Batswana in all-embracing TB study in SA

EDGAR TSIMANE
Correspondent | Thursday June 26, 2008 00:00

Like several dozens of others, he has been in and out of this hospital being treated for TB. His condition has now mutated into the dreaded multi-drug resistant TB.

Gadima missed out on preventative TB therapy launched two years ago by the Aurum Institute for Health Research headed by Professor Gavin Churchyard.

The research institute seeks to establish whether community-wide isoniazid preventative therapy is more effective than the one given to high-risk TB patients.

The research was initiated after it became evident in the 1990s that TB among South Africa's gold mining industry had risen sharply, subsequently becoming the principal cause of death in the workforce. It was also noted that the five-fold increase in the rates of TB coincided with the onset of the HIV epidemic.

Added to this is another silent killer - silicosis lung disease - caused by over-exposure to silica dust in underground mines. The concomitant diseases have since been declared occupational harzards by South Africa's Mine Health and Safety Council.

Industry workers who contract both afflictions are financially compensated, but many still die of both infections.

Hence over 17, 000 mineworkers at South Africa's top gold mining companies - AngloGold Ashanti, Gold Fields Limited and Harmony Gold - have been enrolled in the Thibela TB study which is expected to be concluded by 2011, according to Dr Dave Clark, the study's executive director, responding to Mmegi enquiries.

In its second year, the Thibela TB study is one of the largest and most ambitious of its kind in South Africa and has enjoyed unprecedented support from stakeholders in the mining community, including departments of health, labour and minerals and energy, as well as from the country's largest trade union, the National Union of Mineworkers.

Forty shipping containers have been converted into mobile study centres and set up in Carletonville, Welkom and Orkney near Klerksdorp supported by three mobile digital x-ray units.

The study has reached out to miners on all gold mines, who include migrant workers from the Southern African Development Community countries of Botswana, Lesotho, Swaziland and Mozambique.

Although there are presently no monitoring mechanisms in place for workers from neighbouring countries who spend close to two months of their annual leaves in their respective countries, Dr Clark can only emphasize that all mineworkers are at risk.
Therefore, to distinguish them by their countries of origin 'is not epidemiologically relevant to the study and the health of the workers,' he says.

Dr Clark seems contented with the current arrangement where workers are 'monitored by teams at each of the mine shafts involved in the study, assisted by a class-leading electronic data management system which captures all activities, events and effects related to the study.'

He adds that the 'mineworkers participate completely voluntarily in line with international ethical standards for clinical trials. There is an incentive scheme in place to encourage volunteers to stay on the study and to take their medication, but the incentives are small items of nominal value such as T-shirts, peak caps, water bottles and blankets'.

The study seeks to reduce the incidence of TB in the community-wide isoniazid preventative therapy by 60 percent. It is one of the three studies designed by the Consortium to Respond Effectively to the AIDS/HIV Epidemic (CREATE).
Other than the Aurum research partners, CREATE is led by the Johns Hopkins
University, the London School of Hygiene and Tropical Medicine, the
Municipal Health Secretariat (of Brazil) and the World Health Organisation.

CREATE received a $45 million grant from the Bill and Melinda Gates Foundation in 2004 to conduct three large-scale community studies over seven years covering Africa and South America.

The findings of the CREATE research portfolio will be used to develop new
global policies to combat TB/HIV worldwide, according to Professor Churchyard.

*Not his real name