TEBA Tuberculosis Programme

Programme

TEBA Point of Care (POC) Clinics Project.

Background

Statistics show that mineworkers and their families are at high risk of exposure to TB and HIV/AIDS with an incidence rate of 2 500-3 000/100 000.

This figure is completely disproportionate in relation to the World Health Organization (WHO) threshold of 250/100 000.

Some of the factors that contribute to this exceptionally high incidence rate amongst the mining communities are high migration, broken family structures, and poor working and safety conditions.

In 2013, TEBA was appointed to establish Point of Care (POC) Clinics to alleviate this issue, with funding from the URCSA and support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control (CDC).

The TEBA POC Clinics Project was officially launched by the Minister of Health, Maseru, on 30 July 2013. The main aim of the project was to fast-track the identification of affected miners and ex-miners in Basotho communities in the districts of Maseru, Mafeteng and Leribe and to coordinate the administering of treatment to them.

Methodology and approach:

i. Optimising of resources

TEBA already had three established offices that served the mining communities in question with services like pre-employment health screening and the dispensing of deferred wages.

To leverage the existing resources, reach and exposure, the POC Clinics were set up at these offices. The facilities were purposefully created to ensure a seamless, one-stop and on-site service that could be rendered for six days a week.

ii. Tracking of cases

As all miners who have been recruited by TEBA over the years are officially registered on the system, TEBA had an extensive database that could be utilised to contact miners and ex-miners, and to encourage them to make use of the new facilities available. Numerous mining households were also personally visited, and the services were actively promoted amongst miners who visited any of the three TEBA offices where the POC Clinics were established.

iii. Education and awareness

All miners who visited the TEBA offices were exposed to TB and HIV education in the waiting areas, and dedicated care supporters assisted them with questionnaires to detect potential symptoms in a discreet manner.

iv. On-site counselling and testing

Miners who agreed to be tested for HIV and TB received professional group pre-test counselling. From there, they were channelled to dedicated Provider Initiated Testing and Counselling (PITC) points for individual testing.

Miners who wished to be tested for TB were guided to booths for collection of sputum samples for same-day collection and testing by GeneXpert. All sample collections and tests were conducted within the parameters of the relevant prescribed and approved medical protocols.

Patients who tested for HIV, as well as those with presumptive TB or a negative TB screen, also received post-test counselling.

2. Treatment

Treatment involves a series of scheduled visits for thorough examinations, collection of sputum samples, monitoring of the effectiveness of the prescribed medicine and treatment, adjusting of treatment where necessary, and discussion of test results. All this occurs in partnership with the local clinics that the patients have been linked to when arriving in their homes and within the parameters of the medical protocols approved by the respective Ministries of Health. Apart from the medical treatment, patients and their family members also receive TB screening, ongoing counselling and psychosocial support.

3. Exiting of programme

As soon as a patient’s treatment is completed, and an accredited medical practitioner/facility has issued the patient with final results, the patient is exited from the programme.

Challenges

Experience indicates that the main reasons for those affected by TB going untreated, are two-fold.

Firstly, due to the fear of being stigmatised, many mineworkers opt against disclosing their condition to the mines and being medically boarded through the formal system. Secondly, many of the mineworkers who do follow the formal protocol to get medically boarded, provide more than one physical address or change addresses frequently.

As a result, they are very difficult to track down for follow-up, and in many instances, even impossible to reach, especially if they are migrant workers from the neighbouring countries of Lesotho, Mozambique and Swaziland.

Outcomes

With the support of several key stakeholders in the mining industry, including leading mines, donor funders and government, TEBA has, to date, successfully registered ±720 patients on the TEBA TB Programme, including mineworkers in South Africa, Botswana, Mozambique, Lesotho and Swaziland.

Apart from rendering treatment to these patients, TEBA also frequently provides the respective Ministries of Health with invaluable insights and useful data through feedback and reporting.

Overall, the TEBA TB Programme has made and continues to make a notable difference in the prevention and treatment of TB amongst miners, ex-miners and mining communities.