Durban – The Health and other Service Personnel Trade Union of SA (Hospersa) has called upon the Department of Labour to force hospitals to provide adequate protection against TB infection for healthcare workers who are at high risk of contracting and spreading the disease.

Hospersa spokesman, Chumisa Mangaliso, said in a statement ahead of World TB Day on March 24, that while the country had made progress from having the third highest prevalence of TB infections in the world to the fourth highest, it remained in crisis.

Health workers responsible for providing TB treatment and rolling out the largest HIV and antiretroviral programme in the world were facing disproportionate levels of risk of contracting TB, Multi-Drug Resistant (MDR) TB, and XDR TB during the course of duty.

According to the World Health Organisation’s Global TB report 2015, a country is considered in crisis when it has a TB incidence rate of 200-600 cases of TB per 100 000 population.

“South Africa has an incidence of 834 cases per 100 000 population, clearly way above the crisis level,” he said.

“The WHO and the South African government have identified health care workers as a key population at risk of contracting TB, a matter that requires special measures and programmes,” he said.

However, he said employers of healthcare workers in the public and private sector were failing to provide these measures and Hospersa would be filing a complaint with the Department of Labour that ­occupational health and safety compliance to prevent and mitigate TB among workers was “largely absent”.

“Healthcare workers have no access to mandatory routine medical surveillance. Training around TB prevention for healthcare workers is inadequate. Provisioning of personal protective equipment such as N95 masks is often not available,” he said.

He added that occupationally acquired TB was “severely under-reported” because of these absent measures and the stigma around TB because of to its link to HIV infection.

“We cannot end TB if our health workforce becomes TB infected, undiagnosed and untreated, so fuelling the spread of TB instead of reducing it,” he said. “The situation is at crisis level and deserves urgent attention.

Hospersa will approach the ministry of labour to intervene and ensure compliance with the occupational health laws with direction from the national ministry of health, provincial and private sector health employers,” he said.

Professor Olive Shisana, a leading public health expert whose expertise included epidemiological studies of communicable diseases and HIV/Aids, health policy and health systems quality and financing, said the high TB incidence was linked to poor living ­conditions, especially in areas like KZN, where people lived in shacks with poor ventilation, sanitation and overcrowding.

“To reduce new TB infections, you have to change the standard of living of people, and that is not something that is easy to fix, but it needs to be done,” she said.

Shisana said about 270 000, or 60% of the 450 000 people who had TB in South Africa in 2013, were also infected with HIV/Aids, but this had now risen to 73%.

She said healthcare workers faced a major problem with TB patients defaulting on taking their medication, which was impacting the rise in MDR TB, which had risen to 10 000 cases a year in 2015 compared with 1 000 cases in 1996.

“Around 80% of South Africans have latent TB rather than active TB – you get active TB when your immune system deteriorates, so you have to stay healthy and in well ventilated places,” she said. Shisana said about 10% of people exposed to TB contracted it.

Shisana said it cost the public sector between R128 and R143 a month per patient to provide ARV drugs.

This translates to between R1 532 and R1 726 per patient per year, and to between R9.4 billion and 10.6bn for medication for all 6.19 million people living with HIV/Aids.

The same drugs sold in the private sector cost between R22.6bn and 39.3bn.