Abstract
Objective
To better understand tuberculosis (TB) infection control (IC) in healthcare facilities (HCFs) in Georgia.
Design
A cross-sectional evaluation of healthcare worker (HCW) knowledge, beliefs and behaviors toward TB IC measures including latent TB infection (LTBI) screening and treatment of HCWs.
Setting
Georgia, a high burden multidrug-resistant TB (MDR-TB) country.
Participants
HCWs from the National TB Program and affiliated HCFs.
Methods
An anonymous self-administered 55-question survey developed based on the Health Belief Model (HBM) conceptual framework.
Results
In total, 240 HCWs (48% physicians; 39% nurses) completed the survey. Overall average TB knowledge score was 61%. Only 60% reported frequent use of respirators when in contact with TB patients. Only 52% were willing to undergo annual LTBI screening; 48% were willing to undergo LTBI treatment. In multivariate analysis, HCWs who worried about acquiring MDR-TB infection (aOR 1.7; 95% CI 1.28-2.25), who thought screening contacts of TB cases is important (aOR 3.4; 95% CI 1.35-8.65), and who were physicians (aOR 1.7; 95% CI 1.08-2.60) were more likely to accept annual LTBI screening. In regards to LTBI treatment, HCWs who worked in an outpatient TB facility (aOR 0.3; 95% CI 0.11-0.58) or perceived a high personal risk of TB re-infection (aOR 0.5; 95% CI 0.37-0.64) were less likely to accept LTBI treatment.
Conclusion
The concern about TB re-infection for HCWs is a major barrier to their acceptance of LTBI treatment. TB IC measures must be strengthened in parallel or prior to the introduction of LTBI screening and treatment of HCWs.
Introduction
Nosocomial transmission of Mycobacterium tuberculosis has been documented in a variety of resource-limited country settings1, 2 largely due to lack of implementation of effective tuberculosis (TB) infection control (IC) measures. Most high-income countries screen healthcare workers (HCWs) for latent TB infection (LTBI) and provide treatment for those with LTBI as part of their TB IC programs. These practices, however, are not yet widely implemented in resource-limited settings.3, 4 In Georgia, as in other resource-limited, high TB burden countries of Eastern Europe, TB IC measures in healthcare facilities (HCFs) are very limited. Patients with infectious TB have historically been diagnosed and treated in inpatient and outpatient TB facilities organized by the National TB Program (NTP), although persons with undiagnosed TB or suspected cases of TB may be seen at non-TB primary healthcare centers (PHCs), and referred to TB facility later. There are no routine programs in place to screen HCWs for LTBI in Georgia.5, 6
In 2012, the estimated TB prevalence in Georgia was 58 per 100,000 population and estimated percent of TB cases with multidrug-resistant TB was 9% and 31% among new and previously treated cases, respectively.7 A higher prevalence of LTBI among HCWs was reported among those who worked in TB facilities (55%) compared to those who worked in non-TB HCFs (31%) in Georgia. Furthermore, a high rate of recent infection was reported among Georgian HCWs at TB facilities when tested with a commercially available interferon-gamma release assay (22.8/100 person-years).6 These findings suggest a high rate of ongoing TB transmission in Georgian TB facilities. Implementation of effective TB IC measures, including HCW training and education regarding TB and TB IC, is essential in preventing the nosocomial transmission of TB.2, 4, 8 We conducted an anonymous survey of Georgian HCWs to provide baseline data on their knowledge, beliefs, and behaviors related to TB IC. The data will be used for the development and implementation of TB IC interventions/programs at Georgian HCFs.
Methods
Study Setting and participants
A cross-sectional evaluation of HCW knowledge, beliefs and behaviors toward TB IC measures was conducted between July-December 2011 among HCWs in Georgia. HCWs from the Georgian NTP, including the National Center for TB and Lung Diseases (NCTLD) in Tbilisi, its affiliated TB outpatient clinics from whole country, as well as HCWs from PHC were eligible to enroll. Inclusion criteria were age ≥18 years old and being a HCW. HCW was defined as someone who worked in a HCF. Those eligible to participate included 1,400 HCWs employed by the NTP and 3,085 HCWs employed by PHCs. Convenience sampling was used; HCWs undergoing TB education at the NCTLD between July-December 2011were approached with information about the survey before the TB educational sessions. The NTP provides TB education for the NTP and PHC HCWs from entire country on a biennial basis at the NCTLD. HCWs provided oral consent for study participation. The study was approved by the Emory University Institutional Review Board and Georgian NCTLD Ethics Committee.
Data collection
An anonymous self-administered 55-question survey was provided to all participants in the Georgian language (Kartuli). The survey was piloted with 10 HCWs from the NCTLD; these HCWs were not included in the final sample. The survey was developed based on the Health Belief Model (HBM) conceptual framework.9-12 The survey collected information about respondents’ TB knowledge, their health-related behaviors, and willingness to engage in health-related behavioral change with respect to the following: respirator use, UV lights, willingness to be annually screened for LTBI, and willingness to be treated for LTBI if tested positive by LTBI diagnostic tests. In addition, the survey measured the following HBM constructs: perceived susceptibility to and perceived severity of LTBI and TB disease including multi and extensively drug-resistant (M/XDR) TB, perceived benefits of IC measures, perceived barriers to implementing IC measures, and cues to action such as availability of respirators and instructions from managers related to using the respirators. Five-point Likert-type scales were used to assess HCWs’ beliefs and behaviors.13, 14 Perceived susceptibility to TB infection was measured using a five-level variable where 1 indicated no perceived possibility and 5 indicated very good chance of being infected with TB. Perceived severity of TB infection was also assessed using a five-level variable where 1 indicated strong agreement and 5 indicated strong disagreement with the statements of concerns about acquiring LTBI and TB disease. We also asked various socio-demographic questions in order to further characterize the study population.
Statistical analysis
The survey data were entered and managed using a REDCap electronic data capture tool.15 Statistical analysis was performed in IBM SPSS Statistics version 19. We first calculated frequency distributions; if < 10% of participants responded to a question item, that item was excluded from further analysis. Five-level variables measuring HCWs beliefs about TB IC measures were reduced to three-level variables for multivariate analysis. We used binomial logistic regression to estimate the association between HCW demographic characteristics and knowledge of TB; ordinal (when proportional odds assumption was met) or multinomial logistic regression were used to estimate the association between HCW’s beliefs and their IC related behaviors.16 In multivariable models we adjusted for variables that met statistical and epidemiological criteria16 and were congruent with the HBM framework. Collinearity was assessed for multivariable models, variables with significant collinearity were removed from final models. We used the Mann-Whitney U-test to compare the median scores of HCWs’ beliefs among two independent groups – HCWs who answered a TB related knowledge question correctly and HCWs who answered the question incorrectly.17
Results
Study participants
A total of 298 HCWs were approached to enroll in the study; 240 (81 %) agreed to participate. The characteristics of the study population (n=240) are described in Table 1. The mean age of HCWs who participated was 44.3 years (SD=11.4 years). The majority of the participants were female (90%) reflecting the makeup of HCWs at the NTP and affiliated institutions. Respirators were available for 82% of HCWs from the NTP and for only 45% of HCWs from the PHCs. The mean number of years in healthcare was 19.7 (SD 10.9 years).
Table 1.
Demographic Information of Healthcare Workers Surveyed (N=240)
| Characteristic | Subcategory | N (%) |
|---|---|---|
| Demographic | ||
| Age, years | ≤ 35 | 59 (24.6) |
| 36 – 44 | 59 (24.6) | |
| 45 – 51 | 59 (24.6) | |
| 52 – 60 | 37 (15.4) | |
| 60 < | 20 (8.3) | |
| Missing | 6 (2.5) | |
| Gender | Female | 216 (90.0) |
| Location of HCW Employment | Tbilisi | 130 (54.2) |
| Other Locations | 110 (45.8) | |
| Employment | ||
| Health Facility | TB Facility | 136 (56.7) |
| Non-TB health facility | 104 (43.3) | |
| Respirator Is Available for Most of the Time |
Inpatient TB facility | 35 (92.1) |
| Outpatient TB facility | 77 (78.6) | |
| Non-TB health facility | 45 (44.6) | |
| Works Primarily with TB Patients | Yes | 136 (56.7) |
| Occupation | Physician | 114 (47.5) |
| Nurse | 94 (39.2) | |
| Other | 27 (11.3) | |
| Missing | 5 (2.1) | |
| Years Worked in Healthcare | ≤ 5 | 26 (10.8) |
| 6-20 | 98 (40.8) | |
| 21-34 | 80 (33.3) | |
| 35 ≤ | 22 (9.2) | |
| Unknown/Missing | 14 (5.8) | |
Note HCW, Healthcare worker; TB, Tuberculosis
HCWs overall average knowledge score was 61%. HCWs who worked with TB patients knew more about TB with 69 % overall average score compared to HCWs who did not with 49.16% overall average score (p < 0.01). Nearly all HCWs (98%) knew that TB is transmitted by an airborne route and 70% HCWs knew epidemiological, clinical, and laboratory characteristics of LTBI. However, only 43% of HCWs knew about the level of risk of LTBI progression to TB disease, and only 30% were able to correctly identify high-risk groups for LTBI progression to TB disease. The majority (85%) HCWs knew the preferred regimen for LTBI treatment but fewer (66%) knew the justification for latent TB therapy.
With respect to HCWs perceived threat of TB infection and perceived benefits and barriers of TB IC, 53% of HCWs thought that they were at risk of having LTBI at some point in the future, 36% of the participants were concerned about acquiring LTBI with MDR-TB strains, 48% thought of LTBI as a serious health condition, but 43% of HCWs did not want to receive treatment for LTBI because they believed that they would be exposed to TB again (Table 2).
Table 2.
Healthcare Worker Beliefs about Latent Tuberculosis Infection and Tuberculosis Infection Control (N=240)
| Characteristic | No Chance (1) N (%) |
Little Chance (2) N (%) |
No Opinion (3) N (%) |
Some Chance (4) N (%) |
Very Good Chance (5) N (%) |
|---|---|---|---|---|---|
| Perceived Susceptibility | |||||
| Have LTBI now | 48 (20.0) | 71 (29.6) | 11 (4.6) | 72 (30.0) | 38 (15.8) |
| Will test positive for LTBI in the future |
22 (9.2) | 65 (27.1) | 25 (10.4) | 99 (41.3) | 29 (12.1) |
| Will be diagnosed with TB in the future |
35 (14.6) | 75 (31.3) | 14 (5.8) | 104 (43.3) | 12 (5.0) |
| Characteristic |
Strongly
Agree (1) N (%) |
Agree
(2) N (%) |
No
Opinion (3) N (%) |
Disagree
(4) N (%) |
Strongly
Disagree (5) N (%) |
| Perceived Severity | |||||
| Worry about acquiring LTBI | 48 (20.0) | 84 (35.0) | 43 (17.9) | 49 (20.4) | 16 (6.7) |
| Worry about acquiring TB disease |
30 (12.5) | 62 (25.8) | 54 (22.5) | 68 (28.3) | 26 (10.8) |
| Worry about acquiring LTBI with MDR-TB strains |
16 (6.7) | 70 (29.7) | 64 (26.7) | 63 (26.3) | 27 (11.3) |
| Latent TB infection is very serious |
30 (12.5) | 87 (36.25) | 39 (16.3) | 70 (29.2) | 14 (5.8) |
| Perceived Benefits | |||||
| IC measures prevent nosocomial TB transmission |
86 (35.8) | 102 (42.5) | 29 (12.1) | 21 (8.75) | 2 (0.8) |
| UV is an effective IC measure |
48 (20) | 119 (49.6) | 54 (22.5) | 12 (5) | 7 (2.9) |
| Respirator protects HCW from TB exposure |
116 (48.3) | 94 (39.2) | 22 (9.2) | 5 (2.1) | 3 (1.3) |
| Respirator protects HCW from MDR-TB exposure |
89 (37.1) | 109 (45.4) | 36 (15) | 5 (2.1) | 1 (0.4) |
| It is important for Georgian HCWs to be tested for latent TB infection |
100 (41.7) | 106 (44.2) | 23 (9.6) | 9 (3.8) | 2 (0.8) |
| It is important to test contacts of patients with TB (family, friends) for latent TB infection. |
130 (54.2) | 86 (35.8) | 15 (6.3) | 5 (2.1) | 4 (1.7) |
| It is important to test children who have been exposed to TB for latent TB infection. |
147 (61.3) | 74 (30.8) | 16 (6.7) | 0 (0.0) | 3 (1.3) |
| It is important to test individuals with compromised immune systems for latent TB infection. |
103 (42.9) | 92 (38.3) | 38 (15.8) | 5 (2.1) | 2 (0.8) |
| Perceived Barriers | |||||
| UV lights can harm healthcare workers |
31 (12.9) | 70 (29.2) | 57 (23.8) | 73 (30.5) | 9 (3.8) |
| If I tested positive for LTBI, I should not be treated because I will be exposed again in the future |
33 (13.8) | 70 (29.2) | 50 (20.8) | 69 (28.8) | 18 (7.5) |
| If I tested positive for LTBI, I should not be treated because probably I have drug-resistant TB strains |
23 (9.6) | 43 (17.9) | 58 (24.2) | 93 (38.8) | 23 (9.6) |
| Risks of treating LTBI outweigh benefits to treating LTBI |
35 (14.6) | 70 (29.2) | 84 (35.0) | 48 20.0) | 3 (1.3) |
Note HCW, Healthcare worker; LTBI, Latent Tuberculosis infection; TB, Tuberculosis; MDR-TB, Multidrug-resistant Tuberculosis; IC, Infection Control; UV, Ultraviolet
Seventy-eight percent of HCWs from the NTP and only 36% of HCWs from the PHCs reported frequent use of respirators when around patients who are at risk for or who have active TB. TB IC related behavior and willingness to implement TB IC related behavioral change is described in Table 3.
Table 3.
Tuberculosis Infection Control Related Behavior or Willingness to Exhibit Tuberculosis Infection Control Related Behavior
| Characteristic | Subcategory | N (240) | % (100) |
|---|---|---|---|
|
Respirator Use: How often do you wear a respirator when around patients who are at risk for or who have active TB? |
Frequent | 144 | 60.0 |
| Sometimes | 49 | 20.4 | |
| Never | 29 | 12.1 | |
| Missing | 18 | 7.5 | |
|
UV light Use: I do not want to work in an area where UV lights are used |
Agree | 90 | 37.5 |
| No Opinion | 53 | 22.1 | |
| Disagree | 97 | 40.4 | |
|
LTBI Screening: Would you be willing to be tested each year for latent TB infection? |
Yes | 125 | 52.1 |
| No | 59 | 24.6 | |
| Undecided | 45 | 18.8 | |
| Missing | 11 | 4.6 | |
|
LTBI Treatment: If I tested positive for latent TB infection, I should be treated. |
Agree | 116 | 48.3 |
| No Opinion | 40 | 16.7 | |
| Disagree | 84 | 35.0 |
Note TB, Tuberculosis; IC, Infection Control; UV, Ultraviolet; LTBI, Latent Tuberculosis Infection.
Predictors of HCWs knowledge about TB
In multivariate analysis, physicians were more likely to know symptoms suggestive of TB disease (aOR 1.7; 95% CI 1.0-2.9), TB diagnostic methods (aOR 1.9; 95% CI 1.1-3.1), high risk groups for TB disease (aOR 2.3; 95% CI 1.3-4.0), and LTBI treatment rationale (aOR 1.5; 95% CI 1.0-2.5) compared to nurses (Table 5). HCWs who work primarily with TB patients were more likely to know about the risk of LTBI progression to TB disease (aOR 3.2; 95% CI 1.6-6.4), high risk groups for TB disease (aOR 2.2; 95% CI 1.0-4.8), LTBI treatment rationale (aOR 2.3; 95% CI 1.2-4.5), and LTBI treatment regimen (aOR 4.2; 95% CI 1.6-11.1) compared to those who did not work with TB patients (Table 5).
Table 5.
Multivariate analysis for predictors of Tuberculosis Infection Control Related Behaviors
| Outcomes | Respirator Use a | UV Light Use in HCF b |
LTBI Screening a | LTBI Treatment a |
|
|---|---|---|---|---|---|
| Predictors | Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
|
| Modifying Factors | TB inpatient vs. non-TB HCF | 1.6 (0.48, 5.29) |
1.3 (0.43, 3.61) |
1.7 (0.72, 4.09) |
0.3
(0.12, 0.68) |
| TB outpatient vs. non-TB HCF |
1.0 (0.42, 2.18) |
3.1
(1.37, 6.96) |
0.6 (0.30, 1.17) |
0.2
(0.10, 0.35) |
|
| Occupation c |
1.6
(1.04, 2.42) |
0.7 (0.42, 1.06) |
|||
| Respirator availability c |
5.1
(3.50, 7.30) |
||||
| Perceived Threat | Will test positive for LTBI in the future |
1.4
(1.02, 2.03) |
|||
| Worry about acquiring LTBI with MDR-TB strains |
1.4 (0.97, 1.97) |
1.7
(1.29, 2.24) |
|||
| LTBI is very serious |
2.0
(1.48, 2.60) |
||||
| Perceived Benefits | UV light is an effective TB IC measure |
1.6 (0.69, 3.46) |
|||
| It is important to test TB contacts for LTBI |
3.1
(1.25, 7.77) |
||||
| Perceived Barriers | UV lights can harm HCWs |
0.4
(0.24, 0.50) |
|||
| If I tested positive for LTBI, I should not be treated because I will be exposed again in the future |
0.5
(0.36, 0.64) |
||||
Note Occupation was coded as Physician versus Nurse versus other; Respirator Availability was coded as Always versus Most of the Time versus Sometimes versus Rare versus Never; Respiratory Use was coded as Frequent versus Sometimes versus Never; UV Light Use in HCF, LTBI Screening, and LTBI Treatment were coded as Yes versus Undecided versus No. UV, Ultraviolet; HCF, Healthcare Facility; TB, Tuberculosis; LTBI, Latent Tuberculosis Infection; MDR-TB, Multidrug-resistant Tuberculosis; IC, Infection Control; HCW, Healthcare Worker.
Ordinal Logistic regression was used.
Polytomous logistic regression was used.
ordinal variable.
Association between HCWs’ TB knowledge and Beliefs
HCWs who knew about the risk of progression from LTBI to TB disease (p < 0.03) and high risk groups for TB disease (p < 0.01) were more likely to worry about acquiring LTBI with drug-resistant strains than those HCWs who do not have these knowledge. HCWs who knew about LTBI treatment rationale (p <0.01) and TB diagnostics (p < 0.05) were more likely to think that screening of TB contacts for LTBI is important than those HCWs who did not demonstrate the knowledge. HCWs who knew about LTBI characteristics (p < 0.04), LTBI treatment rationale (p < 0.01), and TB diagnostics (p < 0.01) more likely felt that immunocompromised individuals need to be screened for LTBI than those who did not have this knowledge. Only those HCWs who knew LTBI characteristics (p < 0.01) perceived LTBI as a serious infection. As expected, HCWs who work primarily with TB patients consider themselves more susceptible to LTBI than HCWs who do not (p < 0.01).
Predictors of TB IC related behaviors
HCWs who indicated that they worry about becoming infected with drug-resistant TB (aOR 1.7; 95% CI 1.29-2.24), HCWs who think that it is important to screen TB contacts (aOR 3.1; 95% CI 1.25-7.77), and HCWs who were physicians (aOR 1.6; 95% CI 1.04-2.42) were more likely to be willing to undergo annual screening for LTBI (Table 5). HCWs were more likely to refuse treatment for LTBI if they worked in TB facilities (inpatients TB facility - aOR 0.3; 95% CI 0.12-0.68; outpatients TB facility - aOR 0.2; 95% CI 0.10-0.35) and perceived a high personal risk of TB re-infection (aOR 0.5; 95% CI 0.36-0.64). Those who thought that LTBI is a potentially serious health condition were more willing to be treated for LTBI (aOR 2.0; 95% CI 1.48-2.60) (Table 5). Availability of respirators in HCFs was the only significant predictor of routine use of respirators (aOR 5.1; 95%CI 3.50-7.30). In multivariable analysis, working in a TB outpatient facility (aOR 3.1; 95%CI 1.37-6.96), perceived susceptibility to LTBI in the future (aOR 1.4; 95%CI 1.02-2.03), and perception that UV germicidal radiation was unlikely to harm HCWs (aOR 0.4; 95%CI 0.24-0.50) were identified as independent predictors of willingness to use UV lights in HCFs (Table 5).
Discussion
In our survey conducted among HCWs from the NTP and PHCs in Georgia, physicians compared to nurses were found to have greater knowledge related to TB and TB IC measures. Also HCWs who worked primarily with TB patients were more educated about TB and related IC activities compared to HCWs who did not see TB patients regularly. HCWs knowledgeable about TB and TB IC measures were more likely to perceive their susceptibility to TB infection, severity of TB disease, and TB IC intervention benefits and barriers. Moreover, HCWs who perceived their susceptibility to TB infection and net benefit of TB IC measures were more likely to comply with IC interventions.
Evidence supports that knowledge is a facilitator of compliance with interventions.3, 18, 19 Nurses who work mainly with TB patients should be targeted for the training, given their high risk of TB infection6 and lack of knowledge on this topic. Furthermore, Georgian HCWs who work in non-TB HCFs need training about TB and TB IC, as persons with undiagnosed TB or suspected cases of TB may be seen at these facilities.6 This is especially true since TB services are currently being integrated in PHCs as part of the ongoing health system reforms in Georgia.
We analyzed our survey data based on the HBM. The model suggests that individuals conduct an internal assessment of the net benefits of changing their behavior, and decide whether or not to act. The model identifies four aspects of this assessment: perceived susceptibility to ill-health (risk perception), perceived severity of ill-health, perceived benefits of behavior change, and perceived barriers to taking action.12 Consistent with the HBM, UV light use is well accepted by HCWs who believe that they are at risk of TB infection, but HCWs who think that UV lights can be harmful leads to their reluctance to use UV lights in HCFs. Perceived LTBI threat predicted HCWs’ readiness to receive LTBI treatment, while concern for re-infection with TB after LTBI treatment predicted HCWs refusal to be treated for LTBI. Given that a previous study we conducted in the country of Georgia in 2009-2011 reported high rates of occupational acquisition of TB infection (22.8/100 person-years),6 it is not surprising that Georgian HCWs believe that they remain at risk of TB even after treatment for LTBI. We also found that respirators are not always available for all HCWs, especially in non-TB HCFs. These findings emphasize the need to strengthen IC measures in Georgian HCFs and provide important baseline information for the Georgian Ministry of Health, Labor, and Social Affairs that is currently implementing IC interventions in HCFs.
Our study is subject to limitations. One limitation of our study is that TB IC related behaviors were self-reported rather than observed. For instance, respirator use was measured by HCWs’ responses to anonymous questions, rather than by observations of this behavior by the study team. Another limitation of our study is that convenience sampling was used and 19% of those who were approached did not agree to complete the survey. Most of the non-responders (53 out of 58 HCWs) were nurses from the NTP, potentially introducing selection bias. Physician to nurse ratio in TB services and in PHCs is about one to one in Georgia, therefore we expected nearly equal proportion of nurses and physicians in our study population. Physicians comprised 48% of our population, and nurses comprised 40%, so our study slightly overrepresented physicians compared to nurses. A major strength of our study is that it included various types of HCWs from across the whole country.
In summary, our study is the first survey about HCWs’ knowledge, beliefs, and behaviors about TB IC and LTBI screening and treatment in Georgia. We were able to identify specific knowledge gaps and beliefs to be addressed during implementation of TB IC measures in Georgian HCFs. Researchers and HCF administrators should pursue the application of behavioral science methods to strengthen TB IC measures implementation process.20 Based on our survey findings, a targeted campaign is needed to raise HCWs’ awareness about TB and about the benefits of TB IC measures to prevent the nosocomial transmission of TB and the particular threats of drug-resistant TB in the country Georgia.
Table 4.
Multivariate analysis for predictors of Healthcare Workers Tuberculosis Knowledge
| Outcomes ab | Knowledge of LTBI Character. |
Knowledge Risk of LTBI progress. to TB |
Knowledge High risk groups for TB |
Knowledge TB Sympt. |
Knowledge TB diag. |
Knowledge LTBI Treat. Rational |
Knowledge Of LTBI Treat. Regimen |
|---|---|---|---|---|---|---|---|
| Predictors | Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
Adjusted OR (95% CI) |
| Male vs. Female |
1.4 (0.4, 5.5) |
9.3
(1.9, 44.9) |
1.7 (0.5, 6.0) |
0.6 (0.2, 2.5) |
1.6 (0.5, 5.4) |
1.3 (0.4, 4.40) |
3.0 (0.4, 25,8) |
| Age‡, years (60 < vs. 52 – 60 vs. 45 – 51 vs. 36 – 44 vs. ≤ 35) |
1.3 (0.8, 2.0) |
0.9 (0.6, 1.3) |
1.2 (0.8, 1.8) |
1.5 (0.9, 2.5) |
1.2 (0.8, 1.8) |
1.7
(1.1, 2.6) |
1.1 (0.6, 1.9) |
| Occupation c
(Physician vs. Nurse vs. Other) |
1.6 (1.0, 2.6) |
1.4 (0.8, 2.3) |
2.3
(1.3, 4.0) |
1.7
(1.0, 2.9) |
1.9
(1.1, 3.1) |
1.5
(1.0, 2.5) |
0.6 (0.3, 1.1) |
| Work with TB patients vs. Do not work with TB patients |
1.6 (0.8, 3.2) |
3.2
(1.6, 6.4) |
2.2
(1.0 4.8) |
1.6 (0.8, 3.3) |
1.4 (0.7, 2.8) |
2.3
(1.2, 4.5) |
4.2
(1.6, 11.1) |
| Length of Employment c (35 ≤ vs. 21 - 34 vs. 6 - 20 vs. ≤5) |
0.7 (0.4, 1.2) |
0.7 (0.4, 1.3) |
0.9 (0.5, 1.9) |
0.6 (0.3, 1.3) |
0.8 (0.5, 1.5) |
0.5 (0.2, 0.9) |
0.7 (0.3, 1.7) |
Note TB Knowledge variables were coded as correct versus incorrect answers. HCW, Healthcare worker; TB, Tuberculosis; LTBI, Latent Tuberculosis infection.
Definitions of the correct answers are presented in the table 2.
Binary logistic regression was used.
ordinal variables.
Acknowledgements
Financial support. This study was supported in part by NIH Fogarty International Center [D43TW007124 and D43TW007124-06S1], the Atlanta Clinical and Translational Science Institute [NIH/NCATS UL1TR000454], the Emory Global Health Institute.
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article. Manuscript preparation.
Footnotes
Presented in part: 43rd World Conference on Lung Health of the International Union of Tuberculosis and Lung Diseases (the Union), Kuala Lumpur, Malaysia, 2012 (abstract, poster #PC-280-16).
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