The underpinning principles of the TB programme involve the incorporation of recommendations from the World Health Organisation (WHO), the South African National TB Control Programme guidelines, and the Guidelines for TB Control Programmes in the Mining Industry issued by the South African Department of Mineral and Energy Affairs. According to these groups, TB control programmes in high incidence settings should include proactively and rapidly identifying and diagnosing infectious cases and providing them access to rapid bacteriological methods for culture, identification and drug sensitivity testing for TB bacteria, and appropriate therapy with quality drugs. In addition, the isolation of infectious cases, administration of directly observed treatment, and the confirmation of a bacteriological cure at the end of treatment are essential components.
The AGA Health TB Control Program integrates all of these recommended elements. Active case finding is supported by the twice-yearly occupational health chest x-ray screening of all employees working underground and in other "dusty, risk work" positions. The installation of digital x-ray technology at the Occupational Health Centre and the commissioning of two mobile digital x-ray units have also improved the early detection of pulmonary disease. Symptom screening of patients at every health care contact, (i.e., asking direct questions about the presence of coughing for more than two weeks, night sweats, and weight loss) facilitates earlier detection of possible TB patients, as well as their diagnosis and treatment. A modern TB laboratory situated at the Vaal River operation’s West Vaal Hospital processes the sputum microscopy and culture essential for the bacteriological confirmation of diagnosis and, on completion of the treatment, confirmation of the cure for Pulmonary TB (PTB) cases.
Quality combination drug therapy is started as soon as the diagnosis for PTB or other forms of TB is confirmed. Patients are educated about their condition and on the need to take their treatment properly for the entire duration of the treatment programme – six months for new cases and eight months for re-treatment cases. Directly Observed Therapy (DOT) is the strategy applied to the administration of TB treatment and involves the daily supervised administration of therapy either at one of the health care facilities or by a treatment supervisor. The underlying principle is that a health worker or a supervisor must see that the patient swallows his or her daily dose of medication. Using combination-drug therapy ensures that the patient receives all four drugs required for optimal therapy, combined in one tablet formulation.
There is now an isolation MDRTB ward at the West Vaal Hospital where patients with confirmed MDRTB are treated. This is the only facility of its kind outside of the state facilities in South Africa.
Regular quality assurance, quarterly data analysis, and annual audits of the standard operating procedures applicable to all aspects of the TB programme ensure that success or failure of the programme can be evaluated to optimise effectiveness. Benchmarking standards for TB control programmes are identified by both the WHO and the South African National TB Control Programme, and have been met or exceeded by the AGA Health TB control programme since 2001 on a quarter-by-quarter basis for both case finding and successful outcomes.
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