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.
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.
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DOI：
10.1136/bmjgh-2021-007124
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发表时间：
2021-10
影响因子：
8.1
通讯作者：
Grant AD
中科院分区：
文献类型：
--
作者：
McCreesh N;Karat AS;Baisley K;Diaconu K;Bozzani F;Govender I;Beckwith P;Yates TA;Deol AK;Houben RMGJ;Kielmann K;White RG;Grant AD
卫生保健工作者中结核病发病率的升高表明，在高负担环境中的卫生设施中结核分枝杆菌的传播率很高。在一个采用全系统方法预防和控制结核病感染（IPC）的项目背景下，我们旨在评估传统和新型IPC措施对结核分枝杆菌向患者和其他临床参与者传播的潜在影响。开发了一个基于个体的患者通过诊所、候诊区通风和结核分枝杆菌传播的模型，并使用来自南非两个省8个诊所的经验数据进行了参数化。与卫生专业人员和政策制定者共同开发的七种干预措施进行了模拟：(1)设置室外等候区的排队管理系统；(2)紫外线杀菌照射（UVGI）系统；(3)预约系统；(4)打开门窗；(5)门诊人员佩戴外科口罩；(6)简单的诊所改造；(7)通过中央慢性药物调剂和分配（CCMDD）服务增加抗逆转录病毒治疗处方和社区药物收集点的覆盖范围。在该模型中，(1)室外候诊区减少了83% (IQR为76%-88%),(2)UVGI减少了77% (IQR为64%-85%),(3)预约系统减少了62% (IQR为45% - 75%),(4)打开门窗减少了55% (IQR为25%-72%),(5)口罩减少了47% (IQR为42%-50%),(6)诊所改造减少了45% (IQR为16%-64%),(7)将CCMDD的覆盖率增加了22% （IQR为12%-32%）。大多数干预措施使诊所参诊人员的传播率中位数至少降低了45%，这意味着有一系列可根据当地情况量身定制的高效干预措施可供选择。传统上不被视为IPC干预措施的措施，如预约制度，可能与更传统的IPC措施（如戴口罩）同样有效。
Elevated rates of tuberculosis in healthcare workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high-burden settings. In the context of a project taking a whole systems approach to tuberculosis infection prevention and control (IPC), we aimed to evaluate the potential impact of conventional and novel IPC measures on Mtb transmission to patients and other clinic attendees. An individual-based model of patient movements through clinics, ventilation in waiting areas, and Mtb transmission was developed, and parameterised using empirical data from eight clinics in two provinces in South Africa. Seven interventions—codeveloped with health professionals and policy-makers—were simulated: (1) queue management systems with outdoor waiting areas, (2) ultraviolet germicidal irradiation (UVGI) systems, (3) appointment systems, (4) opening windows and doors, (5) surgical mask wearing by clinic attendees, (6) simple clinic retrofits and (7) increased coverage of long antiretroviral therapy prescriptions and community medicine collection points through the Central Chronic Medicine Dispensing and Distribution (CCMDD) service. In the model, (1) outdoor waiting areas reduced the transmission to clinic attendees by 83% (IQR 76%–88%), (2) UVGI by 77% (IQR 64%–85%), (3) appointment systems by 62% (IQR 45%–75%), (4) opening windows and doors by 55% (IQR 25%–72%), (5) masks by 47% (IQR 42%–50%), (6) clinic retrofits by 45% (IQR 16%–64%) and (7) increasing the coverage of CCMDD by 22% (IQR 12%–32%). The majority of the interventions achieved median reductions in the rate of transmission to clinic attendees of at least 45%, meaning that a range of highly effective intervention options are available, that can be tailored to the local context. Measures that are not traditionally considered to be IPC interventions, such as appointment systems, may be as effective as more traditional IPC measures, such as mask wearing.
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DOI：
10.1093/cid/ciaa720
发表时间：
2021-01-23
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Karat AS;Gregg M;Barton HE;Calderon M;Ellis J;Falconer J;Govender I;Harris RC;Tlali M;Moore DAJ;Fielding KL
通讯作者：
Fielding KL
影响因子：
8.1
作者：
Kielmann, Karina;Karat, Aaron S.;Grant, Alison D.
通讯作者：
Grant, Alison D.
DOI：
10.1164/rccm.201107-1190oc
发表时间：
2012-05-15
影响因子：
24.7
作者：
Dharmadhikari, Ashwin S.;Mphahlele, Matsie;Nardell, Edward A.
通讯作者：
Nardell, Edward A.
DOI：
10.5588/ijtld.19.0410
发表时间：
2020-04-01
影响因子：
4
作者：
McCreesh, N.;Grant, A. D.;White, R. G.
通讯作者：
White, R. G.
影响因子：
5
作者：
RILEY, EC;MURPHY, G;RILEY, RL
通讯作者：
RILEY, RL