DOTS WORKS VWSA WORKPLACE PROGRAM of South Africa

DOTS WORKS VWSA WORKPLACE PROGRAM of South Africa

TB IS A GLOBAL EMERGENCY • 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) of South Africa

TB IS ANOTHER HUMAN TRADEGY • 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 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 coinfected with HIV/TB Prevalence Trends in South Africa of South Africa

TB AND OTHER OCCUPATIONAL DISEASES VS. ACCIDENT RATES IN RSA GOLD MINES 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 Gold 1000/100, 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. 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 of South Africa

of South Africa

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 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 of South Africa

VWSA TB WORKPLACE MANAGEMENT • 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 of South Africa

VWSA TB WORKPLACE MANAGEMENT • • Employees with HIV coinfection <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 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! of South Africa