Despite wide recognition of the importance of institutional transmission control in reducing tuberculosis (TB) globally, the presence of WHO policies, and widely available training, actual implementation of sustainable TB transmission control interventions has been disappointingly slow. An important indicator of ongoing institutional transmission – healthcare worker TB infection – continues at rates 2 or 3 times higher than in the general population.

The two most important TB transmission control interventions are administrative and engineering. In recent years our group has introduced FAST (Find cases Actively, Separate temporarily and Treat effectively) as a refocused, intensified administrative approach to preventing TB transmission by identifying unsuspected TB cases and promptly initiating effective therapy. We have also focused on upper room germicidal ultraviolet (GUV) air disinfection due to its efficacy and cost-effectiveness for high burden settings. However, both interventions are technically complex and implementation has been slow.

To facilitate implementation of both of these initiatives, a key element of our work has been capacity building – primarily through an annual course on Building Design and Engineering Approaches to Airborne Infection Control – but also through a NIH/Fogarty International Center-funded fellowship program.