5.1. Prevention and treatment of Tuberculosis (TB)

Some TB statistics:
* South Africa has one of the highest rates of TB in the world. This has increased dramatically as the HIV epidemic has grown, with the number of TB cases doubling since 1996.
* TB is one of the most common opportunistic infections for people with HIV.
* Of the 44 million people in the world living with HIV and AIDS, 12 million are co-infected with TB.
* TB progresses faster in people who are HIV-positive.
* TB is the leading cause of death in people living with HIV and AIDS in the country.
* All around the world, TB has become worse in places where there is a lot of HIV. As HIV has become more common, TB has also become more common. This is because untreated HIV weakens the immune system which fights TB. So people with weak immune systems are more likely to become sick with TB.
* If people are sick with TB and not treated quickly, they can infect friends, family and other people in their community.
Symptoms of TB
* We can get treatment for TB. TB is a curable disease.
* Cover our mouths when we cough, if possible with a handkerchief or cloth. This is called cough hygiene and prevents other people from getting the TB virus.
* Open windows to let fresh air in when we are in crowded places.
* Educate ourselves and our communities about TB.
* Set up TB clubs (support groups of people living with TB). These have been successful in other places in Africa in helping people with TB education, medication, testing and giving people with living with TB a place to share their problems.
* Make our health facilities safer to prevent TB.
* Train all those working in health facilities, including doctors, nurses, administrators, clerks and cleaners in TB prevention and on how to protect themselves against the disease while at work.
Symptoms of TB
* Coughing for 2 weeks
* Coughing up blood
* Night sweats
* Losing weight
Important things to know about TB treatment
It is important to take TB drugs correctly and complete your TB treatment. If you don't, you will risk your own life and the lives of people around you.
* Side effects
All TB drugs have side effects. Some side effects, like nausea (feeling sick), are only minor while others, like the loss of certain bodily functions and hepatitis, can make you very uncomfortable. It is important that you tell your healthcare worker or DOTS (Directly Observed Therapy Short Course) supporter how you are feeling. Sometimes there are other drugs you can take to make the side effects go away.
* Drug interactions (how drugs work together)
If you are taking other medications - like ARVs (medical treatment for AIDS) - they may interact with TB drugs to stop working or to produce more side effects. So it is important to tell your healthcare worker how you are feeling and make sure he or she knows about all of the medications you are taking, including traditional medicines.
* Staying healthy
Like all drugs, TB antibiotics can put a lot of stress on your body. It is important that you do your best to stay healthy. This means eating healthy foods like fruits and vegetables with lots of proteins and vitamins.
See 4.2 How can I help my body fight the virus?
* Alcohol and street drugs
It is very important that you DO NOT drink alcohol while taking TB drugs. Drinking alcohol while taking TB drugs can make you develop hepatitis and cause liver failure. Street drugs make it difficult to stay on treatment because when you are high you may forget to take your medication or just not care.
* Traditional medicine
Traditional healers should know about the symptoms of TB so that they can help people with the diagnosis and treatment process. The medication traditional healers give you may help to boost your immune system but it will not cure TB. Traditional medicines cannot be taken in place of TB antibiotics. You must also tell your healthcare worker if you are taking traditional medicines as some react badly with TB drugs.
* Complete your TB course
Often people stop their TB treatment once they begin to feel better and then take traditional medicines. You must complete your entire treatment course of 6 or 24 months. You must only stop treatment if your healthcare worker tells you to.
* Get support
TB treatment can be difficult. If you are going to start treatment, talk to someone who has had TB treatment. They can tell you what to expect and share their experiences. You should also try to find people who can support you through treatment. Ask someone who cares for you and is reliable to be your DOTS supporter. This is very important.
* IPT (Insoniazid Prevention Therapy) treats latent TB
If you have a positive TB skin test, but no signs of active TB; you probably have TB that is not showing outside evidence (latent TB). If you are on IPT and develop active TB later, you must let your healthcare worker know that you have taken IPT. He/she will need to test you for Isoniazid resistance.
* IPT is important for people who are HIV-positive
It is more likely for latent TB to become active if you are HIV-positive. This is because HIV can weaken your immune system. If you are HIV-positive and not yet taking ARVs, then it is a good idea to take IPT.
* There is a CURE for active TB
TB antibiotics can cure TB if they are taken properly. Unlike ARVs, which help your immune system but cannot completely kill HIV, a full course of TB antibiotics will destroy ALL of the TB bacteria in your body. A complete course of TB antibiotics can last anywhere from 6 to 24 months, depending on the type of TB you have. TB antibiotics can cure TB, if they are taken properly.
* What happens during treatment?
Your symptoms will get better about 2 weeks after you start taking antibiotics. After about 3 weeks, you are no longer infectious or able to spread TB to other people. The 4 drugs you are taking will have killed lots of the bacteria and hopefully made the rest unable to grow. You should still be careful, though. Cover your mouth when you cough and use other TB prevention measures at home.
* What is drug-resistant TB?
Drug resistant TB means that some of the strongest TB drugs cannot fight the TB bacteria in your body. Drug resistant tuberculosis is a very serious problem in South Africa. It is one of the major reasons TB is such a crisis in this country. We must understand drug-resistant TB so we can get control of this problem and prevent it from becoming worse.
Up to now drug resistance happened because people did not complete their treatment. These days, with so much TB and HIV co-infection in some communities in South Africa, up to a quarter of new TB cases are drug resistant TB. As long as people don't complete their treatment course, the problem of drug resistance will get worse. TB bacteria are living things, and just like most living things, they want to survive - that means learning how to resist TB antibiotics.
There is treatment for drug-resistant TB, but this treatment is long and very expensive. It also has many more side effects, which makes sticking to it even more difficult.
* Multi-drug Resistant TB (MDR-TB)
Drug resistant TB is called MDR-TB and has the same symptoms as regular TB: coughing for 2 weeks, night sweats and coughing up blood. This makes it difficult for healthcare workers to tell the difference between TB and MDR-TB. If you have the symptoms of TB, you may have MDR-TB as well. If you suspect you have MDR-TB, tell your healthcare worker right away.


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