TB disease incidence in HCWs is currently used as an
indicator of the effectiveness and quality of infection control
measures [36]. While routine screening of HCWs for
TB symptoms is relatively simple; the implementation of
this can be challenging especially as screening of HCWs
for TB is not mandatory and no official guidelines regarding
screening HCWs for TB currently exist. For example,
we found as part of a separate aim of this study that in
2010 only 19% of all HCWs across the hospitals were
screened [22]. It is critical that at all levels of the health
system, particularly at the hospital level, there be more coordinated
efforts between occupational health and infection
control programs to protect HCWs from TB, such as
screen HCWs for TB, offer HIV counseling and testing,
provide antiretroviral therapy and IPT for HCWs living
with HIV, and provide effective and supportive care to
HCWs with TB and HIV. HCWs should be educated and
encouraged to be screened for TB routinely and efforts
should be made to decrease the stigma associated with TB
and HIV to make HCWs feel more comfortable about
reporting these diseases to occupational health and seeking
treatment.