TB Task Team Feedback MMPA Congress

Date : 21 May 2011

By: Dr Khanyile Baloyi

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

Country All cases Per 100,000 population

India 2,000,000 167China 1,300,000 97South Africa 490,000 978Nigeria 460,000 297Indonesia 430,000 187Pakistan 420,000 232Bangladesh 360,000 222Ethiopia 300,000 362Philippines 260,000 283DR Congo 250,000 379Myanmar 200,000 400Viet Nam 180,000 204Russian Fed. 150,000 106Kenya 120,000 301Uganda 96,000 293Mozambique 94,000 411Zimbabwe 93,000 743Thailand 93,000 137Brazil 87,000 45Tanzania 80,000 183Cambodia 65,000 439Afghanistan 53,000 188Global total 9,400,000 138

Countries All cases

South Africa 490000

Zimbabwe 93000Cambodia 65000

Mozambique 94000

Myanmar 200000

DR Congo 250000

Ethiopia 300000

Per 100,000 population

978

743439

411

400

379

362

TUBERCULOSIS STRATEGIC PLANFOR SOUTH AFRICA, 2007-2011

There have been a number of international, regional and national political and policydirectives 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 othermajor diseases.” The indicators for this target are much more specific to TB and are asfollows: 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 acceleratedexpansion of control measures and for increased political commitment and financialresources 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

TUBERCULOSIS STRATEGIC PLANFOR 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 theincrease in the estimated prevalence of HIV in the adult population. This has resulted in theincreasing recognition of the problems posed to public health by TB.

TUBERCULOSIS STRATEGIC PLANFOR SOUTH AFRICA, 2007-2011

South African National Strategic Plan on TB

VISIONA 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.

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 LancetVolume 375, Issue 9732, Pages 2179-2191 (June 2010)

DOI: 10.1016/S0140-6736(10)60554-5Copyright © 2010 Elsevier Ltd Terms 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.

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)”.

A CALL FOR ACTION IN 2009

Susceptibility

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

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

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.

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 clinics Cough questionnaires not administered 33%

c) DOTS Few cases lost to follow up.

d) TB Clinic Lack of follow up and review of pts during, after transfer and D/C

e) laboratory, radiology and Pharmacy

Mostly well run, some were outsourced.

Comments

Deceased cases Case review of post mortem reports from MBOD was not done in most instances.

Targets In some instances targets could not be calculated because TB Registers were not well kept.

Indicators Results Targets

Cure and treatment completed

Range: 78 – 92 %Average: 82%

> 85%

Outcome known Range: 51 – 100%Average:89%

>90%

Recurrence rate Range: 2 – 10%Average: 6%

<5%

Report cont.

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

Provincial TB Report

Province Status

Gauteng Done

Free State Done

Northwest Done

Mpumalanga Done

Limpopo planned

North Cape planned

Thank You