ReportING on TB and HIV in South African mines to reduce incidence rates

Reporting on tuberculosis [TB] and the Human Immunodeficiency Virus [HIV] was not compulsory as South African mines were only required to report on occupational diseases. Therefore, progress in reducing these diseases in the South African mining industry could not be accurately determined.

Management and reporting on TB and HIV

Following the adoption of targets and recommendations on TB and HIV by the mining sector in 2011, the Department of Mineral Resources and Energy spearheaded the compilation of a National Report on TB and HIV/AIDS in the South African mining industry. The following risk factors are associated with the epidemic of HIV and AIDS in the mines:

Migrant labour system.
Hostel accommodation.
Alcohol abuse.
Informal settlements around the peri-mining communities.
Risky sexual behaviour.

Due to reporting limitations and as a result of the high incidence of TB in HIV-positive mine workers, the Mine Health and Safety Inspectorate commissioned the National Institute of Occupational Health [NIOH] to conduct a study to determine the burden of TB in HIV in the mining sector. Consequently, a reporting form, the DMPR 164-form was developed through the Mining Industry TB and HIV Advisory Committee [MITHAC] of the Mine Health and Safety Council [MHSC].

The reporting template has since been revised to include indicators on the UNAIDS 90:90:90 targets for TB and HIV. Since the inception of the South African mining industry reporting system for TB and HIV/AIDS, reporting rates have improved steadily. With South Africa's adoption of the 90:90:90 strategy in 2014, the country turned a corner in its approach to managing HIV and AIDS on the one hand and tuberculosis on the other hand. Together these two edipemics forms leading causes of deaths in the country.

RESOURCES

Reporting on TB and HIV Form [DMPR 164]

Reporting on TB and HIV Form [DMPR 164] Explanatory Notes

interaction between tuberculosis and other occupational diseases in mining

The interaction between TB, silica exposure and HIV do not merely add to one another but multiplies the incidence rates of TB in the mining industry. Biological and social factors influence the interaction amongst tuberculosis, silicosis and HIV which requires integrated and multi-faceted treatments. Biological and social factors influence the interaction amongst tuberculosis, silicosis and HIV which requires integrated and multi-faceted treatments.

Historically, high levels of TB incidences associated with the gold mining industry of South Africa was recognised as a health hazard in mining as early as the 1890s. The high mortality from TB in miners led to the inquiry by the Tuberculosis Commission of 1912 after which tuberculosis was classified as a compensable disease.

Tuberculosis

Tuberculosis [TB] is a bacterial infection caused by mycobacterium and is an infectious disease that typically affects the lungs. It is an airborne disease that usually spreads from person to person by droplet nuclei produced when an infected person coughs or sneezes. Active tuberculosis or tuberculosis diseases occurs when the human body is unable to contain the bacterial infection especially when the immune system is weakend due to other ilnesses and is infectious. Latent tuberculosis on the other hand is not infectious for as long as the immunity of individuals are high. It only becomes highly infectious when the disease is no longer dormant.

Generally, the symptoms of tuberculosis are a persistent cough, fever, drenching night sweats and unexplained weight loss. Although a large portion of the South African population is infected with tuberculosis, it is most prevalent in the mining industry and in prisons. Only persons with active TB can transmit the infection, but most people with tuberculosis cannot transmit the tuberculosis bacteria after receiving at least two weeks of treatment. The two types of clinical manifestations of tubeculosis are:

Pulmonary tuberculosis [PTB] when it affects the lungs which is the most common manifestation.
Extra-pulmonary tuberculosis [EPTB] when it affects organ systems other than the lungs.

DID YOU KNOW?

Annually, 10 million people falls ill with tuberculosis despite it being a preventable and curable disease. This makes it one of the top infectious killers in the world while the mortality from tuberculosis in miners are higher than that of mine accidents.

TB and HIV

The Human Immunodeficiency Virus [HIV] causes HIV infections and if untreated it may cause Acquired Immunodeficiency Syndrome [AIDS]. AIDS is the most advanced stage of HIV infection. HIV attacks and destroys the CD4 cells or the CD4 T lymphocyte of the immune system which makes it difficult for the body to fight infections. Without treatment, HIV can gradually destroy the human immune system, but with treatment the immune system can recover.

Antiretroviral therapy [ART] can eliminate the risk of HIV trasmission to an undetectable viral load. ART is recommended for any person that tested positive for HIV infection, but treatment only reduce the viral load and life expectancy of the individual. If HIV is untreated and not controlled people can transmit HIV. HIV is an incurable disease.

People with suppressed immunity due to HIV have a higher risk to opportunistic infections such as tuberculosis and treatment for tuberculosis can be complex in persons with HIV infection. Opportunistic infections occur more often and are more severe in persons with HIV. Individuals with both HIV and tuberculosis should be treated for both diseases, but treatment depends on the circumstances of each individual.

DID YOU KNOW?

Worldwide tuberculosis is one of the leading causes of death in persons with HIV.

Silico-tuberculosis

Silicosis is an incurable occupational lung disease caused by the inhalation of tiny particles of crystalline silica dust as a result of cruching, drilling or blasting in the mining industry. It is common in the South African gold mining industry but also occurs in the platinum and coal mines.

Silico-tuberculosis [Sil+TB] is the co-existence of tuberculosis and silicosis in an individual. The presence of silicosis increases the risk of pulmonary tuberculosis [PTB] approximately four-fold and is linked to the severity of silicosis and the intensity of the silica exposure.

The annual incidence of tuberculosis can also increase even if mine workers do not have silicosis, but have been exposed to crystalline silica dust over long periods. Silicosis and silica exposure are second to HIV infections as a risk factor for tuberculosis.

DID YOU KNOW?

Phthisis is the antiquated term for silico-tuberculosis.

In 1902, the Weldon Miners’ Phthisis Commission was appointed to investigate the cause and prevalence of miner’s phthisis. It was determined that breathing air that were contaminated with silica dust was the primary cause of this disease and following this investigation, the Miners’ Phthisis Act of 1910 was promulgated. From 1902 until 1925, this was the subject of nine legislative acts, six commissions, ten parliamentary select committees and four major state industry reports.