Workplace HIV and TB Programmes for Laboratory Health Workers: A Rapid Review

Abstract

Introduction

Human immunodeficiency virus (HIV) and tuberculosis (TB) remain global health challenges. Health workers (HWs), particularly laboratory HWs who handle infectious samples, face increased occupational risks of infection. Laboratory HWs are essential for disease diagnosis and monitoring, yet their health is endangered by workplace exposures to HIV and TB, potentially leading to workforce depletion and compromised healthcare delivery. Despite existing guidelines and policies for access and implementation of effective occupational health services (OHS), including hazard identification, medical surveillance, and postexposure preventive treatment, these are often obstructed by resource limitations.

Objective

This review paper discusses the morbidity of HIV and TB among laboratory HWs, and explores the enablers and barriers to accessing HIV and TB OHS.

Methods

A literature search was conducted using the EBSCOhost databases. Relevant keywords identified studies related to HWs, specifically laboratory HWs. Eligible studies were organised using a flow diagram, resulting in 13 papers. Data concerning morbidity, enabling factors, barriers, and recommendations were extracted using a modified tool.

Results

Studies consistently demonstrate a high prevalence of latent TB Infection and active TB among laboratory HWs handling mycobacteria. Barriers to accessing OHS are more frequently reported than enablers, and HIV data specific to laboratory HWs were limited. Recommended interventions include enhanced surveillance, stronger OHS programmes, and integrating OHS and infection control.

Conclusion

Despite growing evidence, gaps remain in implementation, and further studies are needed to assess the real-world application of recommended measures.

1. Introduction

Human immunodeficiency virus (HIV) and tuberculosis (TB) remain significant public health threats globally [1], continuing to cause morbidity and mortality despite the availability of prevention and treatment strategies [2] The World Health Organization (WHO) reports an estimated 39.9 million people living with HIV (PLHIV) in 2023 [1]. Tragically, in the same year, HIV-related illnesses claimed the lives of approximately 630,000 people worldwide [1]. Sub-Saharan Africa (SSA), especially the Eastern and Southern Africa regions, is the epicentre of the HIV epidemic [2]. In 2023, these regions accounted for 20.8 million PLHIV, 450,000 new HIV infections and 260,000 AIDS-related deaths [3].

Tuberculosis (TB), the oldest infectious disease, often combines with HIV to form a lethal combination that accelerates the other's progress, and is often referred to as the dual epidemic of HIV and TB [4,5] TB is a leading cause of death among PLHIV [3]. Alarmingly, in 2023 TB caused an estimated 1.25 million deaths globally, with 161,000 of those deaths occurring among PLHIV, highlighting HIV-associated TB as a major contributor to preventable mortality [6]. Further, a high prevalence of HIV and TB in the general population increases the occupational exposure risk for health workers (HWs), including laboratory HWs who are involved in diagnostic testing and handling of infectious samples [[7], [8], [9]]. HWs are routinely exposed to both HIV and TB during healthcare activities, which supports the designation of both diseases as occupational diseases in healthcare settings, especially in high-burden regions [[10], [11], [12]]. An occupational disease covers any disease contracted as a result of an exposure to risk factors arising from work activity [10,13].

HIV occupational exposure in healthcare settings occurs when HWs are exposed through percutaneous exposure and mucous membrane or nonintact skin contact. This includes splashes or sprays of infectious fluids, which enter the body through the eyes, nose, mouth, or any areas of broken skin, which lack the protective barrier of healthy skin [14,15]. Whereas occupational TB exposure occurs when a worker is exposed to Mycobacterium TB (MTB) in the course of their employment. This usually happens when individuals share the same airspace in healthcare settings with an individual who has active TB disease [16]. In the context of laboratory HWs, they are most likely to contract TB through the handling and processing of infected samples, especially TB-positive specimens during laboratory procedures that generate aerosols [17].

Laboratory HWs are a vital subcategory of HWs and offer laboratory services that are essential for diagnosing and monitoring diseases, forming the backbone of quality healthcare [18,19]. If left unmanaged, HIV and TB can pose a serious threat to both laboratory HWs and the healthcare system as a whole. The negative impact on laboratory HWs include acute illnesses requiring hospitalisation, long-term absenteeism, impacting their wellness and reducing their ability to work effectively [20]. A depleted workforce due to HIV and TB infection will therefore disrupt healthcare service delivery, resulting in poor healthcare for the general population [21,22].

In recognition of the need to safeguard and invest in HWs, the WHO collaborated with the International Labour Organization (ILO) to issue a 2022 guideline on developing and implementing occupational health services (OHS) specifically for HWs [23]. The guideline, recommends a tripartite-plus health sector stakeholder to formulate and implement specific OHS interventions at national and facility level [23]. Further, the ILO's convention 161 advises member states, including employers and employees, on how to create a safe and healthy work environment that promotes both physical and mental well-being [24].

Globally, occupational safety and health (OSH) is mandated by law, with minor differences across countries, including for HIV and TB OHS for HWs [25]. For examples, in South Africa, the Occupational Health and Safety Act (OHSA) 85 of 1993 provides a comprehensive legal framework for protecting the health and safety of workers [26]. It outlines the employer's responsibility to provide a safe and healthy working environment for employees, including HWs. In addition, the OHSA addresses various occupational health hazards, including exposure to infectious diseases such as HIV and TB [26]. However, OSH legal and policy frameworks governing HWs vary across regions and countries, with high-income countries generally operating under more comprehensive and enforceable OSH legislation than many low- and middle-income countries (LMIC) [27]. These differences in regulatory coverage, enforcement capacity, and integration of OHS are important determinants of the availability and effectiveness of workplace HIV and TB programmes for laboratory HWs [23].

Trade unions represents workers in various platforms and advocate for the rights of workers, as well as engage in collective discussions to negotiate better working conditions, including participation in health and safety committees. Through these mechanisms, trade unions play an important role in holding the employer accountable for the implementation of occupational health measures [28,29].

Occupational health services for HIV and TB in healthcare may include hazard identification and risk assessment, risk-based medical surveillance, vaccination programmes, provision and appropriate utilisation of personal protective equipment (PPE) provision, safe work practice training, HIV postexposure preventive treatment, latent TB infection (LTBI) treatment, HIV counselling and testing, etc. [30]. Despite the availability of these services in the workplace, several factors may prevent access to OHS for laboratory HWs. Amukugo et al., identified several contributing factors including resource limitations, stigma, and discrimination, lack of knowledge and awareness of occupational risks, as well as inadequate health education to HWs regarding OSH [31]. Furthermore, access to OHS for HWs has remained consistently low globally, with identified barriers including shortages of human resource, inadequate training, and education in the field of OSH [32].

While it is established that laboratory HWs are especially vulnerable due to their frequent exposure to infectious agents in the workplace [33], this vulnerability is reflected in a 2022 study by Garnett et al., which reported a TB incidence rate of 182.79 per 100,000 person-years among diagnostic pathology laboratory HWs in South Africa [34], highlighting the significant occupational exposure they face. Another South African study found a concerning HIV prevalence rate of 10.4% among laboratory HWs in 2013 [35]; this study emphasised the need for robust OHS programmes for laboratory HWs. Noting the HIV and TB workplace issues faced by HWs, the objectives of this paper are: 1) to review and document the morbidity related to HIV and TB among laboratory HWs, and 2) to identify enablers and barriers to HIV and TB OHS for laboratory HWs.

2. Methods

This study was a rapid narrative literature review, we searched EBSCOhost, which yielded papers from PubMed, CINAHL, and Medline databases. The search used the following key words “Laboratory workers”, “HIV”, “TB” “workplace health programmes”, and “OHS’’. The search included scientific studies published in English. Additionally, the reference lists of these identified papers were screened to identify additional relevant papers. Grey literature, including government and international agency documents (WHO, ILO, etc.) containing guidelines and policies related to workplace HIV, TB, and OSH, were included in the search. Observational studies (prospective, retrospective, case-control, and cross-sectional) focussing on workplace/occupational HIV TB morbidity and mortality, policy, systems, services, and programmes, were all eligible for inclusion. We included studies published from the year 2000–2024 and excluded studies published before the year 2000, general population studies, review studies, case studies, and studies focussing on other diseases. The following variables were used to characterise included studies: author, country, study design, population, population size, morbidity, and mortality, workplace access to HIV and TB services, enabling factors, barriers, and recommendations.

3. Results

A search of relevant databases yielded 42 potential studies. After removing duplicates, 26 Studies were screened. Of these, 6 were excluded based on their titles and abstracts, leaving 20 studies for full-text studies. Two full-text studies could not be retrieved, resulting in 18 eligible studies that were retrieved. However, 8 of these were excluded due to a lack of desired information, language (not in English) and study design. To enhance the search, 8 additional studies identified through manual search from references of the studies in the included studies were assessed for eligibility and only 3 of them were included in the review. This resulted in a total of 13 eligible studies for data extraction, as illustrated in Fig. 1.

Fig. 1.

PRISMA flow diagram: process of identifying eligible studies. PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses.

In the 13 studies that have been reviewed, 10 studies were on TB in HWs including laboratory workers, one study investigated HIV prevalence in HWs including a small portion of laboratory HWs, one study was on both HIV and TB in HWs, and 1 study was on biological hazards which included HIV and TB among laboratory HWs. The majority of these studies were cross-sectional (n = 10), followed by a small number of cohort studies (n = 3) which were retrospective. Six studies specifically studied laboratory HWs who are involved in the direct contact and processing of laboratory samples, particularly in microbiology laboratories. Six studies identified the target population of HCWs who are working in healthcare facilities, this also included a significant portion of laboratory HWs. One study had a target population of occupational health and infection control nurses who implement occupational health policies and practices related to TB in healthcare settings. The population size across all 13 studies was 8 716.

3.1. HIV and TB morbidity

As shown in Table 1, five studies reported on the morbidity of LTBI, TB, and only one study reported the morbidity of HIV. These studies were conducted in Africa (7), Asia (3), Europe (3), North and South America (4), and collectively illustrate the varying morbidity of TB (LTBI and active TB disease), among laboratory HWs.

Table 1.

Summary of reviewed studies related to HIV and TB occupational health services among laboratory HWs.

Author	Origin Country (City)	Area of research	Type of study	Population	Population size	Morbidity	Workplace access to HIV TB OHS (yes, no, unknown)	Enabling factors for accessing OHS	Barriers for accessing OHS	Recommendations
Garber et al., 2003 [36]	USA (New York City)	LTBI in laboratory HWs	Cross-sectional survey	Laboratory HWs	n = 345	First year of study: Prevalence of a LTBI among all HWs: 57.0% Prevalence of LTBI in mycobacteriology laboratory HWs: 64.0% Prevalence of LTBI in nonmycobacteriology HWs: 53.0% Second year of study: Incidence of TST conversion: 1.0% Previous history of active TB cases: 1 HW 0.3%	Yes	Pre-employment assessment Outreach programme	—	—
Nasehi et al., 2016 [42]	Iran	LTBI in laboratory HWs	Cross-sectional study	HWs (including laboratory HWs)	n = 1006	The prevalence of LTBI among TB laboratory HWs was 24.4%	Unknown	—	—	Effective TB infection control programmes TB screening of high-risk group Baseline TST for all TB laboratory HWs
Zhang et al., 2013 [37]	China	LTBI	Cross-sectional study	HWs (including laboratory HWs)	n = 787	The LTBI rate among TB laboratory HWs (39.1%) LTBI in non-TB laboratory HWs (45.3%)	No	—	—	Prevention and control of nosocomial TB
Miller et al., 2002 [38]	United States of America	LTBI	Retrospective cohort study	HWs (including laboratory HWs)	n = 3248	Among laboratory HWs handling TB specimens the TST conversion rate was 14.3% (3/21), about twofold higher than laboratory HWs	No	—	—	Adopt CDC TB Infection prevention and control guidelines
Garnett et al., 2020 [34]	South Africa	TB	Retrospective cohort study	Laboratory HWs	—	Skilled laboratory HWs reported TB incidence of 159.43 per 100,000 person-years Unskilled laboratory HWs reported TB incidence of 164.5 per 100,000 person-years	Yes	—	Organisational factors such as lack of training and lack of policy and procedure	Functional occupational health surveillance systems can identify subgroups most at risk as well as areas of programme success and weakness
Shiferaw et al., 2021 [40]	Ethiopia	TB in HWs	Cross-sectional study	HWs and support staff (including laboratory HWs)	n = 580	TB prevalence was 1.6%	No	—	Lack of TB pre- and or annual employment screening	Triage of HWs with TB signs and symptoms to aid in rapid diagnosis and treatment.
Kim et al., 2007 [39]	Republic of Korea	TB	Retrospective cohort study	Laboratory HWs including managerial and clerical workers	n = 241	Nonlaboratory HWs had a TB incidence rate of 202 per 100,000 person-years. Laboratory HWs (microscopy technicians) had a TB incidence rate of 284 per 100,000 person-years and laboratory HWs (culture/DST technicians) had a prevalence of 1 569 per 100,000 person-years	Yes	Annual check-up/illness investigations during employment	—	In addition to upgrading facilities and providing safety equipment, safe laboratory practices by technicians are a critical element to secure a safe laboratory environment.
Adeoti et al., 2018 [43]	Nigeria	TB in laboratory HWs	Cross sectional	Laboratory HWs	n = 58	—	Yes	Pre-employment screening for HIV and TB, diabetes, pregnancy and renal function were performed in certain respondents.	Lack of pre-employments screening. Payment for the pre-employment screening	Integration of occupational TB control programme into the national guideline. Policy implementation of the TB infection control All HWs should have pre- and routine -employment assessment and screening for TB in a healthcare setting
Tamir et al., 2016 [44]	Ethiopia	TB	Cross-sectional study	HWs (including laboratory HWs)	n = 647	—	No	—	Lack of training, knowledge, infrastructures and resources, man power, awareness to the community and ignorance and lack of commitment by HWs. Stigma or confidentiality concerns	Health centres should develop TBIC plans and train all healthcare workers. Woreda Health Offices must provide supportive supervision and ensure proper implementation. Adequate supplies and infrastructure are essential. Targeted training for maternal and child health, pharmacy, and laboratory HWs can enhance TBIC practices and prevent TB transmission within healthcare facilities.
Vaquero-Álvarez et al., 2020 [46]	Multiple countries ∗Europe(Spain, Belgium, Sweden, Bulgari, & Latvia) ∗North & South America(Mexico, Colombia the Dominican Republic) Non-Spanish (centres from LMIC)	TB in laboratory HWs	Cross-sectional study	Laboratory HWs	n = 30	—	Unknown	—	Lack of PPE and safety measures Lack of information regarding updates, protocols, or changes in the work environment	Greater compliance with the relevant measures is needed, along with further research that focuses on whether such measures are being followed.
Tudor et al., 2013 [47]	South Africa	HIV and TB in HWs	Cross-sectional study	OH, and IC nurses.	—	—	Yes	—	Lack of training in OH. The absence of a health and safety officer. Overworked and understaffed. Reluctance of staff to undergo TB screening	Greater integration between OH and IC The implementation of OH policies specifically targeted for work in health care settings More attention and support should be provided to OH services and practices in healthcare settings
Tait FN et al., 2018 [45]	Kenya	Biological hazards (including HIV and TB)	Cross-sectional study	Laboratory HWs	n = 204	—	Yes	—	Ignorance among HWs, Inadequate resources, inadequate training on OSH, no policy on OSH, negative attitude on OSH	—
Kirakoya–Samadoulougou et al., 2014 [41]	Burkina Faso	HIV in HWs including laboratory HWs	Survey	HWs (including laboratory HWs)	n = 1570	Crude prevalence of HIV in in laboratory HWs was 4·6%	Unknown	—	—	Prioritisation of a better access to VCT service, improved counselling on safe-sex behaviours and HIV treatment specifically adapted to female HWs should be developed within the Ministry of Health

CDC, Centers for Disease Control and Prevention; DST, drug susceptibility testing; HIV, human immunodeficiency virus; HWs, health workers; LTBI, latent TB infection; OHS, occupational health services; PPE, personal protective equipment; TB, tuberculosis; VCT, voluntary counselling and testing.

In a study of laboratory HWs in New York City, United States of America, the prevalence of a positive Tuberculin skin test (TST) in the first year of the study was 57.0% among all HWs. The prevalence of LTBI was 64.0% in mycobacteriology laboratory HWs and 53.0% in nonmycobacteriology HWs. In the second year of the study the incidence of TST conversion was 0.1% and for the history of active TB cases, it was reported to be 0.3%. In Iran, the LTBI prevalence among TB laboratory HWs was 24.4% [36]. A study in China found the LTBI rate to be 39.1% among TB laboratory HWs and 45.3% in non-TB laboratory HWs [37]. Another study in the United States of America reported a TST conversion rate of 14.3% among laboratory HWs who handled M. tuberculosis specimens [38]. Further, the incidence of active TB in a South African study was found to be 159.43 per 100,000 person-years for skilled laboratory HWs and 164.5 per 100,000 person-years for unskilled laboratory HWs [34]. In the Republic of Korea, non-aboratory HWs had a TB incidence rate of 202 per 100,000 person-years, while microscopy technicians had a rate of 284 per 100,000 person-years, and culture/drug susceptibility testing (DST) technicians had a rate of 1569 per 100,000 person-years [39]. The overall TB prevalence in an Ethiopian study was 1.6% in HWs including laboratory HWs [40]. Out of all the 13 articles reviewed, only 1 study, in Africa, Burkina Faso, reported the crude HIV prevalence in laboratory HWs, which was 4.6% [41].

3.2. Access to occupational health services

Regarding access to OHS related to HIV and TB in the workplace a clear indication of access was reported by studies in New York City, South Africa (2 studies), Nigeria, and Kenya, and the Republic of Korea [34,[41], [42], [43], [44], [45]], while research from Ethiopia (2 studies), China, and the United States of America, indicated a lack of access to these services [37,38,40,44]. Furthermore, studies in Iran and Burkina Faso, as well as the multiregional study by Vaquero-Álvarez et al. covering Europe, North, and South America, reported no clear indication of whether OHS related to HIV and TB is available in the studied workplaces [41,42,46] (Table 1).

3.3. Enablers of occupational health services

Several enabling factors for accessing OHS related to HIV and TB services were identified. Among these, was the availability of general OHS such as pre-employment assessment, which, in certain contexts, included screenings for conditions such as HIV, Tuberculosis (TB), diabetes, pregnancy, and renal function in a study done in Nigeria [43]. Furthermore, Garber et al. reported the provision of pre-employment assessment and outreach programmes as a significant mechanism for service delivery [36]. In a Korean study, the continued access to OHS was supported by annual check-ups and illness investigations conducted during the period of employment [39] (Table 1).

3.4. Barriers to occupational health services

Barriers to OHS were commonly reported, in a Kenyan study, they included a lack of training (29.4%), inadequate resources (41.2%), and no policy on OHS (34.8%), a negative attitude towards OHS (55.9%) and ignorance among laboratory HWs (36.8%) [45]. In Ethiopia, barriers included a lack of knowledge, infrastructure, supplies, and manpower, a lack of awareness in the community, carelessness, and a lack of commitment among laboratory HWs, the majority of participants cited stigma or confidentiality concerns as barriers to HW HIV or TB testing and redeployment of HIV-positive HWs from high risk areas [44]. Additionally, a South African study cited the absence of a health and safety officers, being overworked, understaffed, and the reluctance of HWs to undergo TB screening [47]. In Nigeria, the cost of pre-employment screening was a barrier for some newly employed HWs [43] (Table 1).

3.5. Recommendations for HIV and TB occupational health services

As illustrated in Table 1, the reviewed studies, frequently recommend and emphasised the need for high-level policy support and integration into existing health systems through policy changes. Specifically, the integration of an occupational TB control programme into national TB guidelines. [34,43]. Another study recommended that OH and IC be integrated to enhance HW protection, coupled with increased attention and support for OHS [47]. Zhang et al. recommended that, due to the high TB prevalence, China should prioritise efforts to reduce nosocomial TB transmission [37]. Vaquero-Álvarez et al. suggested that to decrease TB prevalence and risk among workers, greater compliance with relevant measures is needed, along with further research focused on validating that such measures are effectively being followed [46].

A consistent finding was the need for robust systems to identify and monitor at-risk workers: A South African study recommended implementing a functional OH surveillance system capable of identifying high-risk subgroups and tracking programme efficacy to guide policy modifications and training needs [34]. Miller et al. recommended adopting Centers for Disease Control and Prevention (CDC) guidelines to include all HWs in TST programmes, not just those providing direct patient care [38]. Nasehi et al. in Iran recommended screening for TB in high-risk groups and performing a baseline Mantoux test for all TB laboratory HWs at pre-employment, with periodic follow-ups to detect seroconversion [42].

At the facility level, recommendations focused on specific actions to reduce transmission risks, as is seen in an Ethiopian study by Shiferaw et al., who recommended the triage of HWs presenting with TB signs and symptoms to reduce MTB transmission and facilitate rapid diagnosis and treatment [40]. Tamir et al. suggested that health centres in Ethiopia must develop TB IC plans and train all HCWs, noting that adequate supplies and infrastructure are essential for implementation [44]. A key recommendation from a study in the Republic of Korea was that, in addition to upgrading facilities and providing safety equipment, safe laboratory practices by technicians should be strictly adhered to in order to secure a safe laboratory environment [39]. Kirakoya–Samadoulougou et al. in Burkina Faso recommended prioritising better access to voluntary counselling and testing (VCT) services and developing HIV treatment specifically adapted to female HWs within the Ministry of Health [41].

4. Discussion

This review aimed to determine the morbidity of HIV and TB among laboratory HWs and to identify enablers and barriers to HIV and TB OHS for laboratory HWs. Our study found evidence from studies across multiple regions including North America, Asia, Africa, and Latin America. These regions consist of high-income countries (HICs), and low- and middle-income countries (LMICs), allowing comparison of policies, programmes, and OHS differences affecting HWs There was limited literature specifically on HIV and TB morbidity, and especially on HIV, specific to laboratory HWs, as most publications were on patient-facing HWs, such as nurses and medical doctors. Thus, the majority of the studies focused more on TB and LTBI among HWs including laboratory HWs.

Laboratory HWs were consistently treated as a high-risk subgroup in the reviewed papers, due to their frequent contact with human specimens [12]. Tuberculosis transmission in healthcare settings is known to occur through inhalation of aerosolised MTB [15,16,48]. For laboratory HWs, the risk of infection is particularly associated with aerosol-generating procedures such as sputum processing, centrifugation, culture manipulation, and DST [49] Overall, the evidence from reviewed studies, supported by laboratory-specific normative and technical guidance, including the TB laboratory biosafety manual and the TB Work Safe handbook, indicates that laboratory HWs face persistently elevated occupational TB risk due to aerosol-generating procedures and culture handling; this reinforces the need for laboratory-specific biosafety, infection prevention, and occupational health interventions [43,50]. While frontline clinical HWs, including nurses and physicians, face exposure through close and prolonged contact with infectious patients, laboratory HWs experience a distinct occupational risk linked to task-specific exposure to high concentrations of viable bacilli, often within enclosed laboratory environments [16,51]. Though, laboratory HWs have less direct patient contact than frontline clinical HWs, inadequate engineering controls, and/or biosafety practices during aerosol-generating procedures, can result in comparable or even elevated occupational risk [52]. This highlights the importance of transmission-based risks that should consider professional role and specific occupational tasks when designing TB OHS interventions.

The prevalence of LTBI and active TB varies significantly across countries and occupational roles, with laboratory HWs, particularly those handling MTB specimens, often exhibiting higher rates of infection or conversion [34,[36], [37], [38],42]. This pattern is evident in South Africa and Ethiopia, as well as in high- and middle-income countries like the Republic of Korea and Iran, respectively. Studies show that laboratory HWs handling MTB cultures, DST procedures, and aerosol-generating tasks have the highest infection rates, often several-fold greater than in non-TB laboratory HWs and substantially exceeding community prevalence estimates [33,39,40,42]. For instance, LTBI prevalence among HWs in Kigali, Rwanda, reached 62% compared with 39% in non-HWs controls, clearly demonstrating an occupational risk [53].

Even in countries where community TB incidence has declined, such as in Iran, where there is a notable improvement showing a decline of 12 cases per 100,000 population from 23 in 2000 to 11 in 2023 [54], the LTBI prevalence among HWs remains significantly higher than in low-risk groups, demonstrating that occupational exposure continues to drive infection despite national gains [50].

Finally, HIV infection in some HWs population, such as in Burkina Faso, where prevalence among HWs reached 3.5%, adds additional vulnerability and risk for TB infection and disease progression [41].

Access to specific HIV and TB OHS in many healthcare settings is often unclear or entirely absent [37,[40], [41], [42],44,46], The absence of OHS specific to HIV and TB is a serious issue, given the high risk of exposure faced by HWs [11,12]. While, the absence of specific HIV and TB OHS is a concern, it is important to acknowledge that some healthcare work settings have general OHS and IPC policies and programmes [43,47]. Even where general OHS or IPC policies exist, a policy-practice gap is common across different workplaces, requiring effective implementation of integrated OHS with HIV and TB [46,47,50,55].

Effective access to OHS related to HIV and TB depends on several structural enablers within healthcare settings. Strong OHS and surveillance systems, such as those implemented in South Africa, improve early case detection and help identify high-risk worker groups, enabling targeted interventions [34]. Similarly, facilities with robust IPC frameworks, adequate PPE supply, and consistent training, as seen in well-performing systems like Rwanda's HWs screening programme, facilitate regular testing and risk assessment [56]. Other key enablers include management commitment, clear workplace policies, supportive management, outreach programmes, pre-employment screening and services, all of which enhance programme uptake by HWs [36,43,57].

Common barriers include resource shortages, such as inadequate PPE supply and poor infrastructure. A study in rural Uganda highlights that some healthcare workplaces struggle to sustain TB contact investigation and HWs screening [58]. The majority of participants in an Ethiopian study, reported stigma and confidentiality concerns as barriers to HW HIV or TB testing [44]. These results correlate with a study conducted in Malawi were stigma and confidentiality concerns undermined HWs’ willingness to access HIV and TB OHS in their workplace, particularly where fears of disclosure affect professional or social identity [59]. In addition to disease-related stigma, laboratory HWs are often an “invisible” or “behind the scene” occupational group within healthcare systems, receiving less recognition and engagement in occupational safety decision-making than frontline clinical HWs. This sense of being less recognised, along with work-related stress, may make laboratory HWs less likely to engage in OHS or consistently follow safety practices. [23]. Additional obstacles include insufficient training, overwork, and weak enforcement of IPC policies, all contributing to the persistent policy-practice gap documented in LMIC settings [44,60].

These policy-practice gaps highlight the need to better integrate OHS within broader Occupational Safety and Health Management Systems (OSHMS) and show how differences in national regulation and enforcement affect workplace HIV and TB OHS [23,61]. At a global level, laboratory-specific evidence on the morbidity of HIV and TB remains limited compared with that of frontline clinical HWs, constraining the development of task-specific and risk-stratified interventions [9,62]. At national and facility levels, despite the existence of OSH and IPC policies, there is limited evidence on real-world implementation, adherence, and effectiveness for laboratory HWs [15,46,52]. Addressing these gaps requires strengthened occupational surveillance, routine evaluation of OHS programmes, and research focused on laboratory-specific practices to ensure that evidence-based guidelines translate into meaningful workplace protection [23,34,61]. International standards such as ISO 45001 further reinforce the systems-based approach to OSH by providing a structured framework for hazard identification, risk management, worker participation, and continuous improvement, within which OHS can be more effectively implemented [63].

In response to these regulatory and implementation gaps, functional occupational health surveillance is important in identifying higher-risk subgroups and guiding targeted training [34]. Strengthening TB IPC within laboratories and integrating occupational TB control into national guidelines remain key priorities that the authors put forward [42,43]. Aligning OHS with IPC efforts further enhances worker protection [47,60,64,65]. Other recommended actions include adopting CDC aligned TB controls, ensuring adequate infrastructure [38,44,47], improving pre-employment screening, triage, follow-up testing [42,43,46], and expanding HIV services such as HIV counseling and testing and tailored treatment strategies [41]; these are consistent with ILO-WHO guidance on protecting HWs from HIV and TB co-infection [30] These measures, along with safety equipment and programmes, require active employee compliance [39]. Further research is needed to assess the actual adherence of laboratory HWs to these crucial measures [46].

5. Limitations

This review has several limitations. As a rapid narrative review, the search and screening process may have led to the omission of some relevant studies and limited the depth and scope of comparative and causal analysis. The search strategy was narrow and did not include Occupational Safety and Health Management Systems such as ISO 45001, and or Laboratory Quality Management Systems such as ISO 15189 and ISO 15190, which may have reduced the available evidence for broader laboratory safety frameworks. In addition, evidence specific to laboratory HWs, on occupational HIV and TB remains relatively limited compared with evidence of patient-facing HWs such as nurses and medical doctors, and the heterogeneity across study designs, settings, and outcomes constrained direct comparison and synthesis of findings.

6. Conclusion

The studies revealed a high prevalence of LTBI and active TB among laboratory HWs, particularly those handling mycobacteria. While some progress has been made in understanding the risks laboratory HWs face and recommending control measures, some gaps still remain. Resource limitations, inadequate training, and a lack of consistent OSH implementation in the workplace disturb the effective protection of laboratory HWs. Studies exploring the co-morbidity of HIV and TB among laboratory HWs, as well as studies focussing on HIV alone in this group, remain limited compared with other HW population, highlighting the need for further research in this area. Additionally, future research should consider assessing the real-world implementation of recommended measures to ensure that guidelines and policies are translated into effective, routine workplace practices for laboratory HWs.

CRediT authorship contribution statement

Selelo Ramahlo: Writing – original draft, Methodology, Formal analysis, Data curation. Nosimilo Mlangeni: Writing – review & editing, Supervision. Muzimkhulu Zungu: Writing – review & editing, Visualization, Supervision, Conceptualization.

Statement on the use of AI tools

During the preparation of this work the author(s) used Microsoft Co-pilot in order to improve readability. After using this tool, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the published article.

Conflicts of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.