Africa Health Research Institute Faculty member Professor Alison Grant has been awarded £1.7-million in funding (R30-million) for a four-year project which takes an innovative approach to tackling the spread of drug-resistant tuberculosis (DR-TB) in clinics in South Africa.
The grant comes via the Cross Research Council Tackling AMR Initiative and is led by the London School of Hygiene & Tropical Medicine.
TB, and particularly its drug-resistant strains, poses a major public health challenge in South Africa. According to World Health Organization statistics, TB incidence rates are estimated at 834 cases per 100 000, while the country contributes 15% of the global burden of multidrug-resistant TB.
Grant’s team will be looking at the social context of the transmission of TB in clinics, bringing multidisciplinary perspectives to identify holistic solutions. The design of clinics and hospitals, the organisation of service delivery, and the movement of healthcare workers and patients often do not take account of the risk of transmission of DR-TB to other patients and to staff. In addition, recommended measures for TB infection prevention and control are often not put into practice. To understand this, researchers will examine these practices in health facilities, and investigate health workers’ and patients’ perceptions of infection risk and accountability for prevention measures.
The study will take a ‘whole systems’ approach, drawing from expertise across disciplines including anthropology, epidemiology, health systems research, mathematical modelling and health economics, to propose inter-disciplinary solutions to preventing transmission of DR-TB.
“Drug-resistant TB is a major threat to public health internationally, and is a serious problem in South Africa. We need to find and treat people with drug-resistant TB earlier, to prevent onward transmission. We aim to find out how much transmission of drug-resistant TB occurs in clinics, why existing recommendations are not put into practice, and how much could be gained if transmission in clinics was stopped,” said Professor Grant.
(Above: Prof Alison Grant)
Grant hopes to develop a package of health systems interventions to reduce DR-TB transmission in clinics, adapted to the constraints and opportunities of the South African health system.
*The study is led by Prof Grant, with colleagues from LSHTM; co-PI Dr Karina Kielmann at Queen Margaret University, Edinburgh; the Africa Health Research Institute, South Africa; the Institute of Development Studies, Sussex; the Universities of Cape Town and KwaZulu-Natal, South Africa; and University College London.
*The funding was awarded under the GCRF Tackling Antimicrobial Resistance: behaviour within and beyond the healthcare setting call. These grants are funded by the UK Economic and Social Research Council working in partnership with the UK Department of Health.
(Top image: A TB public health message at the Somkhele Clinic in northern KwaZulu-Natal. Photo by Ben Gilbert, Wellcome)