PT - JOURNAL ARTICLE AU - Nicky McCreesh AU - Aaron S Karat AU - Kathy Baisley AU - Karin Diaconu AU - Fiammetta Bozzani AU - Indira Govender AU - Peter Beckwith AU - Tom A Yates AU - Arminder K Deol AU - Rein M G J Houben AU - Karina Kielmann AU - Richard G White AU - Alison D Grant TI - Modelling the effect of infection prevention and control measures on rate of <em>Mycobacterium tuberculosis</em> transmission to clinic attendees in primary health clinics in South Africa AID - 10.1136/bmjgh-2021-007124 DP - 2021 Oct 01 TA - BMJ Global Health PG - e007124 VI - 6 IP - 10 4099 - http://gh.bmj.com/content/6/10/e007124.short 4100 - http://gh.bmj.com/content/6/10/e007124.full SO - BMJ Global Health2021 Oct 01; 6 AB - Background Elevated rates of tuberculosis in healthcare workers demonstrate the high rate of Mycobacterium tuberculosis (Mtb) transmission in health facilities in high-burden settings. In the context of a project taking a whole systems approach to tuberculosis infection prevention and control (IPC), we aimed to evaluate the potential impact of conventional and novel IPC measures on Mtb transmission to patients and other clinic attendees.Methods An individual-based model of patient movements through clinics, ventilation in waiting areas, and Mtb transmission was developed, and parameterised using empirical data from eight clinics in two provinces in South Africa. Seven interventions—codeveloped with health professionals and policy-makers—were simulated: (1) queue management systems with outdoor waiting areas, (2) ultraviolet germicidal irradiation (UVGI) systems, (3) appointment systems, (4) opening windows and doors, (5) surgical mask wearing by clinic attendees, (6) simple clinic retrofits and (7) increased coverage of long antiretroviral therapy prescriptions and community medicine collection points through the Central Chronic Medicine Dispensing and Distribution (CCMDD) service.Results In the model, (1) outdoor waiting areas reduced the transmission to clinic attendees by 83% (IQR 76%–88%), (2) UVGI by 77% (IQR 64%–85%), (3) appointment systems by 62% (IQR 45%–75%), (4) opening windows and doors by 55% (IQR 25%–72%), (5) masks by 47% (IQR 42%–50%), (6) clinic retrofits by 45% (IQR 16%–64%) and (7) increasing the coverage of CCMDD by 22% (IQR 12%–32%).Conclusions The majority of the interventions achieved median reductions in the rate of transmission to clinic attendees of at least 45%, meaning that a range of highly effective intervention options are available, that can be tailored to the local context. Measures that are not traditionally considered to be IPC interventions, such as appointment systems, may be as effective as more traditional IPC measures, such as mask wearing.Data are available in a public, open access repository. Data are available upon reasonable request. Model code is available from https://github.com/NickyMcC/WithinClinics. The patient flow datasets will be made available from https://datacompass.lshtm.ac.uk/.