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.
CREATE - Background
The Consortium to Respond Effectively to the AIDS/HIV Epidemic (CREATE) was established in response to the growing recognition by TB and HIV experts that innovative and even radical approaches to TB control will be necessary to reverse the alarming trends of the incidences of these diseases which have been exacting a devastating toll on societies in the developing world. CREATE aims to co-ordinate, organise, implement and evaluate novel strategies to reduce the incidence of TB and related mortality in communities with high HIV infection rates.
At the XV International AIDS Conference in Bangkok in July 2004, The Bill and Melinda Gates Foundation announced the award of a $45 million grant to CREATE which will conduct three large-scale community studies (including the one being conducted by Aurum in the South African gold mining industry) over seven years in Africa and South America.
The Consortium is led by the Johns Hopkins University (School of Medicine, Centre for Tuberculosis Research); research partners are Aurum Health Research, the London School of Hygiene and Tropical Medicine, the Municipal Health Secretariat (Brazil) and the World Health Organization. The University of Stellenbosch is also involved.
The findings of the CREATE research portfolio will be used to develop new global policies to combat TB/HIV, a key criterion of projects supported by The Bill and Melinda Gates Foundation. CREATE will make a major contribution to identifying efficacious strategies to reduce suffering and death from HIV-related TB worldwide.
Aurum, its history and its relationship with AngloGold Ashanti
Aurum Health Research was founded in 1998 by the then AngloGold to research and develop systems to manage AngloGold's occupational lung disease and HIV/Aids and tuberculosis issues, including sexually transmitted diseases. Aurum strives to make significant contributions to the overall health of employees in the mining industry, their families and surrounding communities and has established an international reputation, with the knowledge generated from research initiatives being relevant both nationally and internationally.
The company uses a scientific approach to gather information, create knowledge, make recommendations, design programmes and deliver services to those involved in the health care. Aurum has multiple funders, including Anglogold Ashanti, other Anglo group and non-Anglo companies, National Institutes of Health (through a sub-contract with Johns Hopkins University), SIMRAC, and through CREATE, The Bill and Melinda Gates Foundation.
"Thusanang" (Sesotho for 'helping one another') underlies Aurum's philosophy of partnership with with industry, employees and surrounding communities and it participates with a wide ranging consortium of partners, both internationally and locally, in its research and systems development programmes. Internationally, these include the London School of Hygiene and Tropical Medicine, Johns Hopkins University, National Institute of Occupational Safety and Hygiene, HIV Vaccine Trials Network (HVTN). Local collaborators include, among others, the University of Cape Town (Faculty of Health Sciences); University of KwaZulu-Natal (Faculty of Health Sciences); National Institute for Communicable Diseases; Centre for the AIDS Programme of Research in South Africa (CAPRISA), South African AIDS Vaccine Initiative (SAAVI) and Safety in Mines Research Advisory Committee (SIMRAC).
Until 2004, Aurum has been a wholly owned subsidiary of AngloGold but has now converted to a section 21, not for profit company. It will then register as a public benefit organisation and be self-funding. There will be a contractual relationship with AngloGold from now on.