1. of South Africa DOTS WORKS VWSA WORKPLACE PROGRAM

2. of South Africa 1/3 rd of the world’s population is infected with TB Kills more adults than any other infectious disease About 8 mil new infections per year and >3 Million people die annually from TB Leading cause of death among HIV +ve Incidence rate of TB if HIV + ve is 10 % to 15% per annum if HIV – ve is 10% per lifetime (even if on ARV is 8% per annum) TB IS A GLOBAL EMERGENCY

3. of South Africa First era - Ancient disease – 4,000 year old mummies - No treatment, superstition, stigmatised Second era - Identification of organism, culture, – 1880’s - Effective treatment – 1940’s to 1966 Third era - HIV TB IS ANOTHER HUMAN TRADEGY

4. of South Africa TB IN SOUTH AFRICA South Africa is among the 22 high burden countries targeted as part of the WHO’s Stop TB Initiative Currently ranked 7 th in worldwide caseload with India being the highest Incidence 600/100 000 population 300 000 deaths per year reported Closely linked to HIV epidemic with about 58% of TB patients being co- infected with HIV HIV/TB Prevalence Trends in South Africa

5. of South Africa Typical RSA gold mine: (% per annum) Fatal injury rate : 0,04 (or 0,2 per million hours) Serious injury rate : 1 Lost time injury rate : 2,0 (or 10 per million hours) Silicosis : 1,0 NIHL : 0,3 TB rate : 3,0 (about 4 times RSA National) TB Incidence rates stable up to early 1990’s Gold1000/100,000. Platinum 400/100,000. Steady TB incidence  in parallel to HIV prevalence over past 10 years Gold now 3000/100,000. Platinum 2500/100,000. TB AND OTHER OCCUPATIONAL DISEASES VS. ACCIDENT RATES IN RSA GOLD MINES

6. of South Africa NATIONAL RESPONSE August 2005, Africa declared TB Emergency area TB now the leading natural cause of death in South Africa Government adopted a National Strategic Plan 2006 - Local Metro declared TB Disaster area Eastern Cape is one of 4 provinces identified for intensification of fight against TB Eastern Cape has the second highest cases of XDR-TB

7. of South Africa

8. WHY A WORKPLACE PROGRAM Education and awareness about TB as part of the general or occupational employee activities Advocacy on TB control Referral of employees with TB symptoms to the nearest health facility for diagnosis and treatment or on-site treatment Prevent spread to other employees-untreated 1 person can infect 10-15 other people per annum Promotes worker wellness, reduces absenteeism and increases productivity Support TB patients during treatment, including direct observation of treatment (DOTS) Reduce stigma associated with TB by advocating and publicly promoting quality care for the TB infected Reduce health care costs through early intervention Integrate TB in existing workplace health programs

9. of South Africa VWSA TB WORKPLACE MANAGEMENT One of the National Treatment Centres since 2002 Follow the national treatment protocol and DOTS program Directly Observed Treatment Schedule, Directly Observed Therapy – Short Course?? Following 3 months of treatment report on sputum conversion Then report on outcome when treatment completed As a result of the HIV pandemic more vigilant case-finding ie sputum testing for AFB and routine chest x-ray Every patient offered VCT All MDR’s moved to local treatment centre

10. of South Africa Majority diagnosed and managed at the medical centre – 78% by the OMO and nurses – need more urgent and vigilant case-finding by GP’s On-site cure rate 93% - national cure rate 64% and WHO target 85% Depending on clinical and x-ray presentation, book off work for at least 2 weeks on initiation of therapy; if HIV positive maybe even longer Some, depending on clinical picture, go on to our incapacity and disability program Those missing therapy get called in immediately VWSA TB WORKPLACE MANAGEMENT

11. of South Africa Employees with HIV co- infection <30% - ? because of early identification of HIV+ve employees and their management Majority of co-infection in previously untested employees or those knowing status but not doing anything about it because of fear 2 MDR – 1 returned to work after treatment 4 deaths during reporting period VWSA TB WORKPLACE MANAGEMENT

12. of South Africa TB WORKPLACE MANAGEMENT Majority of infections are pulmonary with increasing non-pulmonary cases Workplace transfers made if necessary, sometimes permanent All patients offered VCT If HIV +ve positive registered on our workplace HIV and AIDS program and referred to GP for management program In-house monitoring No INH prophylaxis offered because of local policy!