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Date : 19/10/2006
Source: Department of Minerals and Energy
Title: Sonjica: Thibela TB Study Event


Minster's speech for Thibela tuberculosis (TB) study event, Tau Tona Mine Carletonville

Your Lordship, the Mayor of Merafong Municipality
Honourable Municipality Councillors
The Chairperson of the Mine Health and Safety Council (MHSC)
The Labour, Employer and State MHSC Stakeholders
The Chairperson and members of the Aurum Health Board
The Chairperson and members of the Thibela TB Study Stakeholder Group
All protocol observed!
Good morning

It gives me great pleasure to be here today with you to familiarise myself with this important event. It is appropriate to quote the now famous words of President Nelson Mandela, at the AIDS 2004 conference in Bangkok and I quote: "We have lost ground in the fight against TB in the face of a spreading AIDS epidemic. Today we are calling on the world to recognise that we cannot fight AIDS unless we do much more to fight TB as well."

TB infection rates in South Africa's mining industry continue to increase despite well-implemented control programmes which exceed international standards. Many countries in sub-Saharan Africa are reporting a four-fold increase in TB incidence rates. It is clear that new strategies are needed to fight the disease. The World Health Organisation (WHO) noted that while global TB prevalence has declined by more than 20 percent since 1990, it has trebled in Africa and continues to rise by three to four percent annually.

In response to this challenge in 2000, the Mine Health and Safety Council (MHSC) decided to co-fund with the Consortium to Respond Effectively to the AIDS and TB Epidemic (CREATE), a study by Aurum Institute for Health Research called the Thibela TB study.

CREATE, a Johns Hopkins University-based research project, is carrying out three studies to evaluate novel techniques for controlling HIV-related TB in countries hard hit by the dual epidemics and is funded by the Bill and Melinda Gates Foundation. It was launched at the 2004 AIDS conference in Bangkok by the then President Nelson Mandela who is its patron. We are very thankful for such a support through this collaboration. The study being co-funded with CREATE will evaluate strategies that could lead to improved TB control on the South African mining industry. The MHSC is to be the lead agent for the Thibela Study within the broader CREATE project.

The focus of CREATE is to give attention to TB and in addition to the Thibela TB project, it is also funding two other project one in Brazil and the other project being done in both Zambia and the Western Cape. The aim of these projects is to evaluate novel strategies to improve TB control in the settings with a high burden of HIV.

The Thibela TB project set out to enrol more than 60 000 gold miners in three provinces of South Africa to participate in the study. Approximately half of these miners will be required to take daily medication for nine months and to attend monthly check-ups at the various Thibela TB study centres run by the Aurum Institute for Health Research.

The staff of the Institute plans to visit various shafts for this purpose. The remaining half of the study population will act as a control sample and will not take the medication, but nevertheless, will be monitored for TB. The Thibela TB study is promising great value for the management of TB in that it is designed to provide the blueprint for reducing TB by up to 60 percent. It is expected that the study will prove that by introducing community based preventative Isonaizid therapy (taking one tablet a day for nine months) a rapid and large positive impact on TB infection rates will be achieve. Such an impact is expected to endure for up to ten years.

Public and occupational health benefits will be significant reduction of TB admissions and deaths, lost productivity and compensation payments leading to substantial positive social and economic outcomes. Furthermore, greater awareness for the disease and a review and strengthening of current TB services will be achieved through supplementary training of health care workers and improved laboratory diagnosis of TB.

This event today mark the full rolling out of the study project and the voluntary enrolment of the participants is well appreciated. I am here today on behalf of government to lend support to the Thibela TB project as a milestone in prevention of TB on the mines as well as for the broader CREATE undertakings.

The Department of Minerals and Energy produced a guidance note for Occupational Medical Practitioners in the Mining industry on the control of Tuberculosis on Mines in South Africa. It is intended as a supplement to the national TB Control programme and is based on rigorous adherence to the principles of the Tuberculosis Control Programs (the DOTS – Directly Observed Treatment Strategy

The TB disease is curable. However, people default from the treatment which results in TB drug resistance. Other factors contributing to TB drug resistance include: inappropriate drugs used for treatment, erratic drug supply, poor patient management, poor patient adherence, misuse of TB drugs and poor TB control. This has led to development of Multiple Drug Resistant TB (MDR-TB). MDR-TB is characterised by resistance to so-called first line drugs for treatment of TB.

The Extreme Drug Resistant TB (XDR-TB) sets in when a patient develops resistance to second line drugs. Such a situation poses a higher risk to the mining industry as cure rate is currently very low. To date XDR-TB has claimed over 60 lives in KwaZulu-Natal. Since the beginning of September this year South Africa has hosted a number of meetings to deal with XDR-TB with international participation. In all the forums, the Department of Minerals and Energy has been engaged and participating actively.

This failure of TB-control programmes in South African mines is attributable to a high prevalence of silica disease of the lungs and an escalating HIV infection. Both of these conditions weaken the immune system and therefore result in higher chances of contracting TB. Now XDR-TB and HIV have been linked in that most of those diagnosed with XDR-TB were found to be HIV positive.

Throughout the world there are deliberations and discussions on the best way to address this deadly TB strain. This type of TB is not unique to South Africa; it has been identified as early as 2000 in other parts of the world such as Latin America, Eastern Europe, Asia and Republic of Korea.

Whilst there have been a few cases of XDR-TB reported in the mining industry, this industry is particularly vulnerable. This is mainly because despite well-implemented control programmes for drug susceptible TB, it remains the most common cause of illness and death in the South African mining industry, killing more than twice as many mine workers as occupational accidents. Between two percent and four percent of the workforce are reported to develop the disease every year.

Whilst reliable cure regimes are being developed, we need to focus on intensifying our current programmes that are designed to curb TB in South Africa, specifically, our national TB Control Programme, Stop TB Strategy and the Thibela TB research project.

To conclude, we must
* emphasise the strengthening of treatment adherence to achieve high levels of completion for all TB patients
* ensure that second line drugs used to treat MDR-TB and XDR-TB are strictly controlled and properly used according to World Health Organisation (WHO) guidelines which includes the following seven point action plan
* develop national emergency response plans for MDR-TB and XDR-TB and ensure that basic TB control measures meet international standards for TB care and are fully implemented
* conduct rapid surveys of MDR-TB and XDR-TB using a standardised protocol to assess the geographical and temporal distribution of XDR-TB in vulnerable populations
* strengthen and expand national TB laboratory capacity by addressing all aspects of laboratory procedures and management
* implement infection control precautions in healthcare facilities according to WHO guidelines, with special emphasis on those facilities providing care for people living with HIV and AIDS
* establish capacity for clinical and public and occupational health managers to respond effectively to MDR-TB and XDR-TB
* strengthen universal access to antiretroviral therapy for all TB patients through close collaboration with treatment and care programmes for people living with HIV and AIDS
* support and increase funding for research into the development of new anti-tuberculosis drugs and rapid diagnostic tests for MDR-TB and XDR-TB.

For enquiries:
Sputnik Ratau
Cell: 082 521 9614

Issued by: Department of Minerals and Energy
19 October 2006

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