Abstract
Tuberculosis (TB) remains a significant global public health concern and continues to be one of the leading causes of death from infectious diseases worldwide. Healthcare workers (HCWs) are at increased risk of TB infection due to occupational exposure to infectious patients, particularly in high-burden settings such as South Africa. This study aimed to determine the prevalence of TB among HCWs and to identify demographic, clinical and occupational factors associated with TB infection at a tertiary hospital in Tshwane using retrospective data from 2018 to 2023. A retrospective record review design was employed. A total of 330 HCWs were selected using a two-stage random sampling method from the Occupational Health Unit records. Data were extracted using a structured tool and included demographic characteristics (age and sex), occupational variables (job category, work area, and length of service) and clinical and behavioural factors (HIV status, comorbidities, smoking, and alcohol use). Descriptive statistics were used to estimate the period prevalence of TB over the study period. Associations between categorical variables and TB infection were assessed using Fisher’s exact test. Variables of interest were included in a multivariable logistic regression model to identify independent predictors while adjusting for potential confounders.
Among the 324 HCWs with complete TB data, 2% (n = 7) were diagnosed with TB between 2018 and 2023, indicating a low prevalence. In bivariate analysis, HIV-positive status was significantly associated with TB infection (p = 0.008). No statistically significant associations were observed between TB infection and occupational variables, including job category, work area, and length of service. Similarly, no significant associations were found for sex, age, smoking status, alcohol consumption, or other comorbidities. In multivariable analysis, HIV-positive status remained the only statistically significant predictor of TB infection (adjusted odds ratio [aOR] = 32.89; 95% CI: 3.62–299.16). Other variables were not significantly associated with TB infection, and estimates were characterised by wide confidence intervals, reflecting limited statistical precision due to the small number of TB cases. The study identified a low prevalence of TB among HCWs and found no statistically significant associations between occupational factors and TB infection. HIV-positive status emerged as the only significant predictor, highlighting the increased vulnerability of immunocompromised HCWs.
These findings underscore the importance of strengthening infection prevention and control (IPC) measures and integrating HIV care within occupational health services. Enhanced surveillance, routine screening, and larger longitudinal studies are recommended to characterise occupational TB risk better and inform policy and practice in high-burden healthcare settings.