THE TUBERCULOSIS CONTROL PROGRAM AT ANGLOGOLD ASHANTI HEALTH

2. THE TUBERCULOSIS CONTROL PROGRAM AT ANGLOGOLD ASHANTI HEALTH Dr A D Calver M.B.,B.Ch.(Wits) F.C.P.(SA) Senior Specialist Physician OCTOBER 2010

3. WHO REPORT 2009 UPDATE - Global Tuberculosis Control

4. TUBERCULOSIS CONTROL PROGRAM AT AGAH SOUTH AFRICA IS A HIGH TB INCIDENCE SETTING: Ranked 4 on the WHO list of the 22 countries with the highest TB burden. WHO best estimated incidence in SA ~ 960/100000 population/year. SOUTH AFRICA IS A HIGH HIV INCIDENCE SETTING: One of the worst countries, with a rapidly advancing HIV epidemic. SOUTH AFRICAN GOLD MINING INDUSTRY HAS THE HIGHEST INCIDENCE OF TB IN THE WORLD. 3000 – 7000/100000 population /year HIV and SILICOSIS are the major risk factors driving the incidence. Multiplicative effect

5. TUBERCULOSIS CONTROL PROGRAM AT AGAH Underpinning Principles: In line with the: SA National TB Control Program. WHO recommendations for TB Control Programs. DMR Guideline for TB Control in the Mining Industry. International Standards for TB Care. Complies with: Occupational Diseases in Mines and Works Act. Compensation for Occupational Injuries and Diseases Act. Rand Mutual Assurance requirements. Mine Health and Safety Act. National Health Act

6. TUBERCULOSIS CONTROL PROGRAM AT AGAH • TB Control Programs in high incidence mining settings should include: • Case finding – symptom screening, 6/12 CxR for “dust” risk workers. • Rapid diagnosis of infectious patients - in house laboratory. • Access to rapid culture, drug sensitivity testing, Hain test for TB. • Rapid institution of appropriate treatment regimens with quality drugs. • Isolation of infectious cases. • Directly observed therapy short course with case retention. • Confirmation of conversion of infectious cases. • Confirmation of cure of infectious cases. • Notification to the authorities, DoH, MBOD-ODMWA, COIDA, RMA COM. • Audit and data analysis of how the program functions. • Linkage to a robust HIV management and control program.

7. TUBERCULOSIS CONTROL PROGRAM AT AGAH

8. TUBERCULOSIS CONTROL PROGRAM AT AGAH TB control in the Mining Industry requires: A Good TB Control Program: Case Finding DOTS driven Outcome driven Quality Control A Good HIV Program: HCT Wellness Clinics Anti retroviral therapy INH and Cotrimoxazole PT Outcome Driven Quality Control Commitment and buy in from all stakeholders Limiting Silica Dust Exposure.

9. TUBERCULOSIS CONTROL PROGRAM AT AGAH A GOOD TB CONTROL PROGRAM INVOLVES: Setting Goals for success: To cure 85% of all new smear positive cases. Smear Conversion Rate of 85% (New) 80% (ReTreat) by the end of the Intensive Phase. DOTS for 100% of sputum smear positive TB. Less than 5% treatment interruption. Less than 1% acquired drug resistance. To prevent lung damage and therefore disability.

10. TUBERCULOSIS CONTROL PROGRAM AT AGAH

11. TUBERCULOSIS CONTROL PROGRAM AT AGAH

12. TUBERCULOSIS CONTROL PROGRAM AT AGAH

13. TUBERCULOSIS CONTROL PROGRAM AT AGAH WHO

14. TUBERCULOSIS CONTROL PROGRAM AT AGAH Successes: Robust TB and HIV program with Databases with QA program TB cohort managed – In house health service – DOTS - Case retention Active TB screening – Good Outcomes – Reducing Incidence Audit Process – MOHAC Audit tool Good relationship with DoH – Central, Provincial, Local Area Building relationships with Labour Sending Countries Challenges: 30 – 40% of TB cohort are HIV unknown Skills Base Retention Shrinkage of South African Mining Industry

15. TUBERCULOSIS CONTROL PROGRAM AT AGAH • TAKE HOME MESSAGE FOR TB CONTROL IN INDUSTRY: • Robust, concurrent TB and HIV programs running • Commitment and buy in from all stakeholders (Mx, Emp, Org Lab) • Comply with International Standards and National Law • Set goals for success – Outcome driven • Quality Assurance and Audit - Information systems • Prevention of disability and death

16. TUBERCULOSIS CONTROL PROGRAM AT AGAH THANK YOU FOR LISTENING