Jiang, Shulin

South Africa

MINE TB: Active TB Case Finding in Mine Labour-Sending Regions

South Africa is burdened by the highest prevalence of HIV/AIDS in the world (5.6M people living with HIV) as well as one of the worst tuberculosis (TB) epidemics in the world. Among occupational groups, the South African gold mining industry has the highest incidence of TB in the world, with estimated cases ranging from 3,000 to 7,000 per 100,000 miners per year (10 times the level considered a "TB emergency" by WHO). Working and living conditions, such as exposure to silica dust and poor ventilation in the mines, increase risk of disease, and regular migration among miners makes case detection and treatment adherence a challenge.

IRD SA and The Aurum Institute are collaborating with South Africa’s National, Provincial and District Departments of Health to increase tuberculosis (TB) and HIV case detection and treatment initiation in select districts in KwaZulu Natal chosen for their high rates of mine labor-sending. The project has been made possible by a generous donation from the TB REACH Secretariat, which is a WHO Stop TB Partnership initiative dedicated to promoting early and increased TB case-detection using innovative approaches among poor, underserved, and vulnerable populations. More information about TB REACH can be found here: http://www.stoptb.org/global/awards/tbreach/

There are 2 major components of MINE-TB:

1. Health System Strengthening through Facility-based Screening.
To assist with increasing the quality of care provided at select high-volume fixed facilities, routine and standardized active case finding is provided by dedicated health screeners. Systematic symptom screening of patients at these facilities utilizing the national TB Screening Tool assists facilities in reaching their targets for TB screening, increasing TB case detection and promoting early TB treatment initiation

2. Innovative Approaches in Community-based Screening.
To increase access to care among hard-to-reach populations, the program is deploying community-based screeners linked to mobile teams of screening agents to increase quality TB and HIV screening, testing, and treatment in rural communities using a Social Franchising model. Sputum is collected from all those with presumptive TB who are able to expectorate at the time of screening, and is transported by the project to local government Clinics and Hospitals within 24 hours of expectoration. Clients with presumptive and diagnosed TB will be referred for HIV counselling and testing.

This project uses mobile phone technology (mHealth) to facilitate immediate data collection and reporting at points of contact and collection. Reduced loss to treatment initiation and early TB treatment initiation will increase positive TB outcomes and reduce the burden of infectious TB.

Additionally, the project will use incentives for screeners in the community beyond a basic stipend in the form of conditional cash transfers for specific tasks performed and results achieved, including identification of an unreported bacteriologically positive cases and treatment initiation.

IRD has offices in Dubai, Karachi, Singapore, and Johannesburg. This posting is for the South Africa field sub-office.

Faculty Mentor: Aamir Khan, Associate Professor at JHSPH

In-Country Mentor: Lauren Oldja

Group picture of the IRD&Aurum Port Shepstone team and all dedicated health screeners of Ugu district:

A typical rural cliniic in Ugu district, KZN, South Africa:

Dedicated health screener working in a rural clinic, using smart phone to input patient information:

Splendid view of rural South Africa:

One of our community screener visits rural households to collect sputum samples for TB tests:

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