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THIBELA TB
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The Effect of Community-wide Isoniazid Preventive Therapy on Tuberculosis Among South African Gold Miners.
What is the problem?
TB control is failing in South African gold mines, despite well-implemented TB control programmes that meet international standards. The failure of TB control is attributable to:
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A high prevalence of silicosis
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An escalating HIV epidemic
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The combined effect of HIV & silicosis, which is multiplicative
There is no good evidence to guide the choice of further intervention in this situation.
Is there a solution?
Computer modelling suggests that treatment of an entire community to prevent TB (community-wide TB preventive therapy, CWPT) could have a rapid and large impact on TB rates, which should be durable for approximately 10 years. However, without additional measures following the intervention a rebound may occur due to re-infection with TB from communities that did not receive the intervention. CWPT, coupled with other interventions, was used to gain control of epidemic TB among Alaskan Inuit in the 1950s.
What is proposed?
A proof of concept, cluster randomised study among South African gold miners is planned. The aim is to demonstrate that CWPT in addition to the standard TB control programme is an effective way of rapidly reducing the burden of TB infection and disease, and can improve TB control in high HIV prevalence areas.
Our Patron
Mr Nelson Mandela in his key note address at the CREATE launch at the International AlDS congress in Bangkok in July 2004 said "We have lost ground in the fight against TB in the face of a spreading AlDS epidemic. Today we are calling on the world to recognize that we can't fight AlDS unless we do much more to fight TB as well". We have a unique opportunity to meet the challenge issued to us by Mr Mandela.
Potential to transform international policy
If the intervention is effective in reducing TB rates at the population level, this strategy could be applied to other communities with high TB transmission, such as settings with high density living and poor working conditions, especially where a large proportion of the population have increased susceptibility to TB, particularly due to HIV infection.
Who is funding the study?
The study is funded by the Mine Health and Saety Council and the Consortium to Respond Effectively to the AlDS & TB Epidemic (CREATE), as part of a grant from the Bill and Melinda Gates Foundation.
How will the study be done?
Participating mine shafts, with a predicted life of mine of 5 years or greater, will be grouped into clusters, defined as associated mine shafts and hostels. Clusters were randomized at a public function to either the intervention or control arm. In the intervention shafts all employees and contractors will be invited to participate in the study, screened for TB and those without evidence of active TB will be offered TB preventive therapy (isonaizid) for nine months. The control shafts will continue to receive the standard TB control programme. TB rates will be followed for two years and compared between the intervention and control shafts.
What are the benefits of participating in the study?
The benefits include:
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An expected reduction in TB rates by at least 60% in the intervention shafts. TB admissions and deaths, lost productivity and compensation for TB should also be significantly reduced leading to substantial cost savings.
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Community-wide TB awareness activities conducted in all shafts.
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A review of TB services.
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Strengthening of the TB services through supplementary training of health care workers and improved laboratory diagnosis of TB.
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Free access to a customised TB management system that will allow standardised data collection and reporting across the industry.
Who is collaborating in this study?
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Aurum Institute for Health Research
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London School of Hygiene and Tropical Medicine
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Johns Hopkins University
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AngloGold Ashanti
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Gold Fields
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Harmony Gold
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Department of Minerals and Energy
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Department of Health
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Department of Labour
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Mining Unions and Associations
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