‘I had to choose between being deaf and being dead’, this is what Dalene von Delft, a Medical Doctor from Stellenbosch University in South Africa, said in her testimony at a two-day Southern Africa meeting held recently to strengthen and scale up TB /HIV responses in the workplace. The meet was supported under the TB Care II program by University Research Company in collaboration with USAID. In the meeting, Swaziland, Namibia, South Africa were represented by their government, workers and employers’ organizations working in the field of TB.
Dr Delft is one of the few doctors who work in high risk healthcare facilities and thus are constantly exposed to TB. She contracted the disease from her workplace and was diagnosed with Multiple Drug Resistant Tuberculosis (MDR-TB). Despite being a doctor, she was unfortunate enough to be burdened by an irreparable side effects of MDR-TB treatment—deafness. She noted that tuberculosis needs to be considered seriously as an occupational health concern and more importantly as a preventable risk.
In the same meeting a presentation by Dr. Babatunde from the United Nation Population Fund (UNFPA) indicated that an employee with TB loses 3-4 months of work in a year, amounting to 30%-40% of annual household income. His presentation highlighted the magnitude of TB in the countries present at the meeting, where HIV prevalence has prepared a fertile ground for MDR-TB. TB is indeed affecting productivity in the workplace as well as the quality of life in the extended community through the affected families. As Dr Paula Fujiwara, a Scientific Director at the International Union Against Tuberculosis and Lung Disease (The Union) expressed, “In countries with resources, people are often given a tuberculin skin test and a Chest X-ray (CXR). If the skin test is positive and the CXR is negative, they can be placed on preventive therapy. However, people with HIV may have a negative skin test and/or a negative CXR, even though they have ACTIVE TB."
Dr Babatunde noted that workplaces have to scale up and strengthen their infection control methods and TB responses. He explained that in workplaces there is already an easy access to a large number of people who can be a ready audience for communication. There are also existing structures and systems to build in TB-HIV support systems that can manage stigma and discrimination. The Swaziland Business Coalition on HIV-AIDS (SWABCHA), an employer established institution, has introduced TB-HIV awareness dialogues and adopted the national basic screening tools through a mobile wellness clinic for most at risk populations, like migrant workers who live in congested environments and have long labour intensive working hours in textile factories, construction sector and as cane cutters in agriculture sector. In particular for healthcare workers, Swaziland has established a Wellness Center, and provides TB-HIV screening services for them at their workplace itself. Further, the wellness center is equipped to provide HIV counseling and testing, antiretroviral treatment (ART) for HIV, as well as Directly Observed Treatment Short course (DOTS) for TB. This has helped to minimize healthcare workers fear of queuing up at the same healthcare centre with their own patients. It has also helped them in forming support system groups with other health care workers managing the same disease and, in some cases, both HIV and TB treatment.
National TB programmes still face many challenges, which include limited funding for the workplace since TB-HIV are still not highly rated as an occupational hazard; stigma and discrimination associated with TB-HIV resulting in poor access to services and non- completion of treatment which further fuels MDR-TB—the latter making it more difficult to treat and reduce mortality rates due to TB. The high burden of HIV in majority of Southern African countries has prepared a fertile ground for easy spread of both drug susceptible and drug resistant TB that is difficult to diagnose as well as to treat as expressed by Dr.Fujiwara from The Union. Then again, there are most at risk populations, who work long labour intensive hours and they are a highly mobile and migrant workforce working in factories, and as agricultural seasonal workers and construction workers.
In the light of the challenges noted above, SWABCHA has proposed possible future responses for TB-HIV in the workplace. Firstly there is a need to expand the use of GeneXpert for point of care diagnosis of basic TB and MDR-TB. Secondly, we will have to intensify infection control in congested workplaces and focus on geographic targeting of hot spots of TB, with a view to maximize programme investments. Thirdly, there is need to strengthen partnerships and multi-sectoral responses, addressing TB as not only a medical challenge but also as a social and economic threat. And lastly, establishing mobile data collection and management to increase efficiency in patient tracking and strengthening data collection for continuous research on TB drugs especially drug resistant TB is also necessary. SWABCHA will be launching a mobile phone data collection, linked to an electronic data base this August 2013.
TB is a preventable and, most importantly, a curable disease and there should be no deaths as a result of poor diagnosis (or no diagnosis at all) and/or lack of access to quality treatment.
Alice Tembe, Citizen News Service - CNS
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