Implementation of tuberculosis infection control guidelines in seven high burden countries: A global policy analysis

Mr Md Saiful Islam1, Dr  Abrar Ahmad  Chughtai1, Sayera Banu2, Holly Seale1

1School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia, 2International Center for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh


Healthcare workers in high tuberculosis (TB) burden countries are at increased risk of infection due to higher exposures to TB patients in health settings and the lack of adequate implementation of TB infection control (TBIC) measures. While various TBIC policies and guidelines have been developed internationally, there are gaps in our knowledge regarding the policy content and the factors that influenced development and implementation.


We aimed to critically analyse TB IC policies and guidelines in seven high TB burden countries. We also examined the published literature which was focused on any aspect of TB policy development, implementation or evaluation. We categorized the policy process into different levels including policy identification, agenda settings, policy formulation, adoption, and evaluation.


The analysis showed that the resurgence of TB in the United States and globally in the 1980s contributed to the development of TBIC policies. In the following decades, WHO asked its member countries to adopt the WHO TBIC policy or develop national TBIC policy and implement. However, while the majority of the countries adopted the policy, the actual translation into practice had been limited and impaired by poor infrastructure, lack of TBIC training, limited supply of resources along with social and economic context.


The poor implementation of the TBIC policies impacts on the risk of TB infection among healthcare workers. Local context-appropriate policies supported by infection control research data may improve the compliance of TBIC policies and effectiveness of the measures in the high TB burden countries.


Mr Islam is a PhD student at the UNSW, Sydney, Australia. The focus of his PhD research is Tuberculosis infection control policies, practices and the risk of TB infection among healthcare workers. Mr Islam has been reviewing the global TB infection control policies and also the implementation of national TB infection control policies in seven TB high burden countries. Mr Islam is also an Associate Scientist at the International Center for Diarrheal disease research, Bangladesh and has been working on infection control since 2007.

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