Airborne infection control measures at HIV settings in India and potential areas for TB cross transmission

HIV-care settings are priority setting for the implementation of Air-borne infection control (AIC) measures to prevent cross TB transmission. Earlier Indian report on AIC assessment at HIV settings are limited only for few facilities. This national level cross-sectional study was undertaken to assess various AIC measures adopted at HIV-care settings (ART centre (ARTC) and Link ART centres (LACs)) in India and to identify potential high-risk patient care rooms for airborne infection transmission. A total of 95 HIV facilities were selected across 14 high HIV-TB burden states and various AIC measures viz. administrative, environmental and personal protective measures were assessed with the help of pre-tested checklist at these centres. Risk for airborne infection transmission in pre-identified rooms were categorized based on seating arrangements of patients and health-care workers and air changes per hour (ACH). Data was collected and analyzed by SPSS 24.0. Mixing of HIV and TB patients was observed across 36/95 (38%) centers. A total of 488 patient care rooms ( 276 from ART centers and 212 from LAC) were identified for ventilation assessment. Both AIC and Biomedical Waste (BMW) trainings were conducted only at 7/37 (18.9%) ARTCs and 3/58 (5.17%) LACs. Overall across 9/37 ARTCs (24.3%) and 27/58 LACs (46.6%), the Designated Microscopic Centres ( DMCs) were co-located along with mixing of HIV and TB patients. Appropriate HCW-patient seating arrangement with respect to airflow direction was observed at 223 (46%) rooms and adequate ACH was recorded at 284 (58%) rooms. Out of all rooms assessed, 122 (25%) were classified as high risk, 225 (46%) as moderate risk, and 141 (29%) as low risk. In 61% high-risk rooms, cross ventilation was adequate, overhead vents were available but not fully opened and airflow was obstructed by furniture. Overall at 399 (82%) rooms, natural ventilation could have been improved further by removing obstructed furniture and or fully opening of overhead vents. Though AIC measures adopted at HIV-care settings was suboptimal at the time of assessment, there was room for significant improvements by simple feasible measures. Not applicable.