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Home / The International Journal of Tuberculosis and Lung Disease, Volume 24, Number 4

Tuberculosis from transmission in clinics in high HIV settings may be far higher than contact data suggest

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BACKGROUND: In South Africa, it is generally estimated that only 0.5–0.6% of people's contacts occur in clinics. Both people with infectious tuberculosis and people with increased susceptibility to disease progression may spend more time in clinics, however, increasing the importance of clinic-based transmission to overall disease incidence.

METHODS: We developed an illustrative mathematical model of Mycobacterium tuberculosis transmission in clinics and other settings. We assumed that 1% of contact time occurs in clinics. We varied the ratio of clinic contact time of human immunodeficiency virus (HIV) positive people compared to HIV-negative people, and of people with infectious TB compared to people without TB, while keeping the overall proportion of contact time occurring in clinics, and each person's total contact time, constant.

RESULTS: With clinic contact rates respectively 10 and 5 times higher in HIV-positive people and people with TB, 10.7% (plausible range 8.5–13.4%) of TB resulted from transmission in clinics. With contact rates in HIV-positive people and people with TB respectively 5 and 2 times higher, 5.3% (plausible range 4.3–6.3%) of all TB was due to transmission in clinics.

CONCLUSION: The small amount of contact time that generally occurs in clinics may greatly underestimate their contribution to TB disease in high TB-HIV burden settings.

Keywords: South Africa; healthcare facility; mathematical model; nosocomial; social contact

Document Type: Research Article

Affiliations: 1: Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London 2: TB Centre, London School of Hygiene & Tropical Medicine, London, UK, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa 3: Section of Infectious Diseases and Immunity, Imperial College London, London, Institute for Global Health, University College London, London, UK 4: TB Centre, London School of Hygiene & Tropical Medicine, London, UK

Publication date: April 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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