Tona Mine Carletonville
19 October 2006
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 â 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
