Combatting HIV/AIDS and TB in Africa
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Transcript of Combatting HIV/AIDS and TB in Africa
Private Sector
Responsibilities and Opportunities
in Combatting HIV/AIDS and TB in Africa
Dr Brian Brink – Chief Medical Officer
How Africa turned AIDS around
2
Special Report to the
African Union Summit
May 2013
Source:
How Africa turned AIDS around
3 Special Report to the African Union Summit May 2013 Source:
PRIVATE SECTOR RESPONSIBILITIES IN DEVELOPING COUNTRIES
5
APPROACH TO HEALTH
Benchmarking Standards Guidelines Support Assurance
Occupational Hygiene Leading indicators
Occupational Medicine Leading and Lagging indicators
Occupational Health Anglo American Occupational Health Way
Employee Health and Wellness Including HIV/AIDS and TB
Families Health Insurance
Communities
Global Health
Health Management Information Systems
6
EMPLOYEE HEALTH AND WELLNESS
• Focus on all employees receiving an annual health screening and basic medical examination:
– Medical history screening for common diseases and lifestyle risks
– Height, Weight, Body Mass Index (BMI)
– Visual acuity
– Blood pressure
– Haemoglobin
– Blood sugar
– Cholesterol
– Substance abuse screening
– Voluntary counselling and testing (VCT) for HIV and TB
• Early diagnosis, early access to counselling, care, support and treatment. Ensuring that chronic diseases are properly managed.
• Reducing absenteeism, improving productivity
• Analysis of health trends over time and focusing management attention on emerging health issues
7
PROGRESSION OF HIV INFECTION OVER TIME
AIDS TREATMENT
HIV TREATMENT
Deteriorating health Absenteeism Tuberculosis Disability Risk of death
YEARS
IMM
UN
ITY
(C
D4
CO
UN
T)
HIV/AIDS Key indicators
2008 2009 2010 2011 2012
Number of employees 81,450 66,661 73,129 77,075 70,690
Best estimate of HIV prevalence 18% 18% 16.5% 16.7% 16.8%
Estimated number of HIV positive employees 14,444 12,057 12,066 12,864 11,884
Number of employees participating in VCT 63,817 54,662 68,741 70,909 57,810
Number of contractors participating in VCT 37,397
Percentage employee VCT uptake 78% 82% 94% 92% 82%
New HIV infections 902 527
Crude HIV incidence 1.17% 0.74%
Number of HIV positive employees enrolled in
HIV wellness programmes 7,361 6,116 7,105 7,846 8,361
% HIV Wellness programme enrolment 51% 51% 60% 61% 70%
Number of employees taking ART 3,072 3,211 3,971 4,730 5,332
% of HIV positive employees taking ART 21% 27% 33% 37% 45%
HIV Incidence trend amongst employees at Thermal Coal
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
2005 2006 2007 2008 2009 2010 2011 2012
HIV Incidence
HIV Incidence
9
94% of
employees
retested for
HIV every year
since 2006
MOAE0203
Company-level ART provision to
employees is cost saving
A modelled cost-benefit analysis of the impact of
HIV and ART in a mining workforce in South Africa
Gesine Meyer-Rath1,2,3,4, Jan Pienaar10,11, Brian Brink11, Andrew van Zyl6, Debbie
Muirhead5,6, Emma Beruter6, Alison Grant6,7, Rory Leisegang6,8,9, Lilani
Kumaranayake5, Gavin Churchyard6, Charlotte Watts5 , Peter Vickerman5
1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK 2 Center for Global Health and Development, Boston University, US
3 Health Economics and Epidemiology Research Office (HE2RO), Wits Health Consortium, South Africa 4 Faculty of Health Sciences, University of the Witwatersrand, South Africa
5 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK 6 The Aurum Institute, South Africa
10 Anglo Coal Highveld Hospital, South Africa 11Anglo American, South Africa 7 Department of Clinical Research, London School of Hygiene and Tropical Medicine, UK
8 Division of Clinical Pharmacology, University of Cape Town 9 Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town
11 *Benefits include: disability, ill-health early retirement, death benefits, dependant pensions
CONCLUSIONS OF LSHTM STUDY
The cost of AIDS in the workforce is due to:
• Increased benefit* payments 44%
• Absenteeism 39%
• Training and recruitment 7%
• Medical costs 10%
The cost of ART makes up only 5% of the cost of AIDS
The savings under ART are mainly due to reductions in benefit payments and
absenteeism costs by 14% - 18%
Anglo American Thermal Coal mines have been saving 9% on the annual cost
of HIV/AIDS by making ART available to their workforce since 2003 ($31.2
million reduced to $27.6 million)
These results are based on real programme experience over 10 years
The results demonstrate strongly that investment in treatment is worthwhile
TUBERCULOSIS
13
ANGLO AMERICAN TUBERCULOSIS INDICATORS
2009 2010 2011 2012
Employees 66,661 73,129 77,075 70,690
Pulmonary TB 786 582 758 517
Extra-Pulmonary TB 133 145 148 160
Total new TB cases 919 727 906 677
TB Incidence per 100,000 population
1,379 994 1,175 958
MDR TB Cases 12 19 28
TB Deaths 86 65 59
14
ANGLO AMERICAN THERMAL COAL
TUBERCULOSIS STATISTICS
2006 2007 2008 2009 2010 2011 2012
Annual TB Incidence Rate/100 000 937 704 856 712 525 468 696
0
100
200
300
400
500
600
700
800
900
1000
Annual TB Incidence Rate/100 000
Annual TB Incidence Rate/100 000 Expon. (Annual TB Incidence Rate/100 000)
YTD Forecast for 2012
CONTRACTOR CEO
HEALTH AND WELFARE SUMMIT Johannesburg - 29 November 2012
16
• All contractors are required to comply with and participate in Anglo
American’s occupational health programmes and comply with
standards
• Long-term contractors will be required to participate in Anglo
American’s Health and Wellness programmes in the same way as
Anglo American employees. A monthly capitation fee ($20) will be
levied if the contractors do not have health insurance. Anglo American
will subsidise half the capitation fee.
• Basic package of care will include a comprehensive response to HIV
and TB including treatment.
HEALTH OUTCOMES OF THE CONTRACTOR SUMMIT
COMMUNITY HEALTH
Facilitating tangible health
improvements in local communities
and
Being a positive influence on health in
developing countries
18
• The pillars of health system strengthening are:
– Improving health facilities and equipment
– Human resources for health – the “health workforce”
– Procurement and supply chain management
– Financial management and funding (health insurance)
– Health information systems
– Governance and accountability
– Monitoring and evaluation
• There are many opportunities for companies to get involved by
sharing core competencies.
• Anglo American believes that sharing its health information
system “theHealthSource” can be of great value for health
systems strengthening in rural communities.
HEALTH SYSTEMS STRENGTHENING
IN RURAL COMMUNITIES
19
theHealthSource
THANK YOU