Prof Gladys Kigozi has worked in the field of tuberculosis (TB) and HIV/AIDS since 2007. She seeks to understand the structural and socio-behavioral dimensions of (integrated) TB and HIV/AIDS management and to monitor the implementation of TB and HIV-related policies in public healthcare facilities and communities. Other areas of interest include occupational health, human resources for health, and mental health. Prof Kigozi has participated in several basic, operational, and intervention research projects. She has disseminated her work at more than 40 conferences locally and internationally and in 39 peer-reviewed journals. Currently, she is leading a project to explore the experiences of common mental disorders in patients on TB treatment. The project is funded by both the National Research Foundation and the South African Medical Research Council. She is also a co-researcher on three COVID-19-related projects together with experts from the University of the Free State, Free State Department of Health, and the World Health Organization.
Contribution to previous research
HIV-TB stigma
Occupationally acquired TB poses a major threat to healthcare workers (HCWs) in South Africa. HCWs are also greatly affected by the dual TB-HIV epidemic. A major challenge with the dual epidemic is that HCWs are reluctant to undertake HIV and TB testing and to access treatment and care timeously due to associated HIV and TB stigma. However, given the serious shortages of human resources for health facing public health service delivery in South Africa, it is imperative for HCW to access HIV and TB treatment. Yet, little has been done internationally and nationally to address HIV and TB stigma among HCWs. This research project addressed the problem of HIV and TB stigma among HCWs in the Free State, South Africa. More specifically the research sought (1) to scientifically assess the extent, sources, and consequences of HIV and TB-related stigma among HCWs and (2) to develop and test an evidence-based intervention to reduce stigma. Results established differential patterns of internal and external stigma among HCWs. Dr Kigozi contributed to the study design and data gathering instruments as well as review of manuscripts resulting from this study.
Tuberculosis case-finding
Prof Kigozi led a study to assess the yield of systematic household contact TB investigation (SHCI) as a case-finding strategy. Household contacts of four categories of TB index cases were targeted including 1) children <5 years, 2) HIV co-infected pulmonary TB (PTB) cases (≥5 years), 3) HIV-negative PTB cases (≥5 years), and 4) multidrug-resistant TB cases. The highest yield of new TB cases was reported among contacts of HIV-negative TB index cases. The high overall yield of new TB among household contacts in this study demonstrated that targeted SHCI may be an effective active case-finding strategy.
Tuberculosis infection prevention and control
Despite intensified efforts to curb the disease, TB remains a challenge to the country’s health system and overall population health outcomes. The high incidence of TB can partly be attributed to poor TB prevention and infection control in healthcare facilities and rapid spread within communities. Prof Kigozi participated in research to investigate the extent of implementation of TB prevention and infection control strategies in primary healthcare (PHC) facilities in Mangaung metropolitan. Overall, TB infection control was poorly implemented at the facilities. In particular, more than a third of the facilities did not have an infection control committee and three-quarters did not have separate waiting areas for TB/coughing patients and general patients, less than one-third of the facilities had open windows in the consultation room on the day of the field visit and the majority of TB nurses were not wearing N95 respirators. The most frequently reported barrier to implementing good TB infection control was the lack of available equipment and the structure/layout of the PHC facilities.
Tuberculosis-HIV/AIDS
In collaboration with colleagues, Prof Kigozi explored the TB-HIV co-epidemic in Central South Africa between 2007 and 2015. The research determined that multi-faceted barriers and facilitators contributed to TB patients’ uptake of HIV testing. Despite the recommendation to integrate these services, it was not always the case due to several patient and institutional-level factors. She participated in the conceptualization of the research, development of data gathering instruments as well as data analysis and reporting.