a workshop on evaluation of AMR interventions. As a consequence, invited to upload work to an AMR hub. |
Year(s) Of Engagement Activity | 2020 |
Description | Zoom meeting with Treatment Action Campaign |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Third sector organisations |
Results and Impact | Had a zoom meeting on the 11th of August from 12h30 to 13h30. Two TAC/Ritshidze organisers joined two project staff. We discussed the work that Ritshidze is doing and how Umoya omuhle relates to it. We discussed the possibility of information sharing. Then we were invited to the provincial feedback meeting for KZN in Umlazi. Shared the UO infgraphic with them. |
Year(s) Of Engagement Activity | 2021 |