Non-consensual disclosure of infectious drug-resistant tuberculosis status in the occupational context: Health workers stuck between a rock and a hard place

Abstract

Background. The burden of drug-resistant tuberculosis (DR-TB) remains high in South Africa (SA), despite ongoing control efforts. DR-TB patients who are infectious and continue to work pose a substantial risk of spreading the disease at the workplace. When such patients refuse or interrupt treatment, and are also unwilling to disclose their status at work, they pose an infectious risk in the workplace, creating a conflict between public health good and individual human rights. Should health workers breach confidentiality and disclose patients’ DR-TB status, or take no action while patients pose transmission risks in occupational settings? Non-consensual disclosure of the infectious DR-TB status of such patients is an intervention intended to address this occupational health risk. Objectives. To provide professional and ethical guidance for health workers in dealing with non-consensual disclosure of the DR-TB status of patients who are unwilling to disclose, continue to go to work and remain infectious. Methods. A comprehensive literature search was conducted to draw on evidence relating to public health best practices and human rights normative standards. We used the findings, along with guidance from DR-TB programme managers, clinicians, occupational health physicians and human rights lawyers to develop an occupational health protocol for disclosure. Results. This protocol establishes the normative, ethical and legal framework for dealing with the complexities of non-consensual disclosure, and provides a set of practical standard operative procedures for health workers in the SA setting. It also provides a legal safeguard to protect health workers from potential litigation that may result from such duty. Conclusion. Non-consensual disclosure to address the spread of DR-TB in occupational settings should be based on professional, ethical and legally sound guidance for health workers.