Healthcare Workers’ Perception of Measures to Reduce the Risk of New Tuberculosis Infections: A Qualitative Study Report

Tuberculosis, which is an infectious airborne disease remained the main leading cause of death in South Africa for three consecutive years from 2016 to 2018. In 2020 alone, the country had an estimated 328,000 people who suffered from TB, with 61,000 dying from it. Collins Chabane Municipality had 129 and 192 new TB cases recorded in 2017 and 2018, respectively, which is far from reaching the END TB STRATEGY targets. WHO scientific evidence demonstrates that TB control measures are effective in reducing the spread and development of new cases. Though scientific evidence revealed negative attitudes towards the recommended TB control measures in public hospitals of the Vhembe district, a deeper understanding of these attitudes is needed to remedy the situation. This study aimed to describe healthcare workers’ perceptions of TB control measures at Collins Chabane Municipality in South Africa. A qualitative, exploratory case study design was adopted. Multi-stage sampling technique was used to select both the healthcare facilities and the participants. Only 24 healthcare workers trained on tuberculosis management were voluntarily recruited. However, data were saturated at the twelfth (12) participant purposively selected from six healthcare facilities of Collins Chabane Municipality. Data collected through unstructured in-depth individual interviews were analyzed thematically. The proposal for this study was ethically cleared by the University of Venda Ethics Committee (SHS/20/PDC/35/1111). Results indicate that TB administrative, environmental and respiratory control measures are well understood by health workers even though there are challenges with implementation concerning some, such as closing windows during winter, UVGI lights that are non-functional and taking too long to be fixed, no specimen collection during weekends and holidays thereby delaying TB diagnosis and lack of skills concerning how to use respirators and cough etiquette. The Vhembe district TB control programme should intensify infection control training and continue monitoring giving the needed support

Outbreak of multidrug-resistant tuberculosis in South Africa undetected by WHO-endorsed commercial tests: an observational study.

Global roll-out of rapid molecular assays is revolutionising the diagnosis of rifampicin resistance, predictive of multidrug-resistance, in tuberculosis. However, 30% of the multidrug-resistant (MDR) strains in an eSwatini study harboured the Ile491Phe mutation in the rpoB gene, which is associated with poor rifampicin-based treatment outcomes but is missed by commercial molecular assays or scored as susceptible by phenotypic drug-susceptibility testing deployed in South Africa. We evaluated the presence of Ile491Phe among South African tuberculosis isolates reported as isoniazid-monoresistant according to current national testing algorithms. We screened records of 37 644 Mycobacterium tuberculosis positive cultures from four South African provinces, diagnosed at the National Health Laboratory Service-Dr George Mukhari Tertiary Laboratory, to identify isolates with rifampicin sensitivity and isoniazid resistance according to Xpert MTB/RIF, GenoType MTBDRplus, and BACTEC MGIT 960. Of 1823 isolates that met these criteria, 277 were randomly selected and screened for Ile491Phe with multiplex allele-specific PCR and Sanger sequencing of rpoB. Ile491Phe-positive strains (as well as 17 Ile491Phe-bearing isolates from the eSwatini study) were then tested by Deeplex-MycTB deep sequencing and whole-genome sequencing to evaluate their patterns of extensive resistance, transmission, and evolution. Ile491Phe was identified in 37 (15%) of 249 samples with valid multiplex allele-specific PCR and sequencing results, thus reclassifying them as MDR. All 37 isolates were additionally identified as genotypically resistant to all first-line drugs by Deeplex-MycTB. Six of the South African isolates harboured four distinct mutations potentially associated with decreased bedaquiline sensitivity. Consistent with Deeplex-MycTB genotypic profiles, whole-genome sequencing revealed concurrent silent spread in South Africa of a MDR tuberculosis strain lineage extending from the eSwatini outbreak and at least another independently emerged Ile491Phe-bearing lineage. Whole-genome sequencing further suggested acquisition of mechanisms compensating for the Ile491Phe fitness cost, and of additional bedaquiline resistance following the introduction of this drug in South Africa. A substantial number of MDR tuberculosis cases harbouring the Ile491Phe mutation in the rpoB gene in South Africa are missed by current diagnostic strategies, resulting in ineffective first-line treatment, continued amplification of drug resistance, and concurrent silent spread in the community. VLIR-UOS, National Research Foundation (South Africa), and INNOVIRIS