Project 1

Improving prevention and care of TB and HIV in health care workers (IMPACT Health care workers): A cluster randomised controlled trial in the Free State, South Africa

Lead researchers


  • Annalee Yassi, UBC
  • Kerry Uebel, University of the Free State -South Africa
  • Michelle Engelbrecht,  University of the Free State -South Africa
  • Asta Rau, University of the Free State -South Africa
  • Elizbeth Bryce, UBC
  • Mark Fitzgerald, UBC
  • Lucky Nophale, University of the Free State -South Africa
  • Jerry Spiegel, UBC
  • David Moore, UBC
  • Jane Buxton, UBC
  • Lyndsay O’Hara, Student Investigator, UBC

Study description

This is a cluster randomised controlled trial in 27 Free State hospitals that aims to strengthen occupational health and infection control and to improve healthcare worker access to HIV and TB services in the workplace in accordance with new World Health Organization/International Labour Organization/Joint United Nations Programme on HIV/AIDS guidelines.  The hospitals are paired according to size, demographics and current level of service provision, and one of each pair is randomly allocated to be an intervention site. Standard care available in all hospitals includes:

1) Regular workplace infection control assessments.

2) Access to voluntary and confidential TB screening and testing, as well as HIV counselling and testing.

3) TB prophylaxis for HIV-positive staff.

4) TB treatment. As of July 1, 2013, when the trial began, staff in intervention hospitals also have access to:

5) HIV treatment at the occupational health unit (OHU).

6) A stigma reduction campaign. Individual, anonymous data on staff accessing TB and HIV services are collected at the OHU and on deaths, sick leave and illness-related retirements from provincial personnel databases.

Publications and presentations

Engelbrecht M, Spiegel JM, Nophale LE, Yassi A, Lockhart K, Janse Van Rensburg A. Protecting the health of health care workers at one tertiary and two regional hospitals in the Free State Province. Public Health Association of South Africa Conference. September 6-7, 2012. Bloemfontein, South Africa.

Uebel K, Yassi A, Rau A, Engelbrecht MC, Nophale LE, Wouters E, Fitzgerald JM, Bryce EA, Buxton J, Moore D, O’Hara LM, Chikobvu P. Improving prevention and care of TB and HIV in Health care workers (IMPACT Health care workers): a randomised controlled trial protocol in the Free State, South Africa. Submitted to Trials. September 2013.

Yassi A. Preparing a randomized population health intervention trial: Lessons from a South African-Canadian partnership to improve HIV and Tuberculosis prevention and care for health workers. SPPH UBC Grand Rounds. January 18, 2013.

Yassi A, Engelbrecht MC, Spiegel JM, Van Rensburg AJ, O’Hara LM, Bryce EA, Nophale LE, Rau1 A. Are we adequately protecting our healthcare professionals from infectious diseases in the workplace? A study in three public hospitals in Free State, South Africa. International Commission on Occupational Health. Sao Paulo, Brazil. September 23-26, 2013.

Yassi A, O’Hara LM, Lockhart K, Spiegel J. Workplace programmes for HIV and Tuberculosis: A systematic review to support development of international guidelines for the health workforce. AIDS Care. 2012 Aug 13.

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