Position Statement: Zeroing in on TB in South Africa.
Tuberculosis is rampant in South African communities and cited as the leading cause of death for the last 6 years (Stats SA). The number of drug-resistant TB patients are increasing. There is growing evidence that health care facilities are sources of increased TB transmission, particularly drug-resistant strains. Healthcare workers and people living with HIV are particularly vulnerable to workplace transmission, but also discrimination and stigmatisation.
TB Proof, an advocacy and education group consisting of TB survivors and affected healthcare workers and students, is calling for the following:
- Specific deliverables:
- Updated, standardised TB infection prevention and control policies (IPC) at all healthcare facilities, including training facilities. All people accessing these facilities should be covered (including workers, students, patients, volunteers and visitors) in line with ILO (International Labour Organization) workplace standards.
- Compliance with policies: infection control officers and/or committees tasked with implementation. Includes training and recruiting more Occupational Health Practitioners and possibly the pooling of IPC, Occupational Health and Quality Assurance Teams.
- Education: why IPC is critically important with an emphasis on rapid risk identification and reduction – targeted teaching sessions can be based on the TB Proof template.
- Monitoring and evaluation: documentation of IPC compliance as well as mandatory notification all occupational TB cases in line with WHO requirements.
- Compensation: educate workers about their rights and streamline COIDA claims process (dramatically improve approval times). “Workers eligible for compensation” should include all those performing a service who are at risk of TB exposure (facility and community based), including those without formal remuneration and/or employment contracts, e.g. students, volunteers and supernumerary health care workers.
- Healthcare workers living with HIV: at greatly increased risk of transmission, but also discrimination. We propose additional supportive measures/policies focused at further risk reduction, e.g. alternative placement, the provision of isoniazid preventative therapy (IPT) and access to ARV’s regardless of their CD4 count.
- Provision of pre-employment TB and HIV screening, and at least bi-annual TB screening (by means of a symptom questionnaire) and N95 fit-testing every 2 years.
- Key advocacy points aimed at reversing DR-TB progression:
- Fast track the development of new drugs, so that they can be used in combination effectively and safely with minimal risk of further resistance developing. Should include novel prophylactic regimens.
- We urgently need a TB vaccine that is far more effective than BCG.
- Prevention, prevention, prevention:
- Improved management of drug sensitive TB cases, so that less resistance develops.
- Infection prevention and control at healthcare facilities, correctional facilities, mines and the homes of all TB patients.
- Improved contact tracing and community screening driven by better diagnostics, to limit pre-treatment transmission.
- Latent TB: prophylactic therapy for all high-risk exposures, particularly DR-TB.
- Patient centred care: includes socio-economic support, community education and reduction of stigma of both TB and HIV.
We look forward to working towards TB elimination together!
TB Proof Team