• establishing linkages between TB and HIV programs in and between Lesotho and South Africa, as well as between the public and private sectors, including traditional healers;

  • building capacity among individuals and communities affected by the cross-border TB/HIV epidemic, including treatment literacy training; and

  • addressing the legal, human rights, and socioeconomic issues affecting TB and HIV control among mine workers, ex-miners, and their families through an advocacy program.

The Department of Health’s Tuberculosis Strategic Plan for South Africa, 2007–2011 states that the South African gold mining industry probably has the highest incidence of TB in the world—between 3,000 and 7,000 per 100,000 population per year (DoH, 2007). The mining companies need to take the burden of TB in mine workers seriously and invest in the fight against the disease. In particular, the “three I’s”—intensified TB case finding, isoniazid preventive therapy, and infection control (see Chapter 3)—need to be advocated on behalf of migrant populations.

In May 2008, the AIDS and Rights Alliance for Southern Africa (ARASA) convened a meeting in Johannesburg together with mining companies, trade unions, the ministries of health of both countries, and activist groups to discuss the prevention and treatment of TB. An outcome of the meeting was a recommendation for collaboration between the ministry of health in Lesotho and the mining companies in South Africa so that when patients are referred to TB facilities in Lesotho, proper documentation concerning previous treatment will be made available and special procedures followed.

Warren observed that in South Africa, the mines have a far more efficient TB control policy than do communities. Among miners, all patients are diagnosed, hospitalized, and treated, and DOTS management is exceptionally good. Despite this infrastructure, and even though a high proportion of patients are cured, outbreaks of drug-resistant TB are still observed. These data have been interpreted to imply that the treatment of patients with standardized regimens for MDR TB inadvertently leads to the emergence of XDR TB. It could not, however, be discerned whether transmission occurred in the household, in the compounds where the miners lived, in the hospitals, or in the mines.

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