Primary healthcare workers at risk during COVID-19: An analysis of infections in HIV service providers in five districts of South Africa

摘要

BACKGROUND:Protecting healthcare workers (HCWs) from COVID-19 is a global priority. Anova Health Institute (Anova) is the PEPFAR?(US President's Emergency Plan for AIDS Relief) District Support Partner for the Johannesburg, Cape Town, Sedibeng, Capricorn and?Mopani districts in South Africa, operating in public sector primary healthcare facilities. At the time of the emergence of COVID-19, Anova?employed close to 4 000 people: 41% community health workers (CHWs), 23% data staff, 20% nurses and doctors, 12% management/support and 5% allied HCWs.OBJECTIVES:To describe rates of COVID-19 diagnosis in Anova-employed HCWs in five districts.METHODS:Employees exposed to, tested for or diagnosed with COVID-19 were required to report the event. These reports were compiled?into a database to monitor the impact of COVID-19 on the workforce. We kept a timeline of key events occurring at national and district?level, including Anova's policies and their implementation, that was used to describe organisational response. We described the number of?confirmed cases, cumulative incidence rates and testing rates, broken down by district and job category. We estimated expected deaths and?the effect on time off work.RESULTS:Of Anova employees, 14% (n=562) were diagnosed with COVID-19 by the end of September 2020. Cumulative incidence was?highest in Sedibeng (29%) and lowest in Mopani (5%). All HCWs experienced high incidences: data staff 17%, allied HCWs 16%, CHWs?14%, nurses and doctors 13%, and management/support 11%. At the peak of the epidemic, for 5 weeks, 5% of employees were unable?to work owing to exposure or infection, significantly disrupting service delivery. The additional administrative burden on managers was?substantial.CONCLUSIONS:It is critical that all cadres of HCWs are protected in the workplace, including in primary care settings, where better structuresare needed to perform risk assessments and conduct outbreak investigations. CHWs and data staff may be at higher risk owing to poor?infrastructure, limited power to negotiate working conditions, and limited experience of infection prevention and control. Their working?conditions must be improved to reduce their risk.