Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob’iTB Project in Zimbabwe
Abstract
:1. Background
2. Strategic Approach to Delivering Health Services to Artisanal and Small-Scale Miners
2.1. KNTB Project Description
2.2. BOHS-Supported Activities for ASMs
2.2.1. Dedicated Occupational Health Clinics (OHCs)
2.2.2. Workplace-Based Screening (WBS) Services for ASMs
2.2.3. Demand Creation for WBS and OHCs
2.2.4. Capacity Building on TB and Occupational Lung Diseases
3. Results
3.1. Occupational Health Clinics and Workplace-Based Screenings
3.2. Capacity Building on TB, HIV and Silicosis
4. Support Services
5. Lessons Learned
- i.
- The burden of TB among ASMs in the project districts of 7400 per 100,000 is 39 times higher than that in the general population (190 per 100,000) in Zimbabwe [29].
- ii.
- The silicosis burden is high at 21% among ASMs who were screened at both the OHCs and WBS services.
- iii.
- TPT initiation among ASMs with silicosis is low at 73% and remains a challenge due to the high mobility and operation in remote and hard-to-reach areas, which makes follow-up for initiation a challenge.
- iv.
- A very high proportion of ASMs (45%) attending the OHCs have an unknown HIV status.
- v.
- The proportion of ASMs with TB who have a bacteriologically confirmed diagnosis is low at 40%. Distinguishing TB and silico-TB from silicosis poses a huge diagnostic challenge due to similarities in radiological appearances. The low proportion of bacteriologically confirmed TB cases requires further exploration.
- vi.
- WBS services reach out to a higher number of ASMs in remote areas, almost double, when compared to OHCs, although the TB and silicosis yields are lower.
- vii.
- Using a collaborative multi-stakeholder approach that includes ASM leadership to mobilize ASMs for screening services is effective in reaching out to ASMs with occupational health services.
6. Recommendations
- i.
- The high demand and prevalence of TB (7.4%), silicosis (21%) and HIV (30%) among ASMs present a strong case for the replication and scaling-up of the KNTB project in other districts in Zimbabwe with high artisanal and small-scale mining activity.
- ii.
- The KNTB project has demonstrated that TPT initiation levels (73%) among ASMs pose a challenge. A targeted TPT program for ASMs with silicosis and/or HIV should be designed to cater to all ASMs who have high mobility and operate in remote areas.
- iii.
- The number of ASMs with a known HIV status at the OHCs is very low at 55%. It is recommended that a strong campaign on voluntary counseling and testing be rolled out among artisanal and small-scale mining areas. Furthermore, it is recommended that data on the HIV status of all ASMs be collected.
- iv.
- There is a need to follow up on the low numbers of bacteriologically confirmed TB cases. Capacity building on TB and silicosis diagnosis and management should be increased to overcome the diagnostic difficulties in distinguishing between the two conditions.
- v.
- In addition to chest radiographs, the MoHCC in Zimbabwe should also consider introducing testing for the biomarker CC-16 during the medical surveillance of all silica-dust-exposed ASMs.
- vi.
- National policy strategies on healthcare delivery systems for ASMs should integrate occupational health services into primary healthcare services, especially in districts with high artisanal and small-scale mining activity.
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Screened for TB | TB Cases | Bacteriologically Confirmed TB n (%) † | Screened for Silicosis | Silicosis Cases n (%) †† | Eligible for TPT | On TPT n (%) ††† | Silico-TB Cases | HIV-Positive | |
---|---|---|---|---|---|---|---|---|---|
October 2020–September 2021 | 1965 | 111 | 43 (39) | 1857 | 330(18) | 302 | 242 (80) | 31 | 201 |
October 2021–September 2022 | 5298 | 350 | 113 (32) | 5147 | 863 (17) | 640 | 414 (65) | 223 | 449 |
October 2022–September 2023 | 3405 | 332 | 158 (48) | 3278 | 957 (29) | 723 | 556 (77) | 220 | 341 |
Total | 10,668 | 793 | 314 (40) | 10,282 | 2150 (21) | 1665 | 1212 (73) | 474 | 991 |
Screened for TB | TB Cases | Bacteriologically Confirmed TB Cases n (%) † | Screened for Silicosis | Silicosis Cases n (%) †† | Eligible for TPT | On TPT n (%) ††† | Silico-TB Cases | HIV-Positive | |
---|---|---|---|---|---|---|---|---|---|
October 2020–September 2021 | 524 | 85 | 33(39) | 524 | 88 (17) | 74 | 51 (69) | 14 | 111 |
October 2021–September 2022 | 1372 | 278 | 87 (31) | 1372 | 406 (30) | 218 | 118 (54) | 188 | 182 |
October 2022–September 2023 | 1557 | 304 | 145 (48) | 1409 | 562 (39) | 349 | 265 (76) | 200 | 285 |
Total | 3453 | 667 (19) | 265 (40) | 3305 | 1056 (32) | 641 | 434 (68) | 402 | 578 |
Screened for TB | TB Cases | Bacteriologically Confirmed n (%) † | Screened for Silicosis | Silicosis Cases n (%) †† | Eligible for TPT | On TPT n (%) ††† | Silico-TB Cases | HIV-Positive | |
---|---|---|---|---|---|---|---|---|---|
October 2020–September 2021 | 1441 | 26 | 10 (38) | 1333 | 242 (18) | 228 | 191 (84) | 17 | 90 |
October 2021–September 2022 | 3926 | 72 | 26 (36) | 3775 | 457 (12) | 422 | 296 (70) | 35 | 267 |
October 2022–September 2023 | 1848 | 28 | 13 (46) | 1869 | 395 (21) | 374 | 291 (78) | 20 | 56 |
Total | 7215 | 126 | 49 (39) | 6977 | 1094 (16) | 1024 | 778 (76) | 72 | 413 |
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Moyo, D.; Kavenga, F.; Moyo, F.; Muzvidziwa, O.; Madziva, G.; Chigaraza, B.; Ncube, M.; Madadangoma, P.; Masvingo, H.; Muperi, T.C.; et al. Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob’iTB Project in Zimbabwe. Int. J. Environ. Res. Public Health 2024, 21, 70. https://doi.org/10.3390/ijerph21010070
Moyo D, Kavenga F, Moyo F, Muzvidziwa O, Madziva G, Chigaraza B, Ncube M, Madadangoma P, Masvingo H, Muperi TC, et al. Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob’iTB Project in Zimbabwe. International Journal of Environmental Research and Public Health. 2024; 21(1):70. https://doi.org/10.3390/ijerph21010070
Chicago/Turabian StyleMoyo, Dingani, Fungai Kavenga, Florence Moyo, Orippa Muzvidziwa, Godknows Madziva, Blessings Chigaraza, Mpokiseng Ncube, Precious Madadangoma, Hellen Masvingo, Tafadzwa Charity Muperi, and et al. 2024. "Health Screening Strategies for Artisanal and Small-Scale Miners for Tuberculosis, Human Immunodeficiency Virus and Silicosis: A Case of the USAID-Supported Kunda Nqob’iTB Project in Zimbabwe" International Journal of Environmental Research and Public Health 21, no. 1: 70. https://doi.org/10.3390/ijerph21010070