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New ICAP Public-Private Partnership is Addressing TB among Mine Workers in Lesotho

August 27, 2013

ICAP has forged a public-private partnership between The Employment Bureau of Africa (TEBA), the sole recruiting company for over 30,000 Basotho miners, and the Ministry of Health to address the tuberculosis (TB) crisis in Lesotho. With funding from WHO this new project—TB REACH—aims to improve the health of mine workers and their families, who are at disproportionately high risk for TB.

Lesotho has the fifth highest incidence of TB in the world. A variety of factors have contributed to this, including the large number of Basotho migrant workers who provide nearly 25 percent of the labor in South Africa’s mining industry. TB incidence in the gold mines of South Africa is among the highest in the world and work inside closed mine shafts, with poor ventilation and prolonged exposure to silica dust, are occupational hazards that increase the risk of TB among workers. In addition, the social consequences of separation from families and community put miners at greater risk of acquiring HIV. Both co-morbidities often go undiagnosed and untreated when workers are reluctant to seek care due to the risk of wage reduction, termination of their contract, forced repatriation, and the social stigma associated with HIV and TB.

Urged by this critical situation, the South African Development Committee (SADC) addressed the issue of TB in the mining sector in its August 2012 declaration, which aims to control TB in the region through improved environmental, health, and safety standards in the mining sector.

ICAP is translating the SADC Declaration on TB in miners into its new TB REACH project that aims to improve health outcomes among 26,000 miners and their families through health education, TB screening, and same-day diagnosis, and treatment initiation. The project utilizes innovative approaches developed through ICAP’s extensive experience scaling up the TB response in Lesotho.

To meet the unique needs of miners, ICAP is supporting newly established TB clinics now open at three TEBA offices—a non-traditional point of entry where miners come on a monthly basis to collect the portion of their salary that is paid out upon their return home. This offers an opportunity to meet the miners at regular intervals and at the TEBA offices all miners are assured of receiving health information and are screened for TB at these visits. Since the launch of the project one month ago, nearly 5,000 miners have been screened for TB and 23 have been diagnosed with TB.

To address the limited human resources to staff additional clinics, ICAP is implementing a task-shifting approach where trained TEBA care supporters provide TB screening, sputum collection and contact tracing, activities that were traditionally performed by a nurse. The TEBA clinics are using GeneXpert, a rapid test for same day diagnosis. To strengthen treatment adherence among miners they are using SMS text messaging to provide Directly Observed Therapy (DOT) from a distance—automated daily reminders to take medication as scheduled. The project also links TB diagnosis and treatment to deferred payment distribution in order to promote retention.

Through these new approaches, TB REACH serves the aspirations of the Government of Lesotho, the Ministry of Health, and the National TB Program in achieving the best for mine workers, their families and the mining community. ICAP is also helping address the gap in current TB services for mine workers and building bridges between the Ministry of Health, TEBA, the South African mining industry and workers, themselves.

The project was launched in July 30, 2013 at the TEBA Lesotho headquarters in Maseru by Honorable Minister of Health Dr. Pinkie Rosemary Manamolela and ICAP Director Dr. Wafaa El-Sadr with support from senior executives at TEBA, WHO and PEPFAR country representatives, the Lesotho Mineworkers Union, and other partners. The launch of TB REACH is a milestone in efforts to support miners and their families. At the end of the one-year project, ICAP aims to use the lessons learned to scale-up TB case finding and management in TEBA offices located in other districts of Lesotho.

The Honorable Minister of Health Dr. Pinkie Rosemary Manamolela and ICAP Director Dr. Wafaa El-Sadr

The Honorable Minister of Health Dr. Pinkie Rosemary Manamolela and ICAP Director Dr. Wafaa El-Sadr at the launch of TB REACH at TEBA’s headquarters in Lesotho.