1. TB Task Team Feedback MMPA Congress Date : 21 May 2011 By: Dr Khanyile Baloyi

2. 1.Introduction 2.Perspectives 2.1 International 2.2 South African perspective 2.3 Mining industry perspective 3.Report on TB Reviews 4.Way forward Contents

3. CountryAll casesPer 100,000 population India2,000,000167 China1,300,00097 South Africa490,000978 Nigeria460,000297 Indonesia430,000187 Pakistan420,000232 Bangladesh360,000222 Ethiopia300,000362 Philippines260,000283 DR Congo250,000379 Myanmar200,000400 Viet Nam180,000204 Russian Fed.150,000106 Kenya120,000301 Uganda96,000293 Mozambique94,000411 Zimbabwe93,000743 Thailand93,000137 Brazil87,00045 Tanzania80,000183 Cambodia65,000439 Afghanistan53,000188 Global total9,400,000138

4. Countries All cases South Africa490000 Zimbabwe93000 Cambodia65000 Mozambique94000 Myanmar200000 DR Congo250000 Ethiopia300000 Per 100,000 population 978 743 439 411 400 379 362

5. TUBERCULOSIS STRATEGIC PLAN FOR SOUTH AFRICA, 2007-2011 There have been a number of international, regional and national political and policy directives aimed at reducing the burden of TB. These include:  Millennium Development Goal 6 Goal 6 of the MDGs refers to “Combating HIV and AIDS, Malaria and other diseases” and Target 8 aims to “halve and begin to reverse the incidence of Malaria and other major diseases.” The indicators for this target are much more specific to TB and are as follows:  Prevalence and death rates associated with TB  Proportion of tuberculosis cases detected and cured under DOTS In March 2000, Ministers of the 22 high burden countries, called for the accelerated expansion of control measures and for increased political commitment and financial resources to reach targets for global TB control by 2005, namely:  Detect at least 70% of people with infectious TB and  Cure at least 85% of those detected. International Context

6. TUBERCULOSIS STRATEGIC PLAN FOR SOUTH AFRICA, 2007-2011 South African National Strategic Plan on TB During the past ten years the incidence of tuberculosis has increased, in parallel to the increase in the estimated prevalence of HIV in the adult population. This has resulted in the increasing recognition of the problems posed to public health by TB.

7. TUBERCULOSIS STRATEGIC PLAN FOR SOUTH AFRICA, 2007-2011 South African National Strategic Plan on TB VISION A South Africa that is free of TB  “ In order to achieve effective TB control, a coordinated multi-sectoral approach must be adopted throughout the country. This plan provides a framework of what needs to be done to reduce the burden of TB and eventually eliminate TB in the country.” Minister of Health SA. In 2005 at the WHO-AFRO Regional Committee meeting held in Maputo,  46 Ministers of Health unanimously declared TB an emergency in Africa.

8. Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: a call to action Ben J Marais, MD, Mario C Raviglione, MD, Peter R Donald, FRCP, Anthony D Harries, MD, Afranio L Kritski, MD, Stephen M Graham, FRACP, Wafaa M El-Sadr, MD, Mark Harrington, BA, Gavin Churchyard, MD, Peter Mwaba, FRCP, Ian Sanne, FRCP, Stefan HE Kaufmann, PhD, Christopher JM Whitty, FRCP, Rifat Atun, FFPHM and Alimuddin Zumla, FRCP The Lancet Volume 375, Issue 9732, Pages 2179-2191Volume 375, Issue 9732, Pages 2179-2191 (June 2010) DOI: 10.1016/S0140-6736(10)60554-5 Copyright © 2010 Elsevier Ltd Terms and ConditionsTerms and Conditions  A resolution at this meeting warned that unless “urgent extraordinary actions” are in place, the situation will worsen and the 2015 Millennium Development Goals will not be met.

9. TB in the South African Gold Mining Industry Milner Commission Report, 1903 “ The extent to which Miners’ TB prevails at the present time is so great that preventive measures are an urgent necessity, and that such a large number of sufferers in our midst is a matter of keen regret”. Leon Commission Report, 1996 “ The failure to control TB in the mining industry must be a matter for grave concern.” Department of Health 2007, TB Strategic Plan for South Africa 2007 – 2011, pg. 32 “ The South African Gold Mining Industry probably has the highest incidence in the world (3000 to 7000/100 000 population/year)”.

10. A CALL FOR ACTION IN 2009

11. Editorial Report on the Study on Preventing tuberculosis with silica dust controls Source: INT J TUBERC LUNG DIS 15(6):713–714 © 2011 The Union doi:10.5588/ijtld.10.0727  TB burdens in silica-exposed populations have also been strongly influenced by the HIV pandemic,  partly because the TB risks of silicosis and HIV infection combine multiplicatively.  A TB incidence of 16 100 per 100 000 person-years has been reported in HIV-positive gold miners with silicosis.  Consequently, the highest recorded rates of TB occur in silica-exposed populations, with an incidence as high as 7000/100 000 in South African gold miners  As a first step, silica dust controls could be more explicitly included in international and national TB prevention and control strategies and program guidelines, as has been done in South Africa.

12. Susceptibility

13.  TB Task Team established 2009 (COM & DOH)  Annual TB Programme Reviews implementation. 2010  Current status of our TB programmes(Baseline)  TB data collection and collation  Register Workshop(2010 COM & DOH)  A protocol on employer obligations on TB (2010)  Diagnosis( case finding), treatment, submissions, notifications & compensation)  A standard Referral form ( Cross boarder)  TB/HIV Programmes integration was agreed on at HPC (after 2010 TB Conference)  All TB patients offered VCT, PICT and ART(where applicable)  Cough questionnaires, admission of AFB smear positives, INH and CMT prophylaxis are standard practices in our programmes.  Infection control policy implementation. HPC decisions in 2009/10

14. PROGRESS  HPC took a decision that all COM members will conduct the annual internal reviews using the tool.  TB Review implementation is a requirement enshrined in the DMR Guidance Note on TB Control Programmes. (not enforceable)  The agreement on external reviews is not finalized as yet. The tool was implemented and the report discussed at HPC and Exco then submitted to the Minister of Health

15. TB Review Report General Remarks  Considering that the reviews were being done for the first time, the response was good at 100% for HPC membership.  Two member companies do not provide TB services due to lack or very few TB patients diagnosed in such companies.  The member companies, that implemented the tool, represent a total of 258 848 employees and 91 938 contractors, and they include the three biggest gold companies, major platinum and coal companies.

16. Report cont. Comments a) Document Policies, staff training, patient education, reporting and notification, TB clinic processes. Policies on contractors not available 33%, MOUs existed in 42% Some companies did not have pt education plans, No employee involvement in programmes b) TB Case Finding clinicsCough questionnaires not administered 33% c) DOTSFew cases lost to follow up. d) TB ClinicLack of follow up and review of pts during, after transfer and D/C e) laboratory, radiology and Pharmacy Mostly well run, some were outsourced.

17. Comments Deceased casesCase review of post mortem reports from MBOD was not done in most instances. TargetsIn some instances targets could not be calculated because TB Registers were not well kept. IndicatorsResultsTargets Cure and treatment completed Range: 78 – 92 % Average: 82% > 85% Outcome knownRange: 51 – 100% Average:89% >90% Recurrence rateRange: 2 – 10% Average: 6% <5% Report cont.

18. Way forward & Conclusion  TB Register workshops ( provincial)  Access to electronic TB Register (MOU with DOH)  Mining industry TB database  External industry wide TB Reviews  Referral System  Committee on TB in Mining Industry lead by NDOH  MITHAC

19. Provincial TB Report ProvinceStatus GautengDone Free StateDone NorthwestDone MpumalangaDone Limpopoplanned North Capeplanned

20. Thank You