DIY Filters for Tuberculosis Surveillance and Infection Control

DAVID KORMOS, Jeffrey Siegel, Sarah Haines, Nehul Agarwal, University of Toronto

     Abstract Number: 579
     Working Group: Health-Related Aerosols

Abstract
Tuberculosis (TB) remains the leading infectious killer globally, with drug-resistant TB (Rr-TB) causing significant mortality. Despite substantial efforts, the incidence of Rr-TB has not decreased since 2020. Global migration exacerbates TB transmission, posing challenges for continuity of care and increasing resistance. The TB Antimicrobial Stewardship Program (TASP) aims to address these issues through improved diagnostic and treatment strategies, aligning with the Team Europe Initiative to enhance health technology access in Africa. This presentation focuses on two key areas: designing and evaluating low-cost, regionally adaptable portable air cleaners (PACs) to reduce healthcare facility (HCF) circulation of airborne pathogens and advancing quantitative filter forensics (QFF) for antimicrobial resistance (AMR) surveillance in bioaerosols. Here, we report on the process for and evaluation of discrete choice experiments (DCE) to determine end-user preferences, ensuring PAC designs meet the needs of staff and patients in three hospitals in Mozambique, South Africa, and Nigeria. Highlighted issues included electric power reliability, noise, placement within TB wards, and aesthetic considerations. For surveillance and monitoring, methods to estimate room-scale AMR priority pathogen density and diversity trends using QFF depend on low-cost and flexible methods for dust extraction from the filters, sample storage, and DNA extraction from the dust. Experiments evaluating dust extraction methods suggest that swabbing can replace vacuuming, although variation in the presence of bacteria as well as qPCR inhibitors can require the use of multiple swabs per filter. Extraction of mycobacterium tuberculosis DNA from dust follows similar procedures as other QFF studies for other bacterial targets with additional attention needed during clean-up steps. Expected outcomes include demonstrating the effectiveness of low-cost PACs in reducing airborne pathogens in HCFs, establishing robust AMR surveillance methods, and providing scalable, sustainable solutions for high-burden settings that align with global health strategies.