Occupational safety and health

Printer friendly

A pioneering research programme to identify appropriate strategies to reduce the incidence of pulmonary tuberculosis (TB) in the gold mining industry in South Africa was launched nationally at the end of October 2005, followed by regional launches on 1 November 2005. The local programme is part of a global research programme to find a way, in the face of escalating TB infection, to reduce the incidence of the disease. The programme is based on the premise that administering TB preventive therapy to an entire community may result in a significant reduction in the incidence of the disease.

In South Africa, the research programme is being led by the Aurum Institute for Health Research in collaboration with the London School of Hygiene and Tropical Medicine and the Johns Hopkins University Center for Tuberculosis Research.

According to Professor Gavin Churchyard, CEO of the Aurum Institute and principal investigator for the study, "Computer modelling suggests that community-wide preventive therapy will reduce the incidence of TB by up to 60%. This in turn will have a marked effect on the communities concerned in terms of both their financial and social well-being.”

The research being conducted by the Aurum Institute, under the auspices of the Mine Health and Safety Council and CREATE, is being done in collaboration and after extensive consultation with several South African gold mining companies as well as various labour unions and associations. The study has received strong support from the government departments of labour, health and minerals and energy. CREATE recently participated in various site visits and was impressed with the progress made to date.

The aim of the research is to determine the likely effects of community-wide preventive therapy on TB rates in the gold mining industry as it has become increasingly apparent in the last 15 years that, despite meeting World Health Organization (WHO) targets for the detection and cure of TB, the rates of TB among employees in the South African gold mining industry have risen sharply, in tandem with the onset of the HIV epidemic in the country. According to the WHO’s report Global Tuberculosis Control 2005, since 1990, the rate of TB has tripled in countries in Africa with a high incidence of HIV/AIDS. This is in stark contrast to a decline in the rate of TB in developed countries.

The incidence of TB in the South African gold mining industry is rising despite the implementation of control programmes which meet international standards. This is largely attributable to silicosis together with the escalating HIV/AIDS epidemic, which compounds the incidence of TB.

The objective of the research is to compare the efficacy of nine months of TB preventive therapy using the TB drug isoniazid offered on a community-wide basis in addition to the standard TB control programme, with that of the standard TB control programme currently practised in the gold mining industry.

The primary research project, Thibela TB (Prevent TB) is being funded by grants from the Mine Health and Safety Council, a tripartite body mandating safety-related research and development and representing government, labour and industry, and CREATE (as part of a grant from the Bill and Melinda Gates Foundation – see box), and a grant from Thibela TB will be conducted on AngloGold Ashanti, Gold Fields and Harmony mines in Gauteng, North West Province and the Free State. Around 68,000 miners will participate in the study. Participating mines were allocated by chance, by public lottery, either as control sites or as a site which will receive community-wide preventive treatment. The process of enrolling participating mines and individuals and the administration of therapy will begin in January 2006 and should last 15 months.

The rationale behind the research is that all individuals in a community at risk of developing TB in the population would be treated rather than only those identified as being high-risk, such as those who have the HIV infection or silicosis. If successful, such a programme would reduce the rate of transmission of TB between people, which would lead to fewer TB cases occurring later, thus resulting in improved control of the disease.

The aim of the programme is to demonstrate that community-wide preventive therapy, used in addition to standard TB control measures, is effective in reducing both the incidence of TB and its consequences and that it can improve the control of TB in high-risk areas such as those with a high incidence of HIV/AIDS. Similar studies are being conducted by CREATE in high-risk communities in Zambia and Brazil.

TB has a high social and economic cost, both for the individual concerned and the industry as a whole. Improved employee health would lead to improved quality of life, improved productivity and reduced costs.

The findings of the CREATE research portfolio will be used to develop new global policies to combat TB/HIV, a key criterion of projects which the Bill and Melinda Gates Foundation supports. If these studies are successful, the use of community-wide treatment could transform international policy on the control of TB, particularly in high-risk communities such as those with high-density living and working conditions where the population is susceptible to TB.

Aurum Institute for Health Research broadens its scope

The Aurum Institute for Health Research, formerly Aurum Health Service and a wholly-owned subsidiary of AngloGold Ashanti, is now an independent, section 21 company (not-for-profit) with public benefit organisation status (with the latter conferring tax exemption). Allied to these changes and increased independence, there is to be a change in the composition of the directorship of the Aurum Institute. The new board of directors will represent the newly transformed Aurum Institute which in turn will represent a range of interests and will undertake and conduct research and health systems development in the interests of the broader South African community as opposed to just one sector of society.

The Aurum Institute receives funding from a range of sources including the President’s Emergency Plan for AIDS Relief (PEPAR) in the United States.

In 2004, the Aurum Institute was granted funding by CREATE, the international Consortium to Respond Effectively to the AIDS/TB Epidemic, of $14 million over a five-year period, and by the Mine Health and Safety Council to research strategies to improve TB control in the South African gold mining industry. CREATE was established in response to the growing recognition by TB and HIV experts that innovative and radical approaches to TB control are necessary to reverse the increasing incidence of the disease in Africa. The grant from CREATE, of which former President Nelson Mandela is a patron, is part of a larger award of $45 million made to CREATE by the Bill and Melinda Gates Foundation to fund research into combating TB.