Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Recent increases in rates of TB among HCWs, as well as hospital-based outbreaks of multidrug-resistant TB among HIV-infected patients, have led to greater concern about the risk of Mycobacterium tuberculosis transmission in healthcare settings, particularly in Africa. A recent study estimated that the risk of exposure to TB for hospital workers may be 40 times greater than that for the general population. This study therefore aims to decrease the nosocomial transmission of TB among HCWs and patients by mapping the routes of transmission using molecular epidemiological methods and to quantify risk in order to develop comprehensive prevention measures. Genotyping will be used to examine the polymorphic marker congruence between patient and HCW TB cases. This study will be conducted at six regional hospitals in South Africa; two in the Free State Province, two in the Western Cape and two in KwaZulu-Natal. Research tools will include a knowledge, attitudes and behaviour questionnaire to assess individual and organizational barriers to compliance with infection control practices for TB, a comprehensive facility-level infection control assessment, investigations of case-to-contact transmission among HCWs and patients, where active TB disease is the outcome of interest, and molecular epidemiological methods for all positive cases involving a HCW to document nosocomial transmission links. Findings will inform the implementation of TB infection control measures as well as an education and training program. Consistent application of infection control principles across the healthcare spectrum is important not only in resource-strained settings such as South Africa, but in Canada as well with the emergence of pandemic influenza, SARS, and other infectious diseases. This research is necessary to ensure that we adequately promote and protect the health of our valued HCWs and all patients in the era of emerging and re-emerging infectious diseases.