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
BMJ Global Health·
- DOI
- 10.1136/bmjgh-2021-007136
- PMID
- 35396264
- PMCID
- PMC8995945
- OpenAlex
- W4226189256
- Study type
- Journal article
- Publisher
- BMJ
- Article type
- journal-article
- Integrity
- current
Publication version
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Open linked preprint →Why this research matters now
The findings indicate that primary healthcare clinics may contribute to community tuberculosis burden in the modeled setting and that clinic infection-prevention measures could have effects beyond healthcare workers and patients. These implications are model-based estimates for the study community and period, not observed outcome measurements.
Structured evidence summary
Research question
The study estimated how much adult tuberculosis disease in a KwaZulu-Natal community was attributable to transmission in primary healthcare clinics and assessed the potential effect of clinic infection-prevention measures on community tuberculosis cases and deaths.
Study design
The authors developed an individual-based model of Mycobacterium tuberculosis transmission across households, primary healthcare clinics, and other congregate settings. The model used community contact and tuberculosis prevalence data to generate estimates for clinic-attributable transmission and intervention effects.
Population and setting
The model represented a high-HIV-prevalence community in KwaZulu-Natal, South Africa, including adults and transmission occurring in households, primary healthcare clinics, and other congregate settings. Estimates were also stratified by HIV status.
Main findings
The model estimated that clinic-based transmission accounted for 7.6% of adult tuberculosis in 2019, with a plausible range of 3.9% to 13.9%, and estimated higher attribution among people with HIV than among those without HIV. Modeled infection-prevention measures were associated with estimated reductions of 3.4% to 8.0% in incident community cases and 3.0% to 7.2% in deaths during 2021-2030.
Public-health relevance
The findings indicate that primary healthcare clinics may contribute to community tuberculosis burden in the modeled setting and that clinic infection-prevention measures could have effects beyond healthcare workers and patients. These implications are model-based estimates for the study community and period, not observed outcome measurements.
Important limitations
The results are estimates from an individual-based transmission model parameterized with data from one high-HIV-prevalence community, so their applicability to other settings is not established by the supplied evidence. This summary relies only on the supplied single-article abstract and metadata; the original paper is required for decision-grade assessment of model assumptions, uncertainty, and limitations.
GIDS interpretation
The article is discoverable under tuberculosis, South Africa, transmission dynamics, and antimicrobial resistance-related topic classification. The supplied evidence provides contextual literature information only and does not establish or confirm any live surveillance signal.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 11 auditable classifier relationships to diseases, places, topics, and study design.