title: Aspiring to zero tuberculosis deaths among southern Africa's miners: is there a way forward?
abstract: Tuberculosis notification rates among South African miners range from 4,000 to 7,000 per 100,000 people. These rates far exceed national tuberculosis notification rates for the general population. Tuberculosis mortality also surpasses deaths caused by mining accidents. These extraordinarily high rates of disease are unambiguously linked to a series of contributing factors, including exposure to silica dust, HIV infection, and poor working and living conditions. We argue that the only way to stop the transmission of this airborne disease is to treat the mine and its living quarters as one should any other congregate setting with individuals who have high rates of infection with drug-susceptible and drug-resistant strains of tuberculosis. This means implementing interventions that have been demonstrated to stop the spread of tuberculosis over the last 60 years: immediate treatment of active tuberculosis, concurrent treatment of latent tuberculosis disease to reduce the burden of active cases, and appropriate management of patients infected with HIV. Because tuberculosis is also a social disease, biomedical interventions must be coupled with improved living and working conditions. Achieving zero deaths from tuberculosis in the mines is possible if a clear commitment is made to a strategy that recognizes and ameliorates the biological and social antecedents to this epidemic.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. adharmadhikari@partners.org
authors.forename: Ashwin
authors.initials: A
authors.lastname: Dharmadhikari
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Smith
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Nardell
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Churchyard
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Keshavjee
mesh_terms: D000353:Africa, Southern / Q000453:epidemiology; D015897:Comorbidity; D018450:Disease Progression; D042241:Early Diagnosis; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D006798:Housing / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008906:Mining / Q000592:standards / Q000706:statistics & numerical data*; D009784:Occupational Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D009786:Occupational Health Services / Q000592:standards / Q000639:trends; D055502:Secondary Prevention; D012829:Silicosis / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D012924:Social Conditions / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D000078329:Workforce