{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T01:23:38Z","timestamp":1778808218754,"version":"3.51.4"},"reference-count":39,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T00:00:00Z","timestamp":1676419200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bloomsbury SET","award":["CCF-17-7779"],"award-info":[{"award-number":["CCF-17-7779"]}]},{"DOI":"10.13039\/501100000269","name":"ESRC","doi-asserted-by":"crossref","award":["ES\/P008011\/1"],"award-info":[{"award-number":["ES\/P008011\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2022,12,16]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Nosocomial <jats:italic>Mycobacterium tuberculosis<\/jats:italic> (<jats:italic>Mtb<\/jats:italic>) transmission substantially impacts health workers, patients and communities. Guidelines for tuberculosis infection prevention and control (TB IPC) exist but implementation in many settings remains suboptimal. Evidence is needed on cost-effective investments to prevent <jats:italic>Mtb<\/jats:italic> transmission that are feasible in routine clinic environments.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A set of TB IPC interventions was codesigned with local stakeholders using system dynamics modelling techniques that addressed both core activities and enabling actions to support implementation. An economic evaluation of these interventions was conducted at two clinics in KwaZulu-Natal, employing agent-based models of <jats:italic>Mtb<\/jats:italic> transmission within the clinics and in their catchment populations. Intervention costs included the costs of the enablers (eg, strengthened supervision, community sensitisation) identified by stakeholders to ensure uptake and adherence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All intervention scenarios modelled, inclusive of the relevant enablers, cost less than US$200 per disability-adjusted life-year (DALY) averted and were very cost-effective in comparison to South Africa\u2019s opportunity cost-based threshold (US$3200 per DALY averted). Two interventions, building modifications to improve ventilation and maximising use of the existing Central Chronic Medicines Dispensing and Distribution system to reduce the number of clinic attendees, were found to be cost saving over the 10-year model time horizon. Incremental cost-effectiveness ratios were sensitive to assumptions on baseline clinic ventilation rates, the prevalence of infectious TB in clinic attendees and future HIV incidence but remained highly cost-effective under all uncertainty analysis scenarios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>TB IPC interventions in clinics, including the enabling actions to ensure their feasibility, afford very good value for money and should be prioritised for implementation within the South African health system.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2022-010306","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T11:10:38Z","timestamp":1676459438000},"page":"e010306","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Cost-effectiveness of tuberculosis infection prevention and control interventions in South African clinics: a model-based economic evaluation informed by complexity science methods"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-6885","authenticated-orcid":false,"given":"Fiammetta Maria","family":"Bozzani","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-8531","authenticated-orcid":false,"given":"Nicky","family":"McCreesh","sequence":"additional","affiliation":[{"name":"TB Centre, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indira","family":"Govender","sequence":"additional","affiliation":[{"name":"TB Centre, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, Kwa-Zulu Natal, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4410-6635","authenticated-orcid":false,"given":"Richard G","family":"White","sequence":"additional","affiliation":[{"name":"TB Centre, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5519-1658","authenticated-orcid":false,"given":"Karina","family":"Kielmann","sequence":"additional","affiliation":[{"name":"Institute of Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK"},{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison D","family":"Grant","sequence":"additional","affiliation":[{"name":"TB Centre, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, Kwa-Zulu Natal, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Vassall","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,2,15]]},"reference":[{"key":"2025072913115695000_8.2.e010306.1","doi-asserted-by":"crossref","unstructured":"Apriani L , McAllister S , Sharples K , et al . 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