Healthcare workers (HWs) in North Central Nigeria face a heightened risk of contracting tuberculosis (TB), particularly in settings where they work with people living with HIV (PLHIV). The significant risk stems from the close interaction between HWs and their HIV-infected patients, making them more susceptible to infections. This article explores the perceptions of HWs regarding their risk, the reality of TB infection rates confirmed through medical testing, and the implementation of TB infection control (IC) measures in their workplaces. These critical findings highlight the urgency for strengthened infection control practices to ensure the safety of healthcare workers.
Background
The Global Health Threat of Tuberculosis
Tuberculosis remains a significant global health threat, especially among individuals with compromised immune systems, such as those living with HIV. Even before the COVID-19 pandemic, TB held the grim title of being the leading cause of death from a single infectious agent. Despite advancements in diagnosing and treating TB, the disease continues to claim countless lives worldwide, predominantly affecting PLHIV. The close interaction between healthcare workers and their HIV-infected patients places HWs at an elevated risk of contracting TB. Thus, comprehending HWs’ perception of this risk is imperative to bolster infection control measures and safeguard their health.
The Intersection of HIV and TB
The intersection of HIV and TB presents a daunting dual health crisis, particularly in low-resource settings like North-Central Nigeria. This dual crisis underscores the significant occupational risk of TB infection among healthcare workers in HIV clinics, affecting both clinical and non-clinical staff alike. One notable trend from the study is that HWs with lower educational attainment showed poorer perception and understanding of TB risk. This highlights the essential need for targeted TB IC training programs focused specifically on this demographic. By addressing these knowledge gaps, infection control practices can be significantly improved, offering better protection for HWs against TB.
Study Design and Methods
The TRACING Study
The study was part of the broader “Mycobacterium Tuberculosis Infection Rate among HWs in an HIV Care and Treatment Centre in Nigeria (TRACING) Study,” funded by the European Developing Countries Clinical Trial Partnership (EDCTP). Conducted across 14 health facilities with dedicated HIV clinics in North-Central Nigeria, the study included 337 healthcare workers. These workers completed a structured questionnaire to gauge their perception of TB risk and provided blood samples for Mycobacterium tuberculosis infection testing using the Interferon-Gamma Release Assay (IGRA) method. The data were analyzed using a range of statistical methods, including univariate, bivariable, and multivariable analyses, with significance established at a 5% confidence level using STATA version 18.
Data Collection and Analysis
The findings based on blood samples revealed a 42.8% prevalence of TB infection among healthcare workers in HIV clinics. When comparing IGRA results with perceived risk of TB, it was observed that HWs who did not consider themselves at risk had a higher prevalence of TB infection (48.7%) compared to those who acknowledged the risk (41.9%). This discrepancy between perception and actual infection rates highlights the necessity for reinforced education and awareness programs to accurately convey the severity of TB risk among healthcare professionals. Furthermore, it underscores the importance of regular testing and monitoring to identify and address TB infections promptly.
Results
Perception of TB Risk
The study indicated that an overwhelming majority (86.9%) of healthcare workers perceived themselves to be at risk of TB. Interestingly, the perception of TB risk was significantly lower among male HWs (Odds Ratio [OR]: 0.50; 95% Confidence Interval [CI]: 0.26–0.95). Factors such as age and educational background played critical roles in risk perception. Younger HWs (below 20 years), those with no formal or just primary education, and those working in primary or secondary healthcare facilities were significantly less likely to perceive themselves at risk. On the other hand, daily monitoring of TB IC practices and having a designated area for sputum collection heightened the perceived risk of TB among healthcare workers, emphasizing the role of rigorous infection control protocols in raising awareness among HWs about the actual risks involved.
Factors Affecting Perception of Risk
Several determinants influenced the perception of TB risk among healthcare workers. Age was a significant factor, with younger HWs (under 20 years) perceiving less risk than their older colleagues. Education also played a crucial role; HWs with no formal or primary education were much less likely to recognize their risk compared to those with tertiary education. Additionally, HWs operating in tertiary healthcare facilities perceived a greater risk compared to those in primary and secondary healthcare settings. This could be attributed to better infection control measures and heightened awareness programs typically found in tertiary care settings. The disparities in perception underscore the need for tailored educational initiatives aimed at bridging the knowledge gap, particularly among younger and less-educated HWs.
TB Infection Control Practices
Implementation of TB IC Practices
The study revealed varying levels of implementation of TB IC practices across different healthcare settings. Facilities that employed robust daily monitoring of TB IC practices and designated sputum collection areas showed a higher perception of TB risk among healthcare workers. This finding underscores the importance of stringent monitoring and control measures in shaping HWs’ understanding and awareness of TB risks. Conversely, annual HIV testing within healthcare facilities was linked to a reduced perception of TB risk among HWs. This reduction in perceived risk might suggest a false sense of security among HWs, potentially undermining the effectiveness of TB IC efforts. Ensuring a consistent and comprehensive approach to infection control is key to promoting accurate risk perception and preventing complacency.
Environmental Controls and Administrative Measures
The study underscored the critical importance of environmental controls and administrative measures in managing TB risk within healthcare settings. Areas where TB IC practices were rigorously monitored and those with designated sputum collection zones had healthcare workers who were more likely to understand and perceive their TB risk accurately. This correlation suggests that a well-structured infection control framework is vital in not only reducing infection rates but also in enhancing disease awareness and proactive health-seeking behaviors among HWs. Facilities that lacked these controls often had HWs with a lower perception of TB risk, indicating that gaps in infection control protocols can contribute to an inaccurate understanding of actual TB risks.
Policy Implications and Recommendations
Strengthening TB IC Strategies
The findings from this study provide crucial insights into policy formulation for managing the interplay between TB and HIV. There is an unequivocal need to bolster TB IC strategies, particularly within HIV care settings. One of the primary recommendations is the implementation of regular and comprehensive TB IC training programs. These should target all HWs, with special focus on younger workers and those with lower educational backgrounds to bridge existing knowledge gaps.
Enhanced Monitoring and Resources Allocation
Facilities should adopt rigorous daily monitoring of TB IC practices to promptly identify and rectify gaps. Additionally, the development and maintenance of designated TB IC areas, such as sputum collection zones, are paramount. Such environmental controls can significantly heighten HWs’ awareness and perception of TB risks, promoting better adherence to infection control protocols. Furthermore, it is essential to allocate adequate resources to primary and secondary healthcare facilities to elevate their TB IC standards to match those found in tertiary settings. A uniform standard across all healthcare levels ensures a cohesive and effective approach to TB infection control.
Conclusion
In North Central Nigeria, healthcare workers (HWs) face an increased risk of contracting tuberculosis (TB), especially in environments where they care for people living with HIV (PLHIV). The close interaction required with HIV-infected patients significantly raises this risk, making HWs more vulnerable. This issue is compounded by the high TB infection rates confirmed through medical testing among these workers. The article delves into HWs’ perceptions of their vulnerability, the documented reality of TB infections, and the implementation of TB infection control (IC) measures within healthcare facilities. The findings underscore an urgent need for improved infection control practices to protect these healthcare professionals effectively.
Moreover, the article sheds light on the specific IC measures currently in place and points out their inadequacies in preventing TB transmission among healthcare workers. There is a pressing need for stronger protocols, better training, and more resources to ensure that HWs can perform their duties without the looming threat of contracting TB. Enhancing these measures is critical not just for the safety of the HWs but also for the overall effectiveness of the healthcare system in managing TB and HIV. This calls for a coordinated response that includes policy changes, increased funding, and targeted interventions aimed at reducing TB transmission rates.
