The prevalence and risk factors for tuberculosis among healthcare workers in Yogyakarta, Indonesia

Stephanie Main; Rina Triasih; Jane Greig; Arif Hidayat; Immanuel Billy Brilliandi; Syarifah Khodijah; Geoff Chan; Nova Wilks; Amy Elizabeth Parry; Betty Nababan; Philipp du Cros; Bintari Dwihardiani

doi:10.1371/journal.pone.0279215

The prevalence and risk factors for tuberculosis among healthcare workers in Yogyakarta, Indonesia

PLoS One. 2023 May 18;18(5):e0279215. doi: 10.1371/journal.pone.0279215. eCollection 2023.

Authors

Affiliations

¹ Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia.
² National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
³ Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia.
⁴ Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta City, Yogyakarta, Indonesia.

Abstract

Healthcare workers (HCWs) are at risk of contracting TB, particularly when in high tuberculosis (TB) burden settings. Routine surveillance data and evidence are limited on the burden of TB amongst HCWs in Indonesia. We aimed to measure the prevalence of TB infection (TBI) and disease among HCWs in four healthcare facilities in Yogyakarta province in Indonesia, and explore risk factors for TBI. A cross-sectional TB screening study targeted all HCWs from four pre-selected facilities (1 hospital, 3 primary care) in Yogyakarta, Indonesia. Voluntary screening included symptom assessment, Chest X-ray (CXR), Xpert MTB/RIF (if indicated) and tuberculin skin test (TST). Analyses were descriptive and included multivariable logistic regression. Of 792 HCWs, 681 consented (86%) to the screening; 59% (n = 401) were female, 62% were medical staff (n = 421), 77% worked in the one participating hospital (n = 524), and the median time working in the health sector was 13 years (IQR: 6-25 years). Nearly half had provided services for people with TB (46%, n = 316) and 9% reported ever having TB (n = 60). Among participants with presumptive TB (15%, n = 99/662), none were diagnosed microbiologically or clinically with active TB disease. TBI was detected in 25% (95% CI: 22-30; n = 112/441) of eligible HCWs with a TST result. A significant association was found between TB infection and being male (adjusted Odds Ratio (aOR) 2.02 (95%CI: 1.29-3.17)), currently working in the participating hospital compared to primary care (aOR 3.15 (95%CI: 1.75-5.66)), and older age (1.05 OR increase per year of life between 19-73 years (95%CI: 1.02-1.06)). This study supports prioritisation of HCWs as a high-risk group for TB infection and disease, and the need for comprehensive prevention and control programs in Indonesia. Further, it identifies characteristics of HCWs in Yogyakarta at higher risk of TBI, who could be prioritised in screening programs if universal coverage of prevention and control measures cannot be achieved.

Copyright: © 2023 Main et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Female
Health Personnel
Humans
Indonesia / epidemiology
Latent Tuberculosis* / diagnosis
Male
Prevalence
Risk Factors
Tuberculin Test
Tuberculosis* / diagnosis

Grants and funding

The costs of this study were funded by TB Reach, Stop TB Partnership with additional financial support from the PRIME-TB project funded by the Australian Government's Indo-Pacific Centre for Health Security. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.