Building capacity to secure healthier and safer working conditions for healthcare workers: A South African-Canadian collaboration.

Healthcare workers face difficult working conditions, particularly where HIV and tuberculosis add to understaffing. Questionnaires, workplace assessments, and discussion groups were conducted at a regional hospital in South Africa to obtain baseline data and input from the workforce in designing interventions. Findings highlighted weaknesses in knowledge, for example regarding the use of N95 respirators and safe handling of sharps, and suggested the need for improved training. Access to supplies and personal protective equipment was the major reported reason for failure to follow proper procedures; this was confirmed by workplace assessments. Discussion groups highlighted the important role for worker Health and Safety Committees (HSC), including in combating stigma and encouraging reporting. Interest in data to support decision-making resulted in development of the Occupational Health and Safety Information System (OHASIS); further training of HSCs is still needed. Multi-stakeholder international collaboration aimed at building HSC capacity is well-received.

Workplace interventions to reduce HIV and TB stigma among health care workers - Where do we go from here?

Fear of stigma and discrimination among health care workers (HCWs) in South African hospitals is thought to be a major factor in the high rates of HIV and tuberculosis infection experienced in the health care workforce. The aim of the current study is to inform the development of a stigma reduction intervention in the context of a large multicomponent trial. We analysed relevant results of four feasibility studies conducted in the lead up to the trial. Our findings suggest that a stigma reduction campaign must address community and structural level drivers of stigma, in addition to individual level concerns, through a participatory and iterative approach. Importantly, stigma reduction must not only be embedded in the institutional management of HCWs but also be attentive to the localised needs of HCWs themselves.

Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment.

OBJECTIVE: Healthcare workers (HCWs) in South Africa are at a high risk of developing active tuberculosis (TB) due to their occupational exposures. This study aimed to systematically quantify and compare the preferred attributes of an active TB case finding program for HCWs in South Africa. METHODS: A Best-Worst Scaling choice experiment estimated HCW's preferences using a random-effects conditional logit model. Latent class analysis (LCA) was used to explore heterogeneity in preferences. RESULTS: "No cost", "the assurance of confidentiality", "no wait" and testing at the occupational health unit at one's hospital were the most preferred attributes. LCA identified a four class model with consistent differences in preference strength. Sex, occupation, and the time since a previous TB test were statistically significant predictors of class membership. CONCLUSIONS: The findings support the strengthening of occupational health units in South Africa to offer free and confidential active TB case finding programs for HCWs with minimal wait times. There is considerable variation in active TB case finding preferences amongst HCWs of different gender, occupation, and testing history. Attention to heterogeneity in preferences should optimize screening utilization of target HCW populations.