Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB), despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB) came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof) and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired wellbeing in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.

Helene-Mari van der Westhuizen and colleagues argue that face coverings should be considered not as medical equipment but as a social practice informed by norms and expectations

Medical and physiotherapy students in tuberculosis (TB)-endemic settings are at high risk of developing occupational TB. Didactic lectures are the traditional method for delivering education on the topic of TB infection control (TB-IC) to undergraduate health science students. The aim of this study was to evaluate the impact of a novel educational package for teaching TB-IC to undergraduate health science students in a TBendemic setting.Undergraduate medical and physiotherapy students at Stellenbosch University, South Africa (n = 326) participated in a cross-sectional survey documenting TB-IC knowledge, attitudes and practices at the training institution. A self-administered questionnaire was completed before and after a novel educational intervention which utilized the health belief model (and included personal testimonials from healthcare workers and an IC expert who had survived occupational TB).Students perceived themselves to be at high risk of occupational TB, but underestimated drug-resistant TB mortality. Pre-intervention knowledge of TB-IC measures was poor, but improved post-intervention (58% vs . Senior students had better pre-intervention knowledge of N95 respirator use. Negative attitudes and TB-IC practices of senior staff at the training institution reportedly influenced those of students. TB-IC measures (natural and mechanical ventilation; airborne precaution signage; patient isolation) were reportedly poorly implemented. Access to personal protective equipment was problematic with 49% (87/177) of senior students stating that N95 respirators were never available.IntIn conclusion, students lack knowledge of TB-IC measures and report poor implementation of TB-IC measures at their training institution. A novel structured educational intervention increased students' knowledge of TB-IC measures and heightened awareness of occupational TB risk.