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UO project staff Mandla Khoza, Nondumiso Khumalo, Sinethemba Mabuyakhulu, Slindile Mthembu, and Sanj Karat in South Africa

Umoya omuhle

Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: A whole systems approach.

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Umoya omuhle team present preliminary results including context, methods and key findings of the project to date. 


A collection of resources relating to TB infection prevention and control, ranging from international guidelines to research papers.


Umoya omuhle is a three-year study that began in 2017 and uses a whole systems approach to look at infection prevention and control for drug-resistant tuberculosis in clinical settings of South Africa in an era of decentralised care. The name, Umoya omuhle, means good air in Zulu, and embodies the project vision of bringing a ‘breath of fresh air' to current thinking on infection prevention and control.

Who we are

Umoya omuhle is a collaborative partnership between institutions in the United Kingdom and South Africa and involves people from many different research backgrounds and specialities.


The project is organised around a set of seven research questions looking at various aspects of TB infection prevention and control in healthcare facilities, with an aim to improve it.

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About Umoya omuhle
About Umoya omuhle

Umoya omuhle: Infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care: A whole systems approach

Umoya omuhle is a three-year study that began in 2017, and looks into the transmission of drug-resistant tuberculosis (DR-TB) in South African clinics. The name, Umoya omuhle, means good air in Zulu, and embodies the project vision of bringing a ‘breath of fresh air' to current thinking on infection prevention and control.

South Africa has one of the highest burdens of DR-TB, with more than 19,000 people diagnosed in 2016 according to WHO. Since 2011, its management has been increasingly decentralised to primary healthcare clinics.

Transmission of the disease happens in hospitals and clinics in South Africa, but no one knows how much clinical exposure contributes to this. What is known is that it is difficult to achieve and maintain implementation of existing guidelines for airborne infection prevention and control in health facilities. The physical design of clinics, organisation of care pathways inside the clinic, and the way health workers perceive the risks of tuberculosis may contribute to this.

Download a summary of our project here.

image of UO staff in South Africa
UO project staff member Nondumiso Khumalo in South Africa

Our programme takes a whole systems approach to develop interventions to interrupt DR-TB in primary healthcare facilities in South Africa.

This interdisciplinary project will look at the social, biological, and infrastructural dynamics of DR-TB transmission, and the implementation of infection prevention and control in clinics in the provinces of Western Cape and KwaZulu-Natal, South Africa. It aims to inform, develop, and project the potential impact of  health systems intervention in facilities in these areas.


The project approach sees the clinic as a dynamic site of interactions between policies, practices, and patients. We will focus on four areas of research to get a full picture of the environment that they operate in, including:

  • Policy analysis to investigate how policies on infection and prevention control for DR-TB have evolved and are practiced in primary healthcare clinics
  • Epidemiological studies to assess how much transmission in these clinics contributes to the existence of DR-TB at the community level
  • Spatial mapping, workflow and infrastructural assessments to examine the role of clinic design, organisation of DR-TB transmission and general care and working practices that inhibit or foster infection and prevention control
  • Ethnographic research to elucidate health worker and patient ideas about risk and responsibility

Mathematical and economic modelling can inform the design of interventions to reduce the risk of transmission of infections within health facilities by exploring the potential impact and cost-effectiveness of an intervention aiming to reduce the risk of transmission.

These models critically depend on the accuracy of assumptions about key parameters affecting transmission risk. Parameters include the number of contacts made per visit, the probability that a clinic attendee is infectious, and the probability that contact results in transmission, which for an airborne pathogen will depend on variables including proximity, contact duration and rate of air change. In turn, the parameters are driven by the movement of people within clinics, and therefore how clinics organize their appointments and manage queues/outpatient waiting areas.


Planned outputs for this research include the design of a health systems intervention package that reduces the transmission of DR-TB within healthcare clinics in South Africa with guidelines on behavioural and organisational changes required, and an assessment of the economic impact of an intervention on the health system, healthcare workers, patients, and the wider community.


This project contributes to the GCRF challenge areas of ‘Equitable Access to Sustainable Development’ and ‘Good Governance and Social Justice’ by promoting locally appropriate, systems-based approaches to sustainable health and wellbeing for both patients and health workers in South African health facilities.

The funding was awarded under the GCRF Tackling Antimicrobial Resistance: behaviour within and beyond the healthcare setting call. These grants are funded by the Economic and Social Research Council (ESRC) working in partnership with the Department of Health. 

The support of the ESRC is gratefully acknowledged.

The project is partly funded by The Antimicrobial Resistance Cross Council Initiative supported by the seven UK research councils in partnership with other funders.

Who we are
Who we are Umoya omuhle columns
Who we are Umoya omuhle

Umoya omuhle is a collaborative research project between institutions in the UK and South Africa.

Umoya omuhle inaugural meeting - November 2017, Durban, South Africa. L-R: Karina Kielmann, Hayley MacGregor, Ipeleng Sehunelo, Alvera Swartz, Anna Voce, Alison Swartz, Lindiwe Mvusi, Alison Grant, Anna Vassall, Tom Yates, Jacqui Ngozo, Kathy Baisley, Nicky McCreesh, Indira Govender 

Alison Grant (LSHTM, Africa Health Research Institute [AHRI]) is the principal investigator and a clinical epidemiologist. She initially trained as an infectious diseases physician, and has worked for over 20 years on projects aiming to improve care for people with HIV in South Africa, and particularly TB prevention and treatment.

Karina Kielmann (Queen Margaret University [QMU]) is the co-principal investigator, and a medical anthropologist with training in anthropology and public health.  She has 15 years of experience of applying social science theory and methods to global health issues, in particular strengthening of health systems for tuberculosis and HIV care.

Kathy Baisley (LSHTM, AHRI) is a statistician. Her research interests include the epidemiology of HIV and other sexually transmitted infections in sub-Saharan Africa, with a focus on design and analysis of intervention trials.

Fiametta Bozzani (LSHTM) is a health economist. Her work is mainly in the area of economic evaluation, with a practical focus on supporting decision-making on resource allocation in low- and middle-income countries.

Adrienne Burrough (LSHTM) is the project financial and administrative manager with experience in administering and managing both overseas and UK projects and writing funding proposals.

Chris Colvin (University of Cape Town [UCT]) is a medical anthropologist. His research interests include the interface between communities and health systems in the context of HIV/AIDS, TB and maternal and child health.

Idriss Kallon (UCT) is a social scientist. His background is in social and health science; sociology and public health, and his research is on continuity of care for patients diagnosed with TB referred from hospitals in South Africa.

Aaron Karat (LSHTM) is a TB epidemiologist. His research interests include clinical and health systems interventions to reduce morbidity and mortality in people with HIV and/or TB and methods used to estimate mortality in resource-limited settings.

Hannah Keal (AHRI) is a communications manager.  Her interests are in science communication and public engagement.

Indira Govender (LSHTM) is a clinical research fellow. She is a public health medicine specialist based in South Africa with clinical, management and research experience.

Rein Houben (LSHTM) is an epidemiologist and mathematical modeller. His focus is on applying mathematical models to address academic questions, inform policy decisions and enable capacity building. His academic research focuses on latent infection and socio-economic determinants.

Claire McLellan (QMU) is an institute officer. Her interests are in higher education communications, particularly around research project dissemination.

Nicky McCreesh (LSHTM) is a mathematical modeller. Her research looks at how spatial data can improve TB care and control intervention impact, and how contact data can be used to understand potential transmission sites and inform infection control interventions.

Hayley MacGregor (Institute of Development Studies) is a medical anthropologist. Originally trained as a doctor in South Africa, her research interests include poverty and illness/disability, citizen mobilisation in health provisioning, and ethnography of biomedical research and health technologies.

Alex Pym (AHRI) initially trained as a physician, before conducing the first clinical trials ever for MDR-TB. In 2011, he established a lab in KwaZulu-Natal focused on mechanisms of antibiotic resistance and tolerance in M. tuberculosis, which he currently runs.

Janet Seeley (LSHTM, AHRI) is a social anthropologist. Her research interests are the social aspects of health, particularly HIV across the life course and impact on communities, lives and livelihoods, as well as poverty, social protection, mobility and migration.

Alison Swartz (UCT) is a social scientist trained in social anthropology and public health. Her research has focused on community health workers, the synthesis of qualitative data for qualitative systematic reviews and more recently, youth, gender identity and sexual partnerships.

Anna Vassall (LSHTM) is a health economist. Her research interests are in the priority setting and economic evaluation for HIV, TB and sexual reproductive health, as well as 'real world' evaluation methods.

Anna Voce (University of KwaZulu-Natal) is a public health practitioner. Her research interests are in the public health aspects of reproductive and maternal health, in health systems strengthening, and in health system leadership, particularly in South Africa.

Richard White (LSHTM) a mathematical modeller. He leads the TB Modelling Group and is Director of the TB Modelling and Analysis Consortium. His research focus is the mathematical and statistical modelling of the transmission and control of infectious diseases, particularly TB and HIV.

Tom Yates (University College London) is a clinician and epidemiologist. His research focuses on the transmission of Mycobacterium tuberculosis in high burden settings.

Gimenne Zwama (QMU) is a social scientist. She has 5 years of experience conducting action research in low- and middle-income countries, mostly in South Africa, particularly on increasing health care accessibility for marginalised communities.

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Research Umoya omuhle 2 columns
Research Umoya omuhle
lshtm researcher releasing carbon dioxide to test the ventilation systems in a south african clinic
LSHTM researcher Sanj Karat releasing carbon dioxide to measure ventilation systems


Umoya omuhle is organised into a set of seven research questions around TB infection prevention and control.

  1. Describe the policy and systems context.
  2. Estimate the contribution of healthcare facilities in DR-TB transmission.
  3. Examine the effect of clinic design and working practices.
  4. Understand healthcare workers perceptions of risk and responsibility.
  5. Design whole-systems interventions to improve TB infection prevention and control.
  6. Use mathematical modelling to look at the effect of possible interventions on transmission.
  7. Estimate the costs and economic impact of proposed interventions.
image of blocks of the seven research questions for the project

Key terms

RQ: Research question
DR-TB: Drug-resistant tuberculosis
IPC: Infection prevention and control
HCW: Healthcare worker

Resources UO 2 columns
Resources UO

Project summary document

A summary of the results of the Umoya omuhle project, written for staff at the clinics where the work was done. The summary includes our work to understand why TB is transmitted within clinics and what can be done to reduce transmission.

Preliminary results

A summary look at the preliminary results from the Umoya omuhle project, as of March 2021.

Research Brief

A digestible summary of how system dynamics modelling is used to understand the drivers of TB transmission in primary healthcare clinics

Umoya omuhle - Research Brief photo

Download the research brief

"How to reduce TB transmission in health clinics and public spaces" infographic

A poster-style infographic to show the most effective ways to reduce TB transmission in health clinics and public spaces including post offices and banks.

How to reduce TB transmission in health clinics and public spaces infographic

Download the infographic for free.

Workshop report: measuring and modifying patient flow and waiting times in South African primary health care clinics.

This report summarises the findings of a participatory workshop to share knowledge and to develop methods to measure and modify patient flow in South African primary health care (PHC) clinics. Held in August 2019 in KwaZulu-Natal, South Africa, the workshop was part of the Umoya omuhle study, a multidisciplinary initiative funded by the Economic and Social Research Council (ESRC) of the United Kingdom (UK), taking a whole systems approach to tuberculosis (TB) infection prevention and control (IPC) in South African PHC clinics. 

Why we need randomized controlled trials (RCTs) to find the best ways to treat COVID-19

By Indira Govender

In epidemics, our health facilities can become hotspots. Here’s what to do about it

By Indira GovenderKarina Kielmann & Alison Grant

"Face masks: How do they work?"

Infectious diseases like TB and COVID-19 travel through the air via variously sized droplets and particles. Masks filter the air in different ways to offer various forms of protection from infectious diseases. 


Find relevant literature on whole systems approaches to infection prevention and control for drug-resistant tuberculosis in South Africa in the era of decentralised care:


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Updates List Block
Updates List
Is the clinic a safe space for its workers and users?

To answer this question, we analysed the Ideal Clinic Initiative Framework, tuberculosis infection prevention and control guidelines and our clinic ethnography data of four selected primary health care facilities in KwaZulu-Natal, South Africa. Find out what opportunities and challenges the implementation of health system reform can bring for the prevention and control of TB at South African primary health care facilities. Presented by Gimenne Zwama at the 6th Global Symposium on Health Systems Research. 

Masks: clearing the air?

By Gimenne Zwama

Woman wearing a mask

World Bank photo

It is sometimes hard to imagine life before the COVID-19 pandemic. More than a year ago, we were driving across the beautifully lush South African province of KwaZulu-Natal to visit different health facilities. For our research project Umoya Omuhle, which translates to “good air” from isiZulu, we were interested in improving ways to prevent the bacteria that cause TB from being transmitted through the air at health facilities. At that time, conversations about infection prevention and control measures were not trending as they are today. However, the World Health Organization had already long-established recommendations for ways to prevent the transmission of TB in health facilities. One of which you will certainly have become familiar with: wearing a mask.

During the first three days we spent at each of the six primary health care facilities, it quickly became clear that wearing a surgical mask (for patients) or respirator (for health care workers) was the exception, not the rule. When asked, health care workers often became slightly embarrassed. They know that they are supposed to wear a respirator to protect themselves, but find them suffocating and unbearable to wear in hot temperatures (to which you may be able to relate to by now). There is also stigma among patients and staff towards surgical masks and respirators, particularly if they are only worn by one or a few patients and staff members. An added problem is that the effective use of respirators requires trying on different shapes and sizes through “fit-testing”, but none of the facilities we visited had the capability to do this.

If, at this time, you would have told us that a year later masks would become a familiar sight on the streets and even an appealing source of revenue to the retail industries, we would have been very surprised. To date, a quick Google search shows that the estimated global COVID-19 death toll has surpassed half a million over a 7-month period (though likely to be an underestimate). Strikingly, 1.5 million people died from TB in 2018, and this has been a roughly consistent yearly pattern of the past two decades. Could this pandemic be an opportunity for the return of the mask to prevent TB?

But how effective is mask-wearing for TB and COVID-19? The lack of evidence on the effectiveness of masks in filtering the air we breathe has previously limited the ability to implement strict rules around any type of mask wearing. This lack of clarity coupled with the uncomfortable and fidgety experience of wearing a respirator or mask in stuffy, overcrowded clinics has led to problems with mask-wearing. Let’s discuss the current evidence on what we know, and what we don’t know about mask-wearing for disease protection.

We know that TB bacteria and COVID-19 viruses can move through the air via variously sized droplets and particles. TB bacteria are known to spread in small droplets and can hang around and travel in the air, like specs of dust, after being coughed up. The disease spreads when another person breathes them in – this is known as airborne transmission. In contrast, the virus that causes COVID-19 is mostly carried in bigger, heavier droplets, which settle on surfaces and are then transferred from a person’s hands to their mouth, nose, or eyes. However, recent evidence suggests that COVID-19 may be also spread via the airborne route, similar to TB.

Different types of masks can effectively filter the air of most droplets and bigger particles by collecting them on the mask surface when breathing, talking, laughing, singing, coughing or sneezing. We know that respirators, known as N95 or FFP2/3 masks, protect the wearer from breathing in both large and small droplets containing viruses and bacteria. Although they cannot filter all the tiny particles, they are particularly helpful in high-risk healthcare settings. Surgical masks protect other people from the person wearing the mask coughing, sneezing or breathing out bigger droplets. These are therefore best used by patients and are known to halve the risk of spreading TB. Less is known about the effectiveness of fabric or paper masks, and although they work similarly to surgical masks, they are thought to be less protective. They can, however, provide some protection to others if the fabric or paper used is dense, layered and fits snugly onto the face of the wearer. These are therefore best used by the public, those who do not experience any symptoms but may unknowingly be infected and potentially infectious.

Illustration of different types of mask

In short, we know that none of these masks are 100% perfect in preventing COVID-19 and TB, but wearing something that covers your mouth and nose is likely to reduce the risk of you passing disease to other people. Because the particles and droplets collect on the mask surface, it is crucial to properly and regularly wash your hands to protect yourself, especially immediately before and after you use any type of mask. Physical distancing is another important measure, especially for COVID-19 prevention. Distancing reduces the opportunity to inhale potentially dangerous particles as there is more time for bigger particles to settle on the ground before reaching you. Opening the windows or being outside means that potentially infectious particles are quickly dispersed and are less likely to be inhaled. And, painfully, the less time you spend with others, the less you potentially expose yourself and others.

It is crucial that we continue the conversation on mask-wearing and ‘clear the air’ long after this pandemic. TB is already an existing threat to millions of lives and will continue to burden health systems of many low- and middle-income countries, such as South Africa. The COVID-19 pandemic response gives us an opportunity to establish stronger health systems and practices for sustainable TB prevention, and perhaps change embedded habits around infectious disease control. It’s now time to listen and learn from this pandemic and do our best to protect those most vulnerable to infectious diseases.

More information about fabric masks.

Credit - hand washing cartoon.

Podcast - Controlling the spread of disease with the help of social science

Three researchers from Umoya Omuhle feature in LSHTM Viral's podcast, explain the complex links between TB transmission, COVID-19 and the role human behaviour in controlling infectious diseases.

The way people act and behave inside health clinics can impact the spread of infectious diseases like COVID-19, TB and Ebola. Understanding how this happens is essential for effective, long-lasting public health solutions. We speak to Alison Swartz, Aaron Karat and Karina Kielmann who work through a 'systems approach' that includes social science, anthropology and epidemiology in infection prevention control in South Africa.

Chloe Morrison will be continuing research on TB control in South Africa

After presenting her research proposal to a panel of examiners during her upgrading, Chloe will be continuing her exiting research on TB control in South Africa.

Chloe Morrison
Chloe Morrison researching TB control in South Africa
Why is this important?

It is becoming increasingly apparent that a wider view of TB control is needed, not only for TB treatment today but for TB management in the future. In particular, studying the historical and anthropological elements to infection prevention and linking this to the space in which TB is controlled and treated. Taking a wide approach to research in this area can also help us to understand government responses to public health crises, such as the South African national epidemics of TB and drug-resistant (DR)-TB, and highlight notable contextual and historical issues that play a part in public health treatment and response.

What will Chloe’s project look at?

Chloe will focus on the rural community setting of Mtubatuba in the South African province of KwaZulu-Natal (KZN) and pay particular attention to the space of the primary care clinic. This work will be attached to Umoya Omuhle, which is based in the Western Cape and KZN provinces. Umoya Omuhle demonstrates a pragmatic approach to the public health problem of TB and Drug resistant-TB and is channelled through the established policy of Infection Prevention Control (IPC).

The specific question Chloe will address is: How do histories of South African TB control, public health systems and spatial realities continue to shape contemporary responses to this disease, especially now in its increasingly drug-resistant state?

Chloe will consider the issue of TB control and study the previous attempts to limit drug-resistance. She will use the concept of ‘infrastructure’ to examine how these dimensions intersect within a primary care clinic in rural KwaZulu-Natal and investigating how histories relate to infrastructure of public health work. To study this, she will use a mixture of ethnographic and historical methods, document collection and analysis, observation, and oral histories.

Umoya omuhle: Durban Expert Workshop

The Umoya omuhle project held a successful expert workshop on TB transmission in South African primary healthcare facilities from the 6th – 7th August in Durban, South Africa. TB is a key health priority for South Africa. Preventing TB, and drug-resistant TB, transmission in health facilities is essential, but implementation of well-established guidelines to prevent TB transmission in clinics remains suboptimal. The workshop gathered the perspectives of policymakers and practitioners in South Africa using a method called group model building. The process explored the drivers of TB and drug-resistant TB transmission in health facilities to understand the challenges to policy implementation, and participants' views on potential solutions. The workshop outputs will inform development of novel interventions; we will explore the potential impact of these interventions in modelling work over the next year.

Long clinic waiting times are a potential driver of TB transmission. On Thursday 8th August, a workshop on ‘patient flow’ in primary healthcare facilities gathered stakeholders' perspectives concerning methods to measure waiting times, and potential ways to reduce the time patients spend in primary health clinics.

group of people standing and smiling together
Policy makers and Umoya omuhle researchers, August 2019. Image: Meghann Gregg
man standing in front of chartboard paper explaining model and post-it notes to people
Group model building in action. Image: Jennifer Falconer
group of people standing around table putting post-it notes on chartboard paper
Group model building in action. Image: Jennifer Falconer
people standing looking at paper on wall, adding notes to make a theoretical model
Group model building in action. Image: Jennifer Falconer
woman in red dress and headpiece standing in front of tuberculosis transmission model on chartboard paper
Marie Theunissen, a TB Survivor & Adherence Monitor at FAM-CRU Clinical Treatment Unit (Stellenbosch). Image: Jennifer Falconer
Expert workshop on TB transmission

We recently held an expert workshop on TB transmission in South African primary healthcare facilities, gathering perspectives from policymakers and practitioners.

woman in red dress and headpiece standing in front of tuberculosis transmission model on chartboard paper
Marie Theunissen, a TB survivor and Adherence Monitor at FAM-CRU, Stellenbosch University, with her team model.


Third investigators' meeting in Ballito, South Africa

The Umoya omuhle team attended their third investigators' meeting in Ballito, South Africa. The four-day meeting reviewed project progress to date, reviewing qualitative and quantitative data from 12 health care facilities in KwaZulu-Natal and the Western Cape provinces. The investigators also met with the project reference group which included Ms Jacqui Ngozo, Director of TB programmes, KwaZulu-Natal Department of Health; Dr Vanessa Mudaly, a senior medical officer for health programmes at the HAST Directorate in the Western Cape Provincial Government; Professor Helen Schneider, a public health specialist and health systems and policy researcher from the University of the Western Cape and Dr Thiloshini Govender, a public health medicine specialist and occupational health physician at the King Dinuzulu Hospital.

The aim of this meeting was to consider and prioritise, based on evidence obtained to date, possible interventions to reduce transmission of tuberculosis in primary healthcare facilities in South Africa. The project will employ an innovative approach - system dynamics modelling - to engage policymakers and practitioners to identify, design, and prioritise potential interventions at a meeting in August.

team photo in south africa
Umoya omuhle team in South Africa, 2019

[L-R Anna Voce; Gimenne Zwama; Karin Diaconu, Sanj Karat; Idriss Kallon; Jacqui Ngozo; Indira Govender; Hayley MacGregor; Alison Grant; Alison Swartz; Thilo Govender; Tom Yates; Nicky McCreesh; Fiamma Bozzani. Photo: Adrienne Burrough]

Publications List
Time to change the way we think about tuberculosis infection prevention and control in health facilities: insights from recent research
Tom A Yates , Aaron S Karat, Fiammetta Bozzani , Nicky McCreesh, Hayley MacGregor, Peter G Beckwith , Indira Govender , Christopher J Colvin, Karina Kielmann, Alison D Grant
Antimicrob Steward Healthc Epidemiol . 2023 Jul 17;3(1):e117.
System dynamics modelling and the use of evidence to inform policymaking
Eleanor Malbon and Justin Parkhurst
Policy Studies
Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods
Fiammetta Maria Bozzani , Nicky McCreesh, Karin Diaconu, Indira Govender, Richard G White, Karina Kielmann, Alison D Grant , Anna Vassall
BMJ Glob Health . 2023 Feb;8(2):e010306. doi: 10.1136/bmjgh-2022-010306
Beyond checklists: Using clinic ethnography to assess the enabling environment for tuberculosis infection prevention control in South Africa
Stella Arakelyan, Hayley MacGregor, Anna S Voce, Janet Seeley, Alison D Grant, Karina Kielmann
PLOS Glob Public Health . 2022 Nov 9;2(11):e0000964. doi: 10.1371/journal.pgph.0000964. eCollection 2022
Direct estimates of absolute ventilation in primary health care clinics in South Africa
Peter G Beckwith, Aaron S Karat, Indira Govender, Arminder Deol, Nicky McCreesh, Karina Kielmann, Kathy Baisley, Alison D Grant, Tom A Yates
PLOS Glob Public Health . 2022 Nov 2;2(11):e0000603. doi: 10.1371/journal.pgph.0000603. eCollection 2022
Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens
Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens
Emerg Infect Dis . 2022 Oct;28(10):2016-2026. doi: 10.3201/eid2810.212567. Epub 2022 Sep 1
Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa
Shehani Perera, Justin Parkhurst, Karin Diaconu, Fiammetta Bozzani, Anna Vassall, Alison Grant, Karina Kielmann
Health Policy Plan . 2022 Oct 12;37(9):1177-1187. doi: 10.1093/heapol/czac059.
Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa
Indira Govender, Aaron S Karat, Stephen Olivier, Kathy Baisley, Peter Beckwith, Njabulo Dayi, Jaco Dreyer, Dickman Gareta, Resign Gunda, Karina Kielmann, Olivier Koole, Ngcebo Mhlongo, Tshwaraganang Modise, Sashen Moodley, Xolile Mpofana, Thumbi Ndung’u, Deenan Pillay, Mark J Siedner, Theresa Smit, Ashmika Surujdeen, Emily B Wong, Alison D Grant
Clinical Infectious Diseases doi/10.1093/cid/ciab970/6433207
Estimating waiting times, patient flow, and waiting room occupancy density as part of tuberculosis infection prevention and control research in South African primary health care clinics
Aaron S Karat, Nicky McCreesh, Kathy Baisley, Indira Govender, Idriss I Kallon, Karina Kielmann, Hayley MacGregor, Anna Vassall, Tom A Yates, Alison D Grant.
PLOS Global Public Health
Using system dynamics modelling to estimate the costs of relaxing health system constraints: a case study of tuberculosis prevention and control interventions in South Africa
Fiammetta M Bozzani, Karin Diaconu, Gabriela B Gomez, Aaron S Karat, Karina Kielmann, Alison D Grant, Anna Vassall
Health Policy and Planning
Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa: A Qualitative Study
Idriss I. Kallon, Alison Swartz, Christopher J. Colvin, Hayley MacGregor, Gimenne Zwama , Anna S. Voce, Alison D. Grant and Karina Kielmann
Int. J. Environ. Res. Public Health 2021, 18(22), 12133;
Modelling the effect of infection prevention and control measures on rate of Mycobacterium tuberculosis transmission to clinic attendees in primary health clinics in South Africa
Nicky McCreesh, Aaron S Karat, Kathy Baisley, Karin Diaconu, Fiammetta Bozzani, Indira Govender, Peter Beckwith, Tom A Yates, Arminder K Deol, Rein MGJ Houben, Karina Kielmann, Richard G White, Alison D Grant
BMJ Global Health 2021;6:e007124.
It has become everybody’s business and nobody’s business’: Policy actor perspectives on the implementation of TB infection prevention and control (IPC) policies in South African public sector primary care health facilities
Christopher J. Colvin , Idriss I. Kallon , Alison Swartz , Hayley MacGregor ,
Karina Kielmann, Alison D. Grant
Global Public Health, DOI: 10.1080/17441692.2020.1839932
Impact of the Covid-19 epidemic and related social distancing regulations on social contact and SARS-CoV-2 transmission potential in rural South Africa: analysis of repeated cross-sectional surveys
McCreesh N, Dlamini V, Edwards A, Olivier S, Dayi N, Dikgale K, Nxumalo S, Dreyer J, Baisley K, Siedner MJ, White RG, Herbst K, Grant AD, Harling G.
BMC Infect Dis. 2021; 21: 928. Published online 2021 Sep 8. doi: 10.1186/s12879-021-06604-8
Estimating ventilation rates in rooms with varying occupancy levels: Relevance for reducing transmission risk of airborne pathogens
Deol AK, Scarponi D, Beckwith P, Yates TA, Karat AS, Yan AWC, Baisley KS, Grant AD, White RG, McCreesh N.
PLoS One. DOI: 10.1371/journal.pone.0253096
Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: a scoping review
Gimenne Zwama, Karin Diaconu, Anna S Voce, Fiona O'May, Alison D Grant, Karina Kielmann
Barriers and facilitators of tuberculosis infection prevention and control in low- and middle-income countries from the perspective of healthcare workers: A systematic review
Charlene Tan, Idriss I. Kallon, Christopher J. Colvin, Alison D. Grant
PLoS ONE 15(10): e0241039.
Evidence for the use of triage, respiratory isolation, and effective treatment to reduce the transmission of Mycobacterium tuberculosis in health care settings: a systematic review.
Karat AS, Gregg M, Barton HE, Calderon M, Ellis J, Govender I, Harris RC, Tlali M, Moore DA, Fielding KL
Clinical Infectious Diseases
Tuberculosis infection prevention and control: why we need a whole systems approach
Karina Kielmann, Ph.D.; Aaron S Karat, Gimenne Zwama, Christopher Colvin, Alison Swartz, Anna Voce, Tom A Yates, Hayley MacGregor, Nicky McCreesh, Idriss Kallon, Anna Vassall, Indira Govender, Janet Seeley, Alison D Grant
Infectious Disease of Poverty
Tuberculosis from transmission in clinics in high HIV settings may be far higher than contact data suggest.
McCreesh, Nicky; Grant, Alison D; Yates, Tom A; Karat, Aaron S; White, Richard G;
International Journal of Tuberculosis and Lung Disease. ISSN 1027-3719
Abstract page 58/477 OA05-623-19 Contribution of transmission in clinics to community-wide TB disease incidence, and the impact of infection prevention and control interventions in KwaZulu-Natal, South Africa
McCreesh N, Karat A, Govender I, Baisley K, Diaconu K, Yates T, Houben R, Kielmann K, Grant A, White R
Int J Tuberc Lung Dis 2021: 25 (10 Suppl 2): S1 – S452
Abstract page 23 of PDF: What works to promote TB-IPC in primary care settings in the Western Cape Province, South Africa?
Colivn C, Swartz A, Kallon I, MacGregor H, Kielmann K, Grant A
6th SA TB Conference 2021
Abstract page 59/477 OA05-624-19 Modelling the impact of infection prevention and control interventions on TB transmission in clinics in KwaZulu-Natal, South Africa
McCreesh N, Karat A, Bailey K, Diaconu K, Bozzani F, Govender I, Beckwith P, Yates T, Deol A, Kielmann K, White R, Grant A
Int J Tuberc Lung Dis 2021: 25 (10 Suppl 2): S1 – S452
Abstract: Competing policy imperatives: is the clinic a safe space for its workers and users?
Gimenne Zwama, Chris Colvin, Hayley MacGregor, Karina Kielmann, Alison Swartz, Anna Voce
Antimicrob Steward Healthc Epidemiol. 2023 Jul 17;3(1):e117. doi: 10.1017/ash.2023.192. PMID: 37502244; PMCID: PMC10369445.
umoya omuhle Events 2 columns
umoya omuhle Events 2 columns left paragraph

Health systems webinar: Applying a ‘whole systems’ approach to infection prevention & control in primary health care clinics in South Africa

Watch the webinar recording. 

View the webinar slides.

The Umoya omuhle project team present critical reflections from the project including, understanding complexity, assessing infrastructure, generating evidence through system dynamics modelling and designing whole system interventions.

Screenshot of Umoya omuhle team members on a webinar

Preliminary results webinar: Infection prevention and control for DR-TB in South Africa in the era of decentralised care - a whole systems approach

Read the webinar summary document.

Umoya omuhle team present preliminary results including context, methods and key findings of the project to date.

Umoya omuhle webinar screenshot