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80 000 mineworkers participate in TB study

28th February 2014

By: David Oliveira

Creamer Media Staff Writer

  

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Public-benefit organisation the Aurum Institute has conducted a study involving 80 000 South African mineworkers at 20 different mine shafts owned by gold majors AngloGold Ashanti, Gold Fields and Harmony Gold, aimed at disrupting the transmission of tuberculosis (TB) in mines through mass screening and treatment.

The study, conducted in partnership with these mining companies, as well as labour unions and the South African government, is titled ‘A Trial of Mass Isoniazid Preventive Therapy for Tuberculosis Control’, and was published in the New England Journal of Medicine last month.

“TB has been a problem in mines for more than 100 years and the issue has received a significant amount of attention during this time. However, the problem is currently far more severe than it was 100 years ago,” says Aurum Institute CEO Gavin Churchyard.

He notes that TB has cost the South African mining industry about R1.3-billion a year, as it impacts severely on the productivity of mineworkers and under- mines the production and profit- ability of mining companies.

Sixty-six per cent of the mineworkers employed by the three participating gold companies were screened for TB. Those infected with the disease were placed on preventive therapy.

This involved providing infected mineworkers with isoniazid (INH), an antibiotic used to treat TB. Mineworkers had to take one INH tablet daily.

“The antibiotic treats any infection in the body that is not causing symptoms; it is also effective among individuals infected with the occupational lung disease silicosis, which can progress to TB,” explains Churchyard.

The treatment provided during the study was administered over nine months, which is longer than the six months of treatment recommended by the World Health Organisation (WHO) and accepted as the national guideline in South Africa.

Churchyard explains, how- ever, that although the treatment offered by the researchers was effective while mineworkers received treatment, the effect of INH waned immediately once they stopped.

“There was no difference between the rate of TB disease among the gold mine populations, who had an intervention programme in place, and the control populations, who received standard treatment. This indicated that the intervention programme was not sufficient to properly interrupt the spread of TB.”

He suggests that new research be done on how best to use existing technologies and remedies to fight the TB epidemic. Further, more investment is needed to fund research and development to find new methods of treating and diagnosing the disease, which will require partnerships between the various stakeholders, such as government, the private sector, nongovernmental organisations and multilateral donors.

“More needs to be done to reach the WHO goal of eliminating TB as a public health threat by 2050, and the rate at which TB is declining needs to be much higher to reach this target.”

Churchyard asserts that people at risk of contracting TB, such as those with HIV/Aids or silicosis, need lifelong treatment. However, ensuring that the treatment is taken daily is difficult, as “the mining workforce is vastly male-dominated and men are notorious for not accepting prevention strategies”.

About 85% of mineworkers who develop TB have been infected with HIV, which also highlights the need for mining companies to increase their HIV/Aids treatment programmes and provide free access to HIV testing and antiretroviral (ARV) medication.

Churchyard suggests that mining companies consider administering ARV treatments earlier than they currently do, as it will help combat the spread of HIV/Aids and TB infection among mineworkers.

Further, he highlights silicosis as another risk factor, other than HIV/Aids, that facilitates the contraction of TB. On average, mineworkers who have silicosis are three times more at risk of contracting TB than mineworkers who do not have silicosis.

“In cases where the infection of silicosis is severe, mineworkers are six times more at risk of contracting TB. If they have silicosis and HIV, mineworkers are 18 times more at risk of contracting TB.”

To effectively prevent the spread of TB, Churchyard suggests that a new preventive vaccine, which could protect mineworkers from disease, is urgently needed. By preventing disease, miners would not be required to take daily treament, which often leads to drug resistance. A preventive vaccine will ensure a healthy and productive workforce and prevent the development of side effects.

Churchyard adds that INH treatment may not work if the infection is resistant to the antibiotic, whereas people do not develop resistance to vaccines.

“The mining industry can contribute to the development of a vaccine through partnership, investment and through permitting access to mineworkers to conduct vaccine trials,” he says.

Edited by Samantha Herbst
Creamer Media Deputy Editor

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