Occupational safety and health

Aurum Health Research, a subsidiary of AngloGold Ashanti, has been granted funding of $14 million over a five-year period by the international Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE) to research strategies to improve TB control in the South African gold mining industry. The grant, which is part of a larger award of $45 million to CREATE by the Bill and Melinda Gates Foundation, was announced in July 2004 at the XV International AIDS Conference in Bangkok, where the keynote speaker was former South African President, Nelson Mandela. In his speech, Mr Mandela focused worldwide attention on the need to fight TB in conjunction with the battle against AIDS. He said, "We have lost ground in the fight against TB in the face of a spreading AIDS epidemic. Today we are calling on the world to recognise that we cannot fight AIDS unless we do much more to fight TB as well."

In addition to Aurum, members of CREATE include, among others, the Johns Hopkins University Centre for Tuberculosis Research, the London School of Hygiene and Tropical Medicine, the University of Stellenbosch and the World Health Organization (WHO).

The research being conducted by Aurum, under the auspices of CREATE, is being done after extensive consultation, and collaboration, with several South African gold mining companies, including AngloGold Ashanti, Gold Fields and Harmony and the Departments of Health, Labour and Minerals and Energy. Extensive discussion and debate have also been held with representatives from the National Union of Mineworkers and other labour unions representing mineworkers to obtain their support for the study.

The aim of the research is to determine the likely effects of community-wide preventive therapy on TB rates in the South African gold mining industry, as it has become increasingly apparent in the last 15 years that, despite meeting WHO targets for the detection and cure of TB, the rates of TB among employees in the industry have risen sharply. This has coincided with the onset of the HIV epidemic. Fatalities during TB treatment account for the majority of deaths in the workforce, with a more than four-fold increase in TB rates having been recorded.

According to Prof. Churchyard, the head of Aurum, "It is imperative that new and effective public health strategies are developed, particularly in the gold mining industry which has a high burden of TB. Specifically, the objective is to compare the efficacy of nine months of TB preventive therapy using the TB drug isoniazid offered on a community-wide basis, with that of the standard TB control programme currently practised in the gold mining industry."

The rationale behind the research is that all individuals at risk of developing TB in the population would be treated rather than only those identified as being high-risk, such as those who have the HIV infection or silicosis. If successful, such a programme would reduce the rate of transmission of TB between people, which would lead to fewer TB cases occurring later, thus resulting in improved control of the disease.

Since the start of the project in South Africa, several key appointments have been made, including the study director. Other key positions, such as those of regional project managers, social scientist and project administrator have been filled, while 200 additional staff are currently being recruited. A pilot study is underway to determine the proportion of gold mine workers infected with TB by means of the traditional skin test and a newer blood test. Initially there will be a selection of shafts from the various gold mines (by means of cluster-random methods). Once the participating shafts have been selected, people working on those shafts will be invited to join the study. This is planned for April 2005. In all, around 65,000 people will be involved in the study.