CAPE TOWN, South Africa – Health care workers should be considered a key population along with prisoners, miners, and other populations that are at higher risk than the general public of becoming infected with tuberculosis, speakers here said Friday.
Health workers in high-burden countries have more than three and a half times the risk of others that they will acquire tuberculosis, Courtney Emerson of the U.S. Centers for Disease Control and Prevention said. The majority of workers, though, do not get screened for TB for the same reasons non-health care workers avoid getting tested for TB: stigma associated with the disease, discrimination against those who have it, and a potential loss of income with a positive diagnosis.
“Health care workers are willing to have their blood sugar tested,” Anna Maruta of the Biological Research and Training Institute in Zimbabwe, said. “But, when you say, come for TB screening, no one wants to come.”
In South Africa, only half of health care facilities have occupational health policies, and only slightly more than a third of health care workers are screened for tuberculosis. In Uganda, health care workers reported there is no routine screening for tuberculosis at the workplace, Emerson said. In China, only about a quarter of health care workers were screened for tuberculosis before employment.
In 2010, only two out of 33 health facilities in Zimbabwe had annual TB screening programs for health care workers, Maruta said. While, with funding from the President’s Emergency Plan for AIDS Relief, 24 sites now do routine screening, more than half of health care workers still do not get screened, Maruta said. They fear stigma, breaches of confidentiality, and being tested for HIV, and are unwilling to be screened on site, Maruta, who herself acquired TB as a nursing student, said.
In June, Zimbabwe launched a national infection prevention and control policy, which includes strengthening workplace programs to reduce the risk of workers acquiring TB, HIV, and hepatitis B and C. But, Maruta said, “the introduction of a policy is not sufficient without a more comprehensive approach.” That, she said, would include measures to maintain confidentiality, a standardized questionnaire for screening, stronger occupational health programs, compensation for workers, and the use of improved diagnostic tools.
In Mozambique’s Maputo Central Hospital, Elisabete Nunes said, annual TB screenings for health care workers began in 2014. In the forms they use for screening, names are replaced by identification numbers to protect confidentiality. Of the 690 workers who completed the questionnaire last year, 425 were found to have latent TB, Nunes said, and four were found to have active disease.
During the discussion following presentations, one audience member commented that health care workers are the most noncompliant people, and using positive incentives to get workers to get screened is not enough.
“If we can’t do with the carrot, we need to do it with the stick,” she said. “In the New York City outbreak during the 90s, hospitals would withhold paychecks if people didn’t get screened,” she said. “We went from 50 percent to 100 percent screening very quickly.”